Neck Strain (Pulled Neck Muscle)

What happens in a neck strain

The neck is supported by many muscles, including the trapezius, levator scapulae and sternocleidomastoid. When a muscle or its tendon is stretched beyond its limit, small tears occur, causing pain, inflammation and protective muscle spasm. A sprain is a similar injury to the ligaments that connect the neck vertebrae. Strains and sprains often occur together and are treated the same way.

Causes

• Sleeping in an awkward position or on an unsupportive pillow
• Poor posture: looking down at a phone or laptop for long periods ("tech neck"), or working with a screen too low or high
• Repetitive or sustained positions, such as painting a ceiling or long drives
• Lifting or carrying heavy loads, especially on one shoulder
• Sports: contact sports, swimming, weightlifting
• Whiplash: sudden back-and-forth movement of the head, usually in rear-end car crashes
• Stress, which increases muscle tension

Symptoms

• Pain in the back or side of the neck, worse with movement
• Stiffness and reduced range of motion, especially turning the head
• Muscle spasm and knots
• Tenderness over the muscles
• Headache, often starting at the base of the skull
• Pain spreading to the shoulders or upper back

Symptoms usually start within hours, or the next morning. After whiplash, they may build over 24 to 48 hours.

Arm numbness, tingling or weakness are not typical of a simple strain and suggest a pinched nerve (cervical radiculopathy).

Diagnosis

Diagnosis is usually made from your history and an examination of neck movement, tenderness, and arm strength, sensation and reflexes. Imaging is not needed for most neck strains. X-rays or CT are used after significant trauma, and MRI if there are nerve symptoms or red flags.

Neck strain vs other causes of neck pain

Treatment and home care

• Keep moving gently. Prolonged rest and soft collars slow recovery. Gentle movement within comfort helps the muscle heal.
• Ice or heat: ice wrapped in a cloth for 15 to 20 minutes in the first 48 hours can reduce pain. After that, many people find heat (a warm shower or heat pack) relaxes muscle spasm. Use whichever helps.
• Pain relief: acetaminophen (paracetamol), or an NSAID such as ibuprofen or naproxen, at the label dose. A topical NSAID gel is also an option. Avoid oral NSAIDs with stomach ulcers, kidney disease or some heart conditions.
• Posture: raise your screen to eye level, keep your phone at eye height, take breaks every 30 minutes, and avoid carrying heavy bags on one shoulder.
• Sleep: use a pillow that keeps your neck level with your spine. Avoid sleeping on your stomach.
• Massage can ease muscle tension.
• Stress management and relaxation techniques.

Gentle neck exercises

Once the worst pain eases, usually after a day or two, try these slowly and within comfort, several times a day:

• Chin tucks: gently draw your chin back, as if making a double chin, hold for 5 seconds.
• Side bends: tilt your ear toward your shoulder, hold for 10 to 20 seconds, each side.
• Rotations: turn your head slowly to look over each shoulder.
• Shoulder rolls: roll your shoulders backward in circles.

Stop any exercise that causes sharp pain, numbness or tingling.

Medical treatment

• Physical therapy for persistent pain, including manual therapy and strengthening
• Short courses of muscle relaxants are sometimes prescribed, though they cause drowsiness
• Further assessment if pain persists beyond several weeks

Recovery time

• Mild strain: a few days to 1 week
• Moderate strain: 1 to 3 weeks
• Whiplash: most people recover within weeks to a few months. A minority have longer-lasting symptoms

Prevention

• Set up your workstation ergonomically.
• Take regular breaks and stretch.
• Strengthen neck, shoulder and upper back muscles.
• Warm up before sports.
• Lift with your legs and keep loads close to your body.

Frequently asked questions

How long does a neck strain take to heal?

Most neck strains improve within a few days to 2 weeks. More significant strains can take up to 3 to 6 weeks, and whiplash injuries may take longer. Staying gently active, using heat or ice and taking pain relief help recovery.

What is the difference between a neck strain and a neck sprain?

A neck strain is an injury to muscles or tendons, while a sprain is an injury to the ligaments that connect the vertebrae. Both cause pain and stiffness, often occur together, and are treated in the same way with gentle movement, pain relief and time.

Should I use heat or ice for a pulled neck muscle?

Ice may help in the first 48 hours to reduce pain and swelling. After that, heat often relaxes tight, spasming muscles. Both are reasonable, so use whichever gives you more relief, applied for 15 to 20 minutes at a time with a cloth barrier.

When should I worry about neck pain?

See a doctor urgently if neck pain follows significant trauma, or comes with numbness, tingling or weakness in the arms or legs, fever and headache, sudden severe headache, difficulty walking, or loss of bladder control. Pain lasting more than 2 to 3 weeks should also be checked.

Why do I wake up with a stiff neck?

Waking with a stiff neck is usually caused by sleeping in an awkward position or using a pillow that holds your neck at an angle, which strains the muscles. Gentle movement, heat and pain relief usually ease it within a day or two. A supportive pillow helps prevent it.