Acute neck pain is often described as an ache when the head is still. The movements of the neck are frequently reduced and, in some circumstances, a sharp pain may be felt with certain movements such as turning quickly or looking up. For some people, it may be the first episode of pain or, for others, it is a subsequent episode.

There may be a specific incident that causes acute neck pain. It may come on suddenly from a trivial incident, such as a quick turn of the neck or sleeping in an awkward position. Sometimes the neck feels as though it is ’stuck’. On the other hand, there may be a more substantial injury such as hitting the head and bending the neck on the side of a pool or in a fall from a bike.

In many other cases, the pain comes on gradually over hours or days, and is often related to unfamiliar activity, for instance, after painting ceilings all weekend or working in a poor or awkward posture.

As a result of the incident or unfamiliar activity, the joints and ligaments of neck may become strained and painful. The muscles usually react to limit movement and they too may become painful.

Acute neck pain can range in intensity from mild to moderate severity, and is usually made worse by head and neck movements. The neck is usually tender to touch and sleeping may be uncomfortable.

Your physiotherapist will undertake a clinical examination of the neck to identify the likely cause of pain. X-rays are usually unhelpful and unnecessary. The exception is after a forceful injury, when it is necessary to rule out fractures.

On very rare occasions, acute neck pain may have a serious medical cause. For instance, pain felt running up the front of the neck may be coming from the heart. A rapid onset and rapidly worsening upper neck pain, with a very unusual, severe headache, may indicate a problem with an artery in the neck and requires immediate medical investigation.

Physiotherapists first undertake a clinical examination to determine the reason for the pain and how it is affecting the movement of the joints, and how it has affected the muscles of the neck—some muscles may be in spasm, others may not be working properly because of the pain.

Treatment methods used by physiotherapists that have proven to help ease the pain and restore normal function of the neck include:

• explaining the reason for the pain and providing assurance
• gentle manual therapy
• gentle, specific exercise and self-help strategies.

Physiotherapists often use manual therapy consisting of rhythmic movement (mobilisation) to treat the neck pain, but, on occasions, a manipulation may be deemed necessary. The evidence suggests both of these manual therapy methods are equally helpful.

The gentle, specific exercises have several purposes:

• to ensure the muscles supporting the neck continue to work
• to help ease pain
• to help restore normal neck movements.

The exercises are progressed as pain settles, as it is important that normal movement and muscle function return after an acute episode of pain.

Your physiotherapist will also advise on self-management strategies to be used at home.

The use of ice, but usually heat, can be soothing for a sore neck. The most comfortable sleeping position will depend on the individual. It is usually lying on the side or the back, ensuring that the head and neck are adequately supported by one or two pillows. Lying on the stomach is not recommended, as it places the neck in near end range positions. It is important that the exercises are practised at home and normal activities are resumed as soon as possible.

An episode of milder acute neck pain may get better of its own accord in a few days. However, when pain is stopping normal activities and not seeming to get better, treatment methods such as education on the nature of the neck pain disorder, manual therapy and therapeutic exercise are effective in relieving most neck pain. The advice on care of the neck, lifestyle and the exercises that your physiotherapist prescribes for self-management at home and work will also help the neck recover.

Good self-management at home will help ensure a speedy recovery. When neck pain is acute, heat may soothe the pain. It is important to limit activities to ones that do not aggravate your neck, but at the same time, to stay generally active. Be aware of staying for too long in one neck posture, and try to avoid slouched postures that can be uncomfortable for the neck. Move regularly. Often simple head movements in each direction can be helpful. Gentle exercises to ensure all muscles are working again can be started almost immediately and they also help to ease the pain.

The descriptions of a full range of exercises for the neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.

The time for recovery is variable. The acute episodes of neck pain may settle in a few days. For many, the neck pain will settle in 3–6 weeks and for some it can take up to 12 weeks or a little longer. It is important to resume as many of your normal activities as possible as the neck pain settles. Continue home exercises for three months, even though the pain may have gone, to ensure the neck regains its normal movements and muscle function.