A healthy muscle is comprised of numerous muscle fibers. Within each of these fibers are bundles of myofibrils that contain contractile proteins, which perform the actual contractions for muscle movements.

When the muscle overexerts or stretches too far, small tears can form in the muscle, tendon, or connective tissue between the muscle and tendon, which is usually the weakest part. More extensive neck strains involve more inflammation, which leads to more swelling, pain, and a longer recovery period. The strained muscles strength while the injury is healing largely depends on how many muscle fibers were torn.

Two long neck muscles that are at an increased risk for strain are:

Levator scapulae. This muscle travels down the side of the neck, from top of the cervical spine to the scapula (shoulder blade). The levator scapulae plays a key role in bending and rotating the neck to the side, and these movements can be hindered if the muscle is strained.

Trapezius. This kite-shaped (trapezoidal) muscle runs from the base of the skull and goes more than halfway down the back, as well as out to the shoulders. The upper trapezius muscle helps facilitate many movements, including head tilts and neck extension (looking up).

Other neck muscles can also become strained, and it is possible for more than one neck muscle to become painful at the same time.

Some common causes of neck strain include:

Poor posture or holding an awkward position. The necks muscles, tendons, and other soft tissues can become overstretched when the head is held too far forward or tilted at an angle for too long. Some examples include being hunched over a computer for several hours, holding the phone between the ear and shoulder, or sleeping in a position that does not support the cervical spine well. An increasingly common problem is text neck, which describes neck pain that is caused by looking down at a phone screen or other wireless device for too long or too frequently.

See How Poor Posture Causes Neck Pain

Lifting something too heavy. It is likely for the neck to become overexerted and strained when lifting something that requires too much work for the muscles.

Collision or fall. A sudden impact can jar the head and cervical spine to move too quickly for the muscles, which may lead to whiplash or other types of neck strain injuries. Some examples include auto accidents, bike accidents, or sports injuries, such as in football.

See Whiplash Symptoms and Associated Disorders

Performing a new activity. Putting any muscle through a new type of activity that is somewhat strenuous makes it more susceptible to strain, including in the neck. For instance, athletes are more susceptible to muscle strains at the beginning of a training season.

Repetitive motions. Even for motions and loads that neck muscles can handle, doing too many repetitions can eventually strain the muscles.

Initial Treatments for Neck Strain

When pain from a neck strain first develops, one or more of the following treatments are typically tried:

Activity modification. Resting the neck and/or refraining from strenuous activities for a couple days can give the muscle or tendon time to start healing and feeling better. Trying to push through the pain without reducing activity levels could worsen the injury and prolong the pain.

Ice and/or heat therapy. It is recommended to apply ice within the first 48 hours of an injury to help reduce swelling. After 48 hours, heat or ice may be applied, depending on the patients preference. Heat can help facilitate blood circulation and bring healing nutrients to the damaged tissues. A layer should be kept between the skin and hot/cold source to avoid skin damage, and applications should be kept to 10 to 20 minutes with rest periods in between.

See Heat Therapy Cold Therapy

Over-the-counter pain medication. Taking anti-inflammatory medicines, such as ibuprofen (e.g. Advil) or naproxen (e.g. Aleve), reduces inflammation, which in turn can reduce pain. Pain relievers, such as acetaminophen (e.g. Tylenol), may also be an option.

See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

It should be noted that even if a neck muscle strain is painful with most movements, total bed rest and/or a neck brace are not typically recommended because that could lead to weaker neck muscles and a longer recovery period Most neck strains heal on their own, but finding the right treatment can help alleviate the pain while the injury is healing. In cases where neck pain lingers for more than a few days or initial treatments do not provide enough relief, trial-and-error may be needed to find the combination of treatments that work best.

A pillow with good support can help to minimize pain from a neck strain by relieving pressure on the structures of the neck. Read Pillows for Neck Pain.

Treatments for Neck Strains That Linger

If a neck strain lasts longer than a few days or perhaps another underlying problem in the cervical spine continues and causes muscle spasms and chronic pain, other treatments may need be needed for adequate relief. Some examples include:

Physical therapy. A physical therapist, physiatrist, or other trained medical professional may design a physical therapy program that targets muscles in the neck and elsewhere that need to become stronger and more flexible. Typically, a physical therapy program begins with instruction on how to do the exercises and stretches. After gradually making process over a period of a few weeks or months, the patient continues the program on his or her own at home.

Manual manipulation.A trained medical professional may make manual adjustments to the cervical spine (as well as lower in the spine) with the goal of realigning joints, improving the necks range of motion, and reducing pain.

See Chiropractic Manipulation for the Cervical Spine

Massage therapy. A massage can loosen up and relax the muscles, as well as increase blood flow to the damaged tissues, which may provide some relief. Some medical professionals provide massage therapy in conjunction with manual manipulation.

See Acupuncture: An Ancient Treatment for a Current Problem

Acupuncture. This treatment is based on the theory that unbalanced energy flows (or blockages) within the body may contribute to pain, and therefore strategic placements of thin needles in the body may restore balanced energy flows and reduce pain. While this theory has not been scientifically proven, some people report experiencing pain relief from acupuncture treatments.

See Acupuncture: An Ancient Treatment for a Current Problem

Prescription medications. While rare, sometimes a neck strain may require a prescription medication to provide relief. For example, a muscle relaxant may be prescribed on a short-term basis to alleviate the pain from a particularly bad muscle spasm.

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