Neck Pain: who to see and what helps

Neck Pain · Kitchener, Waterloo & Cambridge

Most neck pain follows a strain, an awkward night or long hours in one position, and lasts only a few weeks. A guideline written in Ontario favours staying active and exercise, with hands-on treatment as an option, and advises against collars. At CARESPACE the first visit is with a physiotherapist or a chiropractor.

What neck pain is

Neck pain can be felt anywhere from the bottom of the head to the top of the shoulders, and it can spread into the upper back or the arms. It is common, especially after 50. Clinicians grade it from I to III. This page covers neck pain without signs that a nerve is affected.

Symptoms of neck pain

• A knot, stiffness or sharp pain in the neck, often worse when you move
• Pain that spreads to the shoulders, upper back or arms
• Trouble turning your head
• A headache

What causes neck pain

• Position and strain. A neck locked in an awkward position overnight, slouching, or holding one posture for hours, as in a day of desk and screen work. The result can be a strain, a sprain or a muscle spasm.
• An injury, such as a fall or a collision.
• A pinched nerve.
• Less often, a medical problem: an infection in the neck, narrowing of the spinal canal, or rheumatoid arthritis.

Sometimes there is no clear cause.

Neck pain, or one of its neighbours?

• After a collision or a fall, read Whiplash first: it covers who needs an X-ray.
• Shooting pain, numbness, tingling or weakness down an arm points to a nerve root: see Pinched Nerve in the Neck. A Herniated Disc in the Neck has its own page too.
• Narrowing of the canal in the neck is covered under Spinal Stenosis. Its signs, such as balance and coordination problems, come on gradually.
• When the headache is the main problem, see Headaches or Migraines.
• Dizziness with a sore neck is covered under Vertigo & Dizziness.
• Pain lower down, between the neck and the bottom of the ribs, is Upper Back Pain.

Trapezius strain

The trapezius muscles run from the base of the neck across the shoulders to the middle of the back, one on each side. They move the head, neck and shoulder blades and hold your posture. A strain here is usually a sports or repetitive-strain injury, and it is less common than strains elsewhere in the body. Slouching at a desk or behind the wheel puts extra tension on these muscles, and so do shoulders held tight under stress. Signs include neck and upper back pain, stiffness, spasms, tenderness and sometimes headaches. Have it examined if you cannot shrug or raise your arm, or if the pain lasts more than a week. We found no guideline for trapezius strain alone. Pain between the shoulder blades is also on the urgent list below, so have that checked first.

How neck pain is diagnosed

By your history and an examination of how the neck moves, with checks for tenderness, numbness, tingling or weakness in the arms and hands. Imaging is not always needed. It may be considered after an injury, when pain has not improved after a few weeks, or when nerve damage is suspected.

When neck pain is an emergency

Call 911 for new problems walking, loss of bladder or bowel control, a sudden loss of coordination, for example with buttoning a shirt, or the signs of a stroke: a face that droops on one side, not being able to lift both arms and keep them up, or speech that is slurred or garbled. Do not wait for an appointment: nobody at CARESPACE can rule these out.

Call 911 as well for neck pain with chest pain or other signs of a heart attack, such as shortness of breath and nausea, and, after a fall, crash or blow to the spine, if you cannot move part of your body, have severe neck or back pain, or have weakness, tingling or numbness in your arms or legs. Call 911 or go to an emergency department for a headache with a very high temperature, a stiff neck or bright lights bothering you, or with a rash that does not fade when a glass is rolled over it.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Ask for an urgent appointment with a physician or nurse practitioner for severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in your arms or legs, pins and needles in an arm together with neck or arm pain, or pain between your shoulder blades. Hands that are slowly getting clumsier, or balance that is slowly getting worse, need an urgent appointment too; if you cannot get one, go to an emergency department. The same goes for numbness that is new or getting worse in your arms, buttocks or legs, a cold arm, long-standing neck pain that suddenly gets much worse for no reason, neck pain that wakes you from sleep, and new or worse neck pain if you have a history of cancer or HIV.

See a physician or nurse practitioner if neck pain or stiffness has not gone after a few weeks, or painkillers have not helped.

What the evidence says about treating neck pain

• Where this comes from. A 2016 guideline written in Ontario by the OPTIMa collaboration, a research group on traffic injuries, whose positions are the ones below unless we name another source; a 2016 Canadian chiropractic guideline; and a 2015 Cochrane review of manipulation and mobilization. “May consider” and “suggest” mean a panel was not certain, and the chiropractic guideline rates all its recommendations weak. “Should not offer” is firm. The wording reflects each panel’s confidence, not only the quality of the studies.
• Reassurance and activity first. Once serious causes are ruled out, clinicians should explain that neck pain usually runs a benign, self-limited course and that staying active matters.
• In the first three months, clinicians may consider education together with range-of-motion exercise, or with that exercise plus manipulation or mobilization. The chiropractic guideline suggests manipulation or mobilization according to the person’s preference, and range-of-motion home exercise.
• After three months, the options widen: range-of-motion and strengthening exercise, yoga, qigong, exercise combined with manipulation or mobilization, clinical massage or low-level laser may be considered, always with education. The chiropractic guideline suggests supervised group exercise, supervised yoga, strengthening exercise, and manipulation with soft-tissue therapy.
• What should not be offered. In the first three months: education alone, a cervical collar, relaxation massage, strain-counterstrain therapy, electroacupuncture, electrotherapy and clinic-based heat. After three months: strengthening exercise as the only treatment, relaxation massage, relaxation therapy for pain or disability, strain-counterstrain therapy, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture and botulinum toxin injections.
• How well manipulation works, and its risks. The Cochrane review found no high-quality evidence for manipulation or mobilization of the neck. In the two trials that compared them, the two gave similar results. Side effects in the trials were temporary and benign, but more than half the trials did not report them, and the authors state that a risk of rare but serious adverse events exists for manipulation; other reviews they cite link it to stroke, disc herniation and serious neurological problems.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit. Muscle relaxants are listed as an option in the first three months and anti-inflammatories after that; prescribing belongs to a physician or nurse practitioner. Surgery is rarely needed.

How each CARESPACE service treats neck pain

Physiotherapy

A physiotherapist can test movement, strength and sensation to grade the problem, teach range-of-motion exercises for the early weeks, and add strengthening if pain passes three months. Mobilization can be part of the plan; in trials its side effects were temporary and benign, though many trials did not record them.

See our physiotherapy team →

Chiropractic

A chiropractor can examine the neck and treat it with manipulation or mobilization, alongside exercise; the choice between the two can follow your preference. In the trials that compared them, they gave similar results. Manipulation carries a risk of rare but serious adverse events, so ask which technique is planned and why before you agree to it.

See our chiropractic team →

Massage Therapy

Timing and type both matter. Relaxation massage should not be offered at any stage. Clinical massage from a Registered Massage Therapist may be considered once neck pain has lasted more than three months, when high-dose massage is also one of the chiropractic guideline’s suggestions.

See our massage therapy team →

Kinesiology

For neck pain past three months, supervised group exercise and strengthening are suggested. For workers with lasting neck and shoulder pain, the suggestion is high-intensity strength training, part supervised and part on your own, or advice alone. A kinesiologist can supervise and progress that training.

See our kinesiology team →

Other services people ask about

Acupuncture. Electroacupuncture should not be offered, and the summary we read of the Ontario-written guideline makes no recommendation on needle acupuncture. Osteopathy. The summaries we read of the two guidelines do not mention osteopathy by name.

Where most people start

Book with a physiotherapist or a chiropractor; both assess and treat at the first visit. If anything on the emergency or urgent lists applies, deal with that first.

How your team works together

In the early weeks one practitioner can cover it: explanation, movement and perhaps some hands-on treatment. Massage therapy and supervised strengthening with a kinesiologist come in if pain passes three months.

Browse by service: physiotherapists, chiropractors, registered massage therapists and kinesiologists.

What to expect at your first visit

1. How it started, how long it has lasted and what a normal day asks of your neck.
2. Safety questions about your arms and hands, walking, balance and any recent injury. Some answers mean a physician or a hospital comes first.
3. An examination of neck movement and of strength and sensation in your arms.
4. Treatment that day, and a plan with exercises to do at home.

What you can do at home

• Keep your neck moving and get back to normal activities as soon as you can. Try neck flexibility exercises.
• Do not wear a neck collar unless a doctor tells you to.
• Put heat on for 15 to 20 minutes, or an ice pack for 10 to 15 minutes, every two to three hours. Neither is strongly proven, and neither does harm.
• Use a low, firm pillow, and avoid sleeping on your stomach with your neck twisted.
• At a desk, sit upright with your feet flat on the floor and take short breaks several times an hour.
• Do not drive or cycle while you cannot turn your head.
• Ask a pharmacist about pain relief.

Outlook

Most neck pain lasts only a few weeks. Pain that follows an injury can take longer, and neck pain can become long-lasting when a condition such as a herniated disc or narrowing of the canal is involved, or when long hours in one position continue. Our sources give no figure for how often it comes back.

Neck pain treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Massage Therapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Massage Therapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Should I see a physiotherapist or a chiropractor for neck pain?

Whichever you prefer. Exercise and advice can come from both, and the choice between manipulation and mobilization is yours to make.

Is it safe to have my neck adjusted?

Side effects reported in trials were temporary and benign, but many trials did not record them, and a risk of rare but serious events, stroke among them, exists. Mobilization gave similar results to manipulation in the trials that compared them. Ask about the risks and the alternatives first.

How long does neck pain last?

Usually a few weeks. See a physician or nurse practitioner if it has not gone by then.

Should I wear a neck collar?

No, unless a doctor tells you to. Clinicians are advised not to offer one, and keeping the neck moving is the usual advice.

Do I need an X-ray or MRI for neck pain?

Not always. Imaging may be considered after an injury, when pain has not improved after a few weeks, or when nerve damage is suspected.

Where can I get neck pain treatment in Cambridge?

Physiotherapy is offered in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Côté P, Wong JJ, Sutton D, et al. Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal, 2016;25(7):2000–2022. (We read the abstract, which sets out all eight recommendations.)
• Canadian Chiropractic Guideline Initiative. Summary of recommendations for neck pain-associated disorders and whiplash-associated disorders, a summary of Bussières AE, et al., Journal of Manipulative and Physiological Therapeutics, 2016;39(8):523–564.
• Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, 2015. (We read Cochrane’s summary.)
• HealthLink BC (Healthwise). Neck Pain and Cervical Spinal Stenosis. Current as of November 2022.
• NHS (UK). Neck pain, reviewed April 2023, and Cervical spondylosis (urgent and emergency signs), reviewed August 2023. Both were due for review in 2026. Headaches (fever, stiff neck and rash), reviewed April 2024.
• Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. American Family Physician, 2016;93(9):746–754. (Signs of spinal cord involvement that need immediate workup.)
• Cleveland Clinic. Trapezius muscle. Reviewed September 2024.

Related conditions

Whiplash · Pinched Nerve in the Neck · Headaches · Back Pain · Posture

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking