Short answer: Most neck pain is caused by strain or irritation of the joints, muscles, ligaments and discs of the neck, often driven by sustained postures, sudden movements, injury or age-related change. Sometimes an irritated nerve root adds arm pain or tingling. Stress, sleep and daily load all influence how much it hurts.
How your neck is built
Understanding what causes neck pain starts with the structures involved. The cervical spine is seven vertebrae stacked between your skull and your upper back. At each level you'll find:
- a disc at the front, cushioning and connecting the vertebrae
- two facet joints at the back, guiding movement
- ligaments binding the vertebrae together
- muscles in layers, from small deep stabilisers to the larger muscles across the shoulders
- nerve roots leaving the spine on each side, heading to the shoulders, arms and hands
The top two vertebrae, the atlas and axis, are shaped differently and allow much of your head's turning and nodding. The upper neck also shares nerve pathways with the head, which is why neck problems can show up as headaches.
Any of these structures can be a source of pain. Often several are involved at once.
The main causes of neck pain
| Source | What's going on | How it often feels |
|---|---|---|
| Joints (facet joints) | Strained, stiff or inflamed joints at the back of the neck | Deep, one-sided ache; sharp on turning or looking up; stiff after rest |
| Muscles and ligaments | Strain, overload or protective guarding | Tight, sore, tender; spreads across the shoulders |
| Discs | Disc irritation, bulge or age-related change | Deep neck pain, sometimes into the shoulder blade |
| Nerve roots | A nerve irritated as it leaves the spine | Pain, tingling or numbness into the shoulder, arm or hand. See pinched nerve. |
| Injury | Car accidents, falls, sport | Pain and stiffness that may build over hours or days |
What sets neck pain off
The structures above are where pain comes from. These are the everyday things that most often load and irritate them:
- Sustained head-forward posture. Laptops, phones, desk work and driving keep the head in front of the shoulders for hours. The muscles at the back of the neck work hard the whole time. Often called tech neck.
- Sleep position. Stomach sleeping or the wrong pillow height can leave you waking up sore.
- Sudden or awkward movements. A quick turn, reaching overhead or a heavy lift.
- Repetitive work. Overhead work, looking up at a ceiling, or holding the phone between ear and shoulder.
- Stress. Tension tends to collect across the upper shoulders and the base of the skull.
- Age-related change. Discs and joints change over the years. This is very common, and many people with changes on X-ray have little or no pain, but it can make the neck stiffen more easily.
- A stiff upper back. When the mid back doesn't move well, the neck often picks up the slack.
If stiffness is your main problem, our article on the causes of a stiff neck goes into more detail.
Neck pain that spreads: headaches and arm pain
Neck pain doesn't always stay in the neck. Two common patterns:
- Headaches. Irritation in the upper neck can refer pain to the base of the skull, behind the eyes or over the head. Read what causes a headache at the base of the skull?
- Arm pain. When a nerve root is irritated, pain, pins and needles or numbness can travel into the shoulder, arm and hand. The pattern of symptoms gives clues about which level is involved.
Pain between the shoulder blades can also come from the lower neck, even when the neck itself doesn't feel too bad.
Neck pain and how your brain controls your neck
Neck pain isn't only about tissues. Your brain is constantly making small corrections to keep your head steady and your eyes level, using information from sensors in the neck's muscles and joints. Pain and injury can change that control. In the current research model, a segment that isn't moving or being controlled well, which chiropractors call a vertebral subluxation, sends the brain poorer information and can help keep the problem going.1
Some of the most interesting chiropractic research has been done in people with neck pain:
- In people with recurrent neck pain, an adjustment reversed an abnormal pattern of communication between the cerebellum, which coordinates movement, and the motor cortex during a motor-learning task.2
- In a small trial of people with mild, recurring (subclinical) neck pain, eight weeks of chiropractic care normalised the cervico-ocular reflex, which governs how your eyes track as your trunk moves, compared with no care.3
These studies are small and measure nervous-system function, not neck pain itself. They suggest the neck's role in coordination goes beyond comfort, and researchers are still working out what that means day to day. See chiropractic and your nervous system.
How we approach this at MPCC
Because neck pain has so many possible sources, the first job is working out which ones are involved for you. Your new patient appointment takes 30 to 40 minutes. We hear your story, take posture pictures, and do a thorough chiropractic, orthopaedic and neurological check of your spine, joints and nerves, including sensation, reflexes and strength in the arms where needed.
X-rays aren't routine. We only refer for them when your history and check point to them, and the imaging clinic we refer to bulk bills X-rays our chiropractors request.
At your report of findings appointment we explain what we found in plain English and what we'd do. Depending on your case, care may include specific chiropractic adjustments to the neck and upper back, home exercises, and practical changes to how you sit, sleep and work. See our neck pain page for more.
Looking after your neck day to day
- Raise screens so the top sits around eye level.
- Take a movement break every 30 to 45 minutes.
- Use a pillow that keeps your neck roughly level with the rest of your spine.
- Keep your upper back moving and strong. Try our neck exercises.
If you're worried about it, call us and we'll talk it through.
References (3)
- Haavik H, et al. (2021). Contemporary model of vertebral column joint dysfunction. Eur J Appl Physiol. doi:10.1007/s00421-021-04727-z
- Baarbé JK, et al. (2018). Cerebellum and motor cortex plasticity in neck pain. PLoS One. doi:10.1371/journal.pone.0193413
- Campbell S, et al. (2024). Cervico-ocular reflex after chiropractic care. Exp Brain Res. doi:10.1007/s00221-024-06915-7