When you have mild back or neck pain on a busy or demanding day, it's easy to forget the obvious. Dr. Santhosh Thomas, D.O., physiatrist
and director of the Westlake Spine Center at the Cleveland Clinic, says the first thing to do for a mild back or neck problem is figure out which activities have led to the problem and then stop doing them. For example, Daniel L. Riddle, PT, PhD and professor at Virginia Commonwealth University, says that the "crick in the neck" is often caused by mechanical factors such as sleeping positions
. So, if you like to pillow up, or there is no give in your pillow, you could be setting yourself up for pain in the morning. In this case, avoid having your neck and head propped forward.
For many people with mild to moderate neck or back pain, the medicine chest is their first stop. As far as strength goes, an over-the-counter pain medication will do the job most of the time. The dosage of an OTC drug is less than what you would get with a prescription drug, still doctors generally suggest starting there.
OTC pain medications come in two types -- acetaminophen (such as Tylenol) and NSAIDs (such as Motrin and Aleve). NSAIDs have an advantage over acetaminophen in that they also help control the inflammatory process that is contributing to the pain. Both types of OTCs may have side effects, so read the label before taking any drug for your back or neck pain.
Applying ice to the painful area for up to 48 to 72 hours after it starts is another way to control inflammation. The inflammation
causes pain and, left unchecked, can contribute to a chronic problem in your neck or shoulders.
There are a number of ways to give yourself ice, as suggested by doctors and physical therapists. For example, consider this method from the American Physical Therapy Association: fill a plastic bag with crushed ice, place a towel around the area of your neck that has the pain, and put the homemade ice bag on the towel. Ice for 15 to 20 minutes, take a 40 minute break, then repeat. (Never apply ice directly to your skin.)
Applying heat to an acute injury
is usually not
the way to go, and most doctors will advise against it. This is because heat tends to make inflammation
worse. There are exceptions, however, and heat does provide pain relief for some.
After the first 2 or 3 days, applying heat is fair game, and it may help you relax those stubborn muscle spasms. Heat should be applied pretty much the same way ice is -- for 15 to 20 minutes at a time, with a 40-minute break between treatments. There are heat wraps on the market that do a good job of providing relief for painfully tense muscles. You can also alternate between heat and ice (after the initial 2 to 3 days) to get the benefits of each.
Dr. Thomas also recommends massage for muscle spasms
that are attributed to a "crick in the neck." For neck and low back pain, the massage should be very gentle during the first few days to avoid making it worse. You may even choose to wait until the acute phase
of the injury has past. Massage moves fluid around, which may help to prevent scar tissue
. After the first few days, massage can help work out tension and knots
in your muscles. At this point, there are even a few moves you can do on yourself:
Years ago, doctors advised people with back pain or injury to lay down and become immobile. Medical research has shown that patients with acute low back pain who stop activity actually have more
pain than those who don't. Sometimes laying on your back with your knees bent and legs resting on a chair or bed can temporarily relieve the pain, making it a good thing to do periodically. But in general, researchers and doctors now know that staying active within your pain limits is the most effective way to deal with acute low back pain
; it is as effective as bed rest for back pain accompanied by sciatica
Right after the pain starts, you will probably feel like protecting the area for a while. Depending upon the severity, you may benefit from some very gentle movements. Like massage, gentle movement may help to prevent chronic scar tissue from taking hold. At this stage, it's important to respect the limits of your pain; stop if notice new inflammation. Ideally, you will work with a skilled therapist who can mobilize the injured area safely and appropriately. After the acute phase is over, you will likely feel better, but keeping the movement gentle is still very important. The new tissues laid down in the acute phase are fragile, and they can be easily damaged by resuming activity at previous, more aggressive levels.
Technically speaking, there are no established guidelines for when to see a doctor about mild back or neck pain. But according to Thomas, if the pain persists for a week or longer and especially if it interrupts your daily functioning, it is time to get it checked. Sometimes pain you think may be due to a simple "crick in the neck" or low back strain
can indicate something more serious, such as an infection
or tumor. A medical doctor
has the diagnostic skills
to determine if your pain indicates a serious problem not directly related to the pain. Thomas also says that sometimes conditions such as disc herniation
or spinal stenosis
can mimic the symptoms
of a "crick in the neck" -- another reason to get it checked.
Sourcesvan der Velde G, Hogg-Johnson S, Bayoumi AM, Cassidy JD, Côté P, Boyle E, Llewellyn-Thomas H, Chan S, Subrata P, Hoving JL, Hurwitz E, Bombardier C, Krahn M. Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis. Spine. 2008 Feb 15.
Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD001254. DOI: 10.1002/14651858.CD001254.pub2.
Kisner, C., Colby, L.A. Therapeutic Exercise: Foundations and Techniques. 4th ed. F.A. Davis Company. Philadelphia. 2002.
More SourcesWhat you need to know about neck pain. American Physical Therapy Association website.
Institute for Clinical Systems Improvement (ICSI). Adult low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Sep. 65 p. [124 references]
Telephone Interview: Dr. Santhosh Thomas, Medical Director Westlake Spine Center, Cleveland Clinic. 3/08.
Telephone Interview: Daniel Riddle, PT, PhD Professor Virginia Commonwealth University and Deputy Director Journal of Physical Therapy. 3/08