Neck pain in the morning – no laughing matter

If you sit in a position where the head is held forward of the shoulders, such as reading or computer use, makes the upper back and shoulder muscles constantly work to hold the head up. Tension in the muscles builds up and causes tightness to build up in the upper shoulder and neck muscles, and results in neck pain and stiffness. Bad night posture leads to pain in the morning.

The spine in the neck is called the cervical spine and is made of a stack of seven block-like bones called vertebrae. These bones are separated by oval cushions called discs. The top vertebra, connects to the base of the skull, and the seventh attaches to the middle (thoracic) spine where the ribs are attached.

In the event of an unexpected sudden twisting movement, a car accident, or unaccustomed repetitive use of the neck, the neck muscles may become sprained or strained. Your neck feels stiff as result of the muscles tightening up and sometimes even going into muscle spasm. If the ligaments that attach to the vertebrae together become injured it is called a cervical sprain.

Both neck strain and neck sprain injuries are treated the same and are hard to tell apart. For the first 24-48 hours, home care with limited activity rest, gentle massage, and a heating pad may provide relief along with over the counter pain medications such as Tylenol, naproxen (Aleve) or ibuprofen (Motrin). Temporary use for short periods of a foam neck collar may be helpful if lying down to rest is not convenient. (Neck rings and other uncomfortable jewelry should be removed.)

neck rings

Medical attention is important if you have unusual other symptoms (severe headache with neck stiffness, lightheadedness, dizziness, nausea, fevers, or constant night pain). Especially severe pain, numbness or weakness in the arms or legs, or difficulty with bladder or bowel control requires urgent medical attention. For severe muscle spasms, a prescription muscle relaxer or a stronger pain medication may be prescribed.

If no urgent symptoms are present, and the pain is not much better after 3-5 days, it would be a good idea to have an evaluation from a licensed health care provider. Frequent attacks also should be investigated as there may be abnormal structure in the neck such as unstable spinal joints causing the problem. X-rays may be taken to check for arthritic or worn discs and can show problems with spinal alignment and stability. MRIs may be ordered when the nerves or spinal cord could be pinched or damaged, and will show a disc herniation.

Neck pain from muscle strain is very common, especially when your posture is poor. Sitting with the spine in a “C” shape makes the neck muscles work overtime holding your head up. Computer work, napping on the couch, falling asleep sitting in a chair are all examples of poor posture which may lead to constant neck pain. If your pillows do not provide enough support of your lower neck and your nighttime posture is poor neck pain and headaches in the morning are common. Thick foam pillows cause the neck to bend at night, and should be replaced by softer pillows or pillows specially designed for neck support.

Sleeping on your stomach instead of your back or sides is very bad for necks. Short term use of over the counter medications like Tylenol, ibuprofen (Motrin) or naproxen (Aleve) can provide relief. Sometimes muscle relaxers are necessary. For more severe or worsening pain, physical therapists provide instruction in posture, stretching and strengthening the neck muscles. Devices which provide traction on the painful neck muscles will help relieve your muscle tightness or spasm. Additional treatments from a massage therapist or licensed acupuncturist may be helpful as well. (photo credit vividvoltage)

About Doug Roberts MD

Board certified practicing rheumatologist and founder of
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