Upper Back & Neck Injuries

Neck pain

Upper back and neck injuries are relatively rare in sport and more often occur from activities of daily living, such as waking up with a wry neck (torticollis). Neck injuries that are sustained in sport must be taken very seriously, especially if they are associated with symptoms of concussion or referred pain into the shoulders and arms.

On this page:

  • When should I see a doctor?
  • Stiff neck
  • Whiplash
  • Cervalgia
  • Radiating neck pain
  • Tight muscles in the neck
  • Inflammed muscle attachments
  • Dislocated vertebra
  • Neck strain
  • Stingers & burners (Brachial plexopathy)
  • Thoracic outlet syndrome

When should I see a doctor about my neck pain?

Significant trauma to the neck and upper back should always receive urgent medical care. Similarly, those that are associated with severe pain or ongoing impairment following a sporting injury should always be seen by a doctor or healthcare professional. Here we explain the symptoms, which indicate when professional medical advice should be sought.

If you experience any of the following symptoms from an upper back or neck injury you should seek professional medical advice from a doctor, physiotherapist, sports therapist, chiropractor or osteopath.

  • Severe neck or upper back pain.
  • Dizziness or a feeling of unsteadiness.
  • Blurred vision or altered vision.
  • Referred pain in the shoulders or arms following a neck or upper back injury, especially if the symptoms do not decrease within 24 hours.
  • “Pins and needles” (paresthesia) feeling or “loss if feeling” (anaesthesia) in the arms or hands.

Stiff neck

A stiff neck is a common complaint which will probably affect everyone at some point in their life. It is, however, usually short-lived, lasting for just a few days at a time. More often than not a stiff neck is caused by muscular tightness.

Symptoms of a Stiff Neck

  • A tight, stiff feeling in the neck and surrounding muscles.
  • Difficulty moving the neck, especially turning the head.
  • Some people may experience headaches.
  • Pain may radiate down into the back or down the arms.

Causes: More often than not a stiff neck is caused by tight neck muscles. A muscle in the neck may have been strained (pulled/torn) or have gone into spasm. Levator scapulae muscle is a common cause of neck pain and stiffness. Poor posture, repetitive neck movements, unusual neck positions (especially when sleeping), stress, sports activities or lifting weights can increase the likelihood of suffering from this.

A stiff neck can occasionally be a symptom of another condition, such as meningitis, although this would feature other symptoms such as a temperature, nausea or vomiting. Neck injuries and problems with the vertebrae or discs may cause a stiff neck due to muscle spasms which help support and protect the injury.

Treatment: Rest is essential to cure a stiff neck. Avoid any activity that may have caused it or increases pain. Often if a neck strain has occurred the pain is so severe in the early stages that movement will not be possible anyway.

Gently stretching the neck muscles if pain allows can increase mobility and reduce pain over the long term.

Neck rotation stretch - Stretching the neck from side to side like this can help ease neck aches, especially if you apply gentle overpressure with your hand. Start facing straight forwards and with your arms in front of you. Keep the elbows straight and clasp your hands together to stop your shoulders from elevating. Turn your neck so that your chin moves towards your shoulder. Hold for between 10 and 30 seconds. This can be varied when twisting the head, by lifting the chin slightly upwards to place more emphasis on Sternocleidomastoid at the front of the neck.

Lateral neck flexion stretch targets the upper trapezius muscle. This stretch can be very useful for people who suffer from tight, aching muscles in the upper back and neck, such as those who work at a computer. Look straight forward and do not let the chin drop down. Move your ear towards the shoulder but do not let your shoulder lift up. Hold for between 10 and 30 seconds. Increase the stretch by using the left hand to apply gentle pressure to the right side of the head.

Apply a heat pack (if there was a sudden point of pain for example if you suffered a neck strain then it is possible muscle damage or tearing has occurred in which case avoid heat for at least 48 hours as this can increase bleeding and the time is taken to heal.

Sports massage is usually very effective in relaxing the muscles. Deep tissue massage can be performed after an initial acute stage and in conjunction with heat can really help relax and stretch the painful muscles.

A doctor may prescribe painkillers or NSAID anti-inflammatory medication such as Ibuprofen (check contraindications) to reduce pain and inflammation.

Whiplash

Whiplash or acceleration/deceleration injury as it is also known as an injury to the neck, caused by a rapid forward and backward motion of the head. This occurs most commonly from a car accident, although can also be sustained through sports involving direct contact or a fall onto the head.

The patient will feel stiffness and pain in the neck which may not come on immediately at the time of injury but develop over the following 24 to 48 hours. They will likely have a significantly reduced range of movement in the cervical spine (neck) with headaches, dizziness and blurred vision (this should go within 24 hours if they persist consult your doctor). The pain and stiffness can last for just a few days to a few weeks depending on severity. Read more on Whiplash.

Cervicalgia

Cervicalgia is a pain in the neck which does not radiate outwards (or down the arms). Cervicalgia is slightly different from a neck strain, which is usually more short-lived.

Symptoms of Cervicalgia Include:

  • An occasional sharp pain in the neck, usually on movement.
  • More constant aching in the neck.
  • Pain is frequent when rotating the head/neck.
  • A feeling of tightness around the neck and upper back.
  • It may be tender to palpate (feel).
  • Stiffness in the neck.
  • Headaches.

Causes: The neck muscles are constantly under tension to hold the head up. The head itself is actually pretty heavy, weighing in on average at about 10lb (4.5kg). The muscles in your neck must work to hold this heavy sphere on top of a relatively thin post (the neck!). Therefore they are often prone to pain through gradual tightening of the muscles which can also result in tearing from sudden sharp movements.

Of course, there are things which can contribute to making the problem worse. The main issue is poor posture, usually where the head position is not held directly over the neck and instead is positioned in a forward position. This places additional strain on the muscles.

Treatment:

What can the athlete do about cervicalgia? Apply ice if a tear in the muscle is suspected. Rest. Wear a special neck collar to help the muscles rest in more severe cases. Ask your Doctor about painkillers or anti-inflammatories. Apply heat for more persistent cases (no sooner than 5 days after initial injury) See a sports injury professional who can advise on rehabilitation.

Look at possible causes of injury.

What can a sports injury specialist do? Advise on a full rehabilitation programme of stretching, strengthening and sports massage techniques. Prescribe muscle relaxing medication. Maybe use acupuncture or electrical stimulation. Maybe apply mobilisations or manipulations.

Tight muscles

A lot of pain that occurs in the upper back and neck is due to tight muscles in the neck, shoulders and upper back. We look at the symptoms, causes and possible treatment options in more detail.

Symptoms of tight upper back muscles include aching and discomfort in the upper back and neck area, reduced range of motion in the neck and tenderness around the neck and shoulder blades. The athlete may get relief from stretching the muscles and applying heat in the form of hot packs and warm baths.

Causes: Tight muscles in the neck is a chronic condition which develops gradually, slowly getting worse until the individual seeks treatment. This is generally different from a neck strain which is most short-lived and usually resolves itself after a few days.

The tight muscles do not allow as much blood in them as is needed and therefore they do not get the energy and nutrients they need to stay healthy. Therefore tight muscles weaken and then tighten up further, so a vicious circle has begun.

Overuse causes small micro tears in the muscles. The muscles then tighten up to protect themselves. Poor neck stretching routines, particularly after training. If the muscle is not stretched to its natural length regularly it may adaptively shorten. If you have a sideways curve in the spine, known as scoliosis then some muscles will be put under more strain than they can cope with.

Poor posture is a major cause of neck pain. The head is a very heavy object and if you position it just a few centimeters the wrong way this can considerably increase the work the muscles of the back and neck have to do.

Treatment: See a sports massage therapist for regular sports massage that will help keep the muscles relaxed and toned. View our sports massage demonstrations. Stretch properly and regularly.

Concentrate on good posture until it becomes second nature. A good taping method can encourage you to maintain correct posture. Use strengthening exercises to strengthen the weak muscles of the back. A professional therapist may also use ultrasound therapy or other forms of electrotherapy to assist in relaxing the muscles.

Dislocated vertebra

A dislocated vertebrae is a displacement of one of the small bones in the neck (which form the spine) in relation to the others. This occurs following a traumatic injury of the head or neck.

Symptoms: Sudden pain in the neck caused by an acute injury or force. Pain may also spread into the shoulder and arm. Tenderness to touch the neck. Neural symptoms such as tingling or numbness in the arm. Muscle spasm in the neck. Weakness in the arms may be present. Deformity may be visible.

Causes: Cervical vertebrae dislocation is usually caused by a traumatic injury to the head or neck as may occur in a fall or road traffic accident. Common mechanisms include axial loading (twisting under lad) of the head, or extreme neck extension, flexion or rotation.

This injury is also often combined with a fractured vertebra.

Dislocations may be classed as either stable or unstable depending on the damage to the soft tissues surrounding the joint, especially the spinal ligaments. In some cases with little to no ligament damage, the vertebrae may reduce itself (i.e. move back into place) before assessment. This can make the condition difficult to diagnose.

As with any spinal injury, the worst case scenario is that the dislocation causes damage to the spinal cord. In this case, quadriplegia or even fatality are possible outcomes.

Treatment

  • If any spinal injury is suspected DO NOT attempt to move the patient.
  • Call for immediate medical attention.
  • Once at the hospital the patient undergoes a thorough examination and scans including X-rays to confirm the diagnosis.
  • Further tests such as MRI, CT scans, and nerve conduction tests may be performed to determine the extent of soft tissue and nerve damage.
  • Provided there are no fractures, the vertebrae can often be reduced (put back in place) by closed manipulation under traction. This means the doctor will manipulate the neck to move the bone back into position.
  • Surgery may be required when closed manipulations are not successful, or in more severe cases involving fractures, disc herniations or considerable neurological symptoms.
  • To maintain stability, the bones may be fixed with wires or pins to hold the vertebrae in place.

Neck strain

A neck strain is a muscle injury of the neck. A neck strain is quite a common injury and generally is a mild to moderate injury which clears by itself within a few days to a week.

Symptoms:

  • Pain in the neck area.
  • Pain on turning the head or looking up or down.
  • A stiff neck.
  • A feeling of tightness in the muscles of the neck.
  • There may be a tender area of muscle when you touch it.
  • You may experience pain or tingling in the arms.

What is a Neck Strain? A muscle strain is a tear of some of the muscle fibres. This may be just a few, in which case it is a grade one strain, or maybe up to 90% of the muscles fibres, which would be a grade 2 injury. A full muscle rupture is a grade 3 injury, this doesn't often happen in the neck and isn't generally described as a neck strain. The muscles which are most commonly injured include Trapezius and Levator Scapulae.

A neck strain is often the result of a sudden movement or force to the head or neck. This may happen from a fall or a car accident and is often referred to as whiplash. Similar pain in one or more of the neck muscles may also occur after holding an awkward position for a prolonged period, such as holding a phone between the ear and shoulder, or sleeping awkwardly (e.g. sitting upright).

Treatment:

  • Rest from whatever activity caused it or anything that aggravates it.
  • Try to keep the neck moving gently by twisting the head and looking up and down.
  • Gently stretch the neck muscles.
  • Anti-inflammatory medications may be recommended to you by a health professional.
  • Apply ice if the injury happened from a sudden incident. 15 minutes at a time every 2-4 hours for the first 24-48 hours.
  • After 48 hours, a warm pack can be used to relax the muscles and increase blood flow.
  • Massage may also be helpful after the first 48 hours to stretch the muscles.
  • If symptoms do not improve within a week, visit your Doctor.

Stingers and Burners

This is a common condition in American Football and other contact sports, caused by nerve compression from impacts to the neck and shoulder area. This can cause a stinging or burning sensation to spread from the shoulder, down the arm, as far as the hand.

Stingers and burners are caused by injury to the brachial plexus. This is a group or nerves which exit the spinal cord at the base of the neck and pass down the arm to supply the arm muscles. The injury usually occurs when the head is forced to the side, such as during a tackle or a fall onto the shoulder or head.

A burning or electric shock sensation may be felt from the neck to the hand which occurs after compression or a traumatic impact to the neck. The sensation usually lasts only seconds or a minute or two although on rare occasions it can be much longer. The patient may describe a warm feeling in the arm and there may be some weakness or numbness after the initial pain has subsided.

Treatment:

  • Stop play and training involving physical contact until all pain, numbness or weakness has subsided.
  • If symptoms persist for longer than 2 days, visit a Doctor.
  • Usually, an examination and discussion of the injury are all that is needed for a diagnosis.
  • Where symptoms are more long-lasting or severe, MRI, CT scans or nerve conduction studies may be used.
  • For those with recurrent stingers or burners, elevated shoulder pads or a neck roll may be recommended to prevent over-stretching and impact to the area.

Thoracic outlet syndrome

Thoracic outlet syndrome is a term used to describe the compression of nerves and/or blood vessels which travel from the neck to the armpit (axilla). Compression of these structures can cause pain, tingling, numbness, and weakness from the neck and throughout the arm.

Read more on Thoracic outlet syndrome.

This article has been written with reference to the bibliography.