Neck pain

What it is

How research defines it

The Global Burden of Disease study defines a case as pain that lasts for at least one day¹. The pain sits between the occiput (the back of the skull) and T1, the first vertebra of the upper back¹. It may or may not spread into the arm¹. The study’s authors describe neck pain as a symptom state linked to a broad range of conditions, not as a single disease¹.

Where the pain may come from

A 1998 systematic review of non-specific neck pain states that no specific cause can be found in the majority of cases⁵. A systematic review gathers the research on a question in a set, checkable way. The Global Burden of Disease authors write that the causes might be unknown¹. They add that causes might include muscle strain, and inflammatory and degenerative (wear-type) changes in the discs, joints, ligaments and nerves¹.

How it is sorted

The Neck Pain Task Force sorts neck pain into four grades⁶. It calls grades I and II together “common neck pain”⁶.

Grade	Task Force description
I	No signs of major pathology (serious disease or damage), and little or no effect on daily activities6
II	No signs of major pathology, yet daily activities are affected6
III	Neurologic signs, meaning signs in the nerves, that a nerve is compressed6
IV	Signs of major pathology6

A neck pain guideline, revised in 2017, describes a second scheme⁷. This page reports how that guideline sorts neck pain, and it is not advice. The revision reports that the 2008 version classified neck pain into four categories⁷:

• with mobility deficits, meaning less movement⁷;
• with movement coordination impairments⁷;
• with headache⁷;
• with radiating pain, meaning pain that spreads⁷.

Research also sorts neck pain by how long symptoms have lasted^7,8:

• Acute: less than 6 weeks, in the 2017 guideline revision⁷.
• Subacute (between recent and long-lasting): 6 to 12 weeks, in the same revision⁷.
• Chronic: more than 12 weeks, in the same revision⁷. A 2023 systematic review of systematic reviews used 12 weeks or more⁸.

Who it affects

How many people

Global Burden of Disease estimates put 203 million people with neck pain worldwide in 2020¹. That is an age-standardised prevalence of about 2,450 per 100,000 people¹. Prevalence is the share of people in a group who have a condition at a given time. Age-standardised means adjusted so groups with different age mixes can be compared fairly.

• Sex. In the same estimates, age-standardised prevalence in 2020 was 2,890 per 100,000 in females and 2,000 per 100,000 in males¹.
• Age. Prevalence peaked between the ages of 45 and 74 in both sexes¹.

Workers and athletes

A systematic review of studies in workers found that yearly prevalence ran from 27.1% (Norway) to 47.8% (Québec)⁹. In a given year, neck pain limited the activities of 11% to 14.1% of workers⁹.

A 2018 systematic review of six studies in athletes reported a one-year prevalence from 38% to 73%¹⁰. Its authors concluded that the evidence was limited¹⁰.

What goes with a first episode

A 2018 systematic review of 10 articles looked at what raises the risk of a first neck pain episode¹¹. Most of the risk factors it found were psychosocial, to do with mood and social life, and not physical¹¹.

• Strongest psychosocial factors. These were a depressed mood, high role conflict, and muscular tension as the person perceived it¹¹.
• Physical factors. No major one was found, and the one reported most often was work in awkward or sustained postures¹¹.
• Protective factors. These included leisure physical activity and endurance of the muscles that bend the neck back¹¹.

Posture and phones

A 2019 meta-analysis of 15 cross-sectional studies looked at forward head posture¹². A cross-sectional study looks at a group once, at a single point in time. Adults with neck pain showed more forward head posture than adults without symptoms¹². In adolescents, the same analysis found no association between this posture and most neck pain measures¹².

A cross-sectional study measured how far 582 volunteers aged 18 to 65 bent the neck while texting on a smartphone¹³. That angle was not associated with the prevalence, frequency or maximum intensity of neck pain¹³.

What studies found

How episodes tend to go

A 2011 meta-analysis pooled seven studies of acute idiopathic neck pain, meaning recent neck pain with no known cause². Mean pain fell from 64 out of 100 at onset to 35 at 6.5 weeks². It stood at 42 at 12 months². Mean disability fell from 30 out of 100 to 17 by 6.5 weeks, with no further improvement at 12 months².

Sources describe the longer course in different ways^14,15. A 2017 overview states that most acute episodes resolve by themselves¹⁴. It adds that over a third of those affected have low-grade symptoms or recurrences more than a year later¹⁴. A summary of the Neck Pain Task Force’s work reported that most people with neck pain do not have a complete resolution of symptoms¹⁵.

A best evidence synthesis (a review that sums up the studies judged sound enough) looked at general-population studies¹⁶. Between half and three quarters of people with current neck pain reported neck pain again one to five years later¹⁶. In the same synthesis, psychosocial factors were the strongest predictors of outcome, and younger age predicted a better one¹⁶.

What scans show in people without symptoms

A cross-sectional MRI study scanned 1,211 healthy volunteers aged 20 to 70 who had no symptoms¹⁷. MRI is a scan that shows soft tissue in detail. In the neck, 87.6% had a disc bulge, a disc that spreads out past the edges of the spinal bones around it¹⁷. The intervertebral disc page covers the tissue itself.

What exercise trials found

Two reviews compared types of exercise in chronic neck pain^3,8:

• A network meta-analysis of 40 randomised trials (studies that assign people to groups by chance) in adults with chronic non-specific neck pain. Three kinds of exercise were effective for pain and disability against no intervention³. They were motor control exercise (training how muscles are switched on and coordinated), yoga, Pilates, Tai Chi or Qigong, and strengthening³. The evidence was very low in quality³. The review concluded that no one type was superior³.
• A 2023 review of 25 systematic reviews in adults. Five exercise types had short-term positive effects on pain against non-exercise controls, on low to high certainty evidence⁸. Results conflicted when one exercise type was compared with other exercise⁸. Its authors concluded that no optimal exercise type could be named⁸.

A 2022 meta-analysis of 12 randomised trials looked at exercises that target the deep neck flexors and extensors¹⁸. The flexors bend the head and neck forward, and extensors are muscles that bend the spine backward. In people with non-specific neck pain, they reduced pain and disability more than other exercise in the short to medium term¹⁸. There was no difference in the long term¹⁸. Certainty, meaning how sure reviewers are that a finding is right, was low for the first finding and very low for the second¹⁸.

What trials of hands-on methods found

A 2025 Cochrane review, a systematic review done to Cochrane’s published standards, covered nine randomised trials⁴. They included 694 adults with neck pain, mostly chronic, and tested manual therapy combined with exercise⁴.

• Against placebo. On low-certainty evidence from two studies, it may make little or no difference to pain at short-term follow-up, while it may moderately improve function⁴.
• Against no intervention. On low-certainty evidence from seven studies with 360 people, it may reduce pain by about 2.4 points out of 10 at short-term follow-up⁴.
• Adverse events (unwanted effects). Those reported were non-serious, such as passing soreness, headache or dizziness, and no data were available on serious ones⁴.

Two reviews looked at manipulation, a hands-on method applied to the spine^19,20:

• A 2015 Cochrane review update of 51 randomised trials in adults with neck pain. In two trials with 446 people, several sessions of neck manipulation were compared with several sessions of neck mobilisation, gentle movement of a joint¹⁹. The two gave similar changes in pain and function up to intermediate-term follow-up¹⁹. Its authors concluded that results against a control were few and diverse¹⁹. They also noted that a risk of rare but serious adverse events exists for manipulation¹⁹.
• A 2023 meta-analysis of 28 randomised trials in adults with neck pain. Spinal manipulation improved pain and disability more than guideline-recommended approaches, on very low to low certainty evidence²⁰. The side effects found were passing ones, such as muscle soreness²⁰.

What guidelines and broad reviews report

A 2021 systematic review covered 17 European guidelines, five on neck pain and one on both neck and low back pain²¹. For neck pain, it found consistent recommendations of weak or moderate strength²¹. They covered reassurance, advice and education, manual therapy, and referral to an exercise programme, among other options²¹.

A best evidence synthesis of studies from 1980 to 2006 looked at neck pain not linked to whiplash²². Manual and supervised exercise approaches were more effective than doing nothing, sham (a dummy version) or alternatives²². No active approach was clearly superior to any other in the short or long term²².

Studies of new episodes

Two reviews pooled randomised trials of exercise in people who had no neck pain at the start^23,24. A 2018 review of two trials with 500 people found, on moderate-quality evidence, that exercise lowers the risk of a new episode²³. One of the two trials combined exercise with other measures²³.

A 2023 review pooled five trials with 1,722 adults, most of them office workers²⁴. It found that exercise programmes probably reduce that risk over 12 months, on moderate-certainty evidence²⁴. That result was not robust when the authors tested it for missing outcome data²⁴.

The 2018 review also pooled three randomised trials of ergonomic programmes, with 3,352 people²³. It found low-quality evidence that these programmes do not lower that risk²³.

Connections

The deep neck flexors

The deep neck flexors are deep muscles at the front of the neck, also called the deep cervical flexors. The authors of a 2019 systematic review write that chronic neck pain is commonly of unknown origin²⁵. They add that in those cases some changes in motor control can appear in the deep cervical muscles²⁵. Motor control is how muscles are switched on and coordinated.

A review of craniocervical flexion test research compared people with and without neck pain²⁶. Craniocervical flexion is a small nod of the head on the top of the neck. The review reports less deep cervical flexor activity during the nod in people with neck pain²⁶.

The levator scapulae

The levator scapulae is a muscle running from the neck to the top of the shoulder blade. Two studies measured its stiffness with shear wave elastography, an ultrasound method, and disagree^27,28:

• In 35 patients with chronic neck pain and 35 people without symptoms, the measure of stiffness was higher in the patients²⁷.
• In 34 people with chronic neck pain and 33 without, no significant difference was found between the groups²⁸.

The neck isometric hold

The neck isometric hold page covers a randomised trial of 180 female office workers with chronic non-specific neck pain²⁹. One group did isometric strength training with an elastic band, and one did dynamic endurance training²⁹. Isometric means the muscle works but the joint does not move. At 12 months, both training groups reported less neck pain and disability than controls²⁹.

Sources

1. GBD 2021 Neck Pain Collaborators (2024). Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021.. The Lancet. Rheumatology. doi:10.1016/S2665-9913(23)00321-1 PMID 38383088
2. Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM (2011). Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis.. Archives of physical medicine and rehabilitation. doi:10.1016/j.apmr.2010.12.025 PMID 21458776
3. de Zoete RM, Armfield NR, McAuley JH, Chen K, Sterling M (2020). Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials.. British journal of sports medicine. doi:10.1136/bjsports-2020-102664 PMID 33139256
4. Chacko N, Gross AR, Miller J, Santaguida PL, Burnie SJ, Gelley GM, et al. (2025). Manual therapy with exercise for neck pain.. The Cochrane database of systematic reviews. doi:10.1002/14651858.CD011225.pub2 PMID 41363159
5. Borghouts JAJ, Koes BW, Bouter LM (1998). The clinical course and prognostic factors of non-specific neck pain: a systematic review.. Pain. doi:10.1016/S0304-3959(98)00058-X PMID 9755013
6. Guzman J, Haldeman S, Carroll LJ, Carragee EJ, Hurwitz EL, Peloso P, et al. (2008). Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. doi:10.1097/BRS.0b013e3181644641 PMID 18204393
7. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK (2017). Neck Pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2017.0302 PMID 28666405
8. Rasmussen-Barr E, Halvorsen M, Bohman T, Boström C, Dedering Å, Kuster RP, et al. (2023). Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews.. BMC musculoskeletal disorders. doi:10.1186/s12891-023-06930-9 PMID 37828488
9. Côté P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, et al. (2008). The burden and determinants of neck pain in workers. Spine. doi:10.1097/BRS.0b013e3181643ee4 PMID 18204402
10. Noormohammadpour P, Farahbakhsh F, Farahbakhsh F, Rostami M, Kordi R (2018). Prevalence of Neck Pain among Athletes: A Systematic Review.. Asian spine journal. doi:10.31616/asj.2018.12.6.1146 PMID 30322241
11. Kim R, Wiest C, Clark K, Cook C, Horn M (2018). Identifying risk factors for first-episode neck pain: A systematic review.. Musculoskeletal science & practice. doi:10.1016/j.msksp.2017.11.007 PMID 29197234
12. Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG (2019). The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.. Current reviews in musculoskeletal medicine. doi:10.1007/s12178-019-09594-y PMID 31773477
13. Correia IMT, Ferreira AS, Fernandez J, Reis FJJ, Nogueira LAC, Meziat-Filho N (2021). Association Between Text Neck and Neck Pain in Adults.. Spine. doi:10.1097/BRS.0000000000003854 PMID 33290371
14. Cohen SP, Hooten WM (2017). Advances in the diagnosis and management of neck pain.. BMJ (Clinical research ed.). doi:10.1136/bmj.j3221 PMID 28807894
15. Haldeman S, Carroll L, Cassidy JD (2010). Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders.. Journal of occupational and environmental medicine. doi:10.1097/JOM.0b013e3181d44f3b PMID 20357682
16. Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, et al. (2008). Course and prognostic factors for neck pain in the general population. Spine. doi:10.1097/BRS.0b013e31816445be PMID 18204403
17. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects.. Spine. doi:10.1097/BRS.0000000000000775 PMID 25584950
18. Villanueva-Ruiz I, Falla D, Lascurain-Aguirrebeña I (2022). Effectiveness of Specific Neck Exercise for Nonspecific Neck Pain; Usefulness of Strategies for Patient Selection and Tailored Exercise-A Systematic Review With Meta-Analysis.. Physical therapy. doi:10.1093/ptj/pzab259 PMID 34935963
19. Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, et al. (2015). Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment.. The Cochrane database of systematic reviews. doi:10.1002/14651858.CD004249.pub4 PMID 26397370
20. Minnucci S, Innocenti T, Salvioli S, Giagio S, Yousif MS, Riganelli F, et al. (2023). Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis.. The Journal of orthopaedic and sports physical therapy. doi:10.2519/jospt.2023.11708 PMID 37561605
21. Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. (2021). Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines.. European journal of pain (London, England). doi:10.1002/ejp.1679 PMID 33064878
22. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, et al. (2008). Treatment of neck pain: noninvasive interventions. Spine. doi:10.1097/BRS.0b013e3181644b1d PMID 18204386
23. de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis.. Journal of physiotherapy. doi:10.1016/j.jphys.2018.05.003 PMID 29908853
24. Teichert F, Karner V, Döding R, Saueressig T, Owen PJ, Belavy DL (2023). Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials.. The Journal of orthopaedic and sports physical therapy. doi:10.2519/jospt.2023.12063 PMID 37683100
25. Martin-Gomez C, Sestelo-Diaz R, Carrillo-Sanjuan V, Navarro-Santana MJ, Bardon-Romero J, Plaza-Manzano G (2019). Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis.. Musculoskeletal science & practice. doi:10.1016/j.msksp.2019.04.010 PMID 31030111
26. Jull GA, O'Leary SP, Falla DL (2008). Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test.. Journal of manipulative and physiological therapeutics. doi:10.1016/j.jmpt.2008.08.003 PMID 18804003
27. Taş S, Korkusuz F, Erden Z (2018). Neck Muscle Stiffness in Participants With and Without Chronic Neck Pain: A Shear-Wave Elastography Study.. Journal of Manipulative and Physiological Therapeutics. doi:10.1016/j.jmpt.2018.01.007 PMID 30442356
28. Varol U, Valera-Calero JA, Sánchez-Jiménez E, Fernández-de-Las-Peñas C, Ortega-Santiago R, Kobylarz MD, Navarro-Santana MJ (2024). Levator Scapulae Stiffness Measurement Reliability in Individuals with and without Chronic Neck Pain by Experienced and Novel Examiners.. Sensors (Basel, Switzerland). doi:10.3390/s24010277 PMID 38203140
29. Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Karppi SL, Kautiainen H, Airaksinen O (2003). Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women. JAMA. doi:10.1001/jama.289.19.2509 PMID 12759322

Every source the library cites

Changes

• October 9, 2026 First published.