A stiff, achy neck could mean you have arthritis. Here’s how to tell, and what you can do to treat it.
When you think of arthritis, you might think of creaky knees or painful, swollen fingers. But if your neck is feeling stiff or you have pain when you turn your head, this neck pain may be caused by arthritis too.
Like the rest of the body, the disks and joints in the neck degenerate due wear and tear. Osteoarthritis of the neck includes these changes that happen over time or because of an injury. Most people 60 years old and older will have a degenerative type of neck arthritis, says Rajat Bhatt, MD, a rheumatologist with Prime Rheumatology in Houston, Texas. Inflammatory types of arthritis that occur because of an overactive immune system can affect your neck as well.
Learn more about what causes neck arthritis and how arthritis of the neck is treated.
Symptoms of Arthritis in the Neck
While arthritis in the neck is common, symptoms of neck arthritis vary, says Neel P. Shah, MD, an orthopedic spine surgeon at Montefiore Medical Center in the Bronx, New York.
For most people, arthritis in the neck causes no symptoms. When neck arthritis symptoms do occur, it’s typically pain and stiffness in the neck that ranges from mild to severe. It may be worsened by looking up or down for a long time, or by activities where the neck is held in the same position for a long time like driving or reading a book. Neck pain usually subsides with rest or lying down.
Other symptoms of neck arthritis may include:
- Grinding or popping noise or sensation when you turn your neck
- Muscle spasms in the neck and shoulders
- Trouble walking
- Weakness in the hands or legs
- Loss of balance
Two other types of symptoms that are common in people with arthritis in the neck are radiculopathy and myelopathy.
Radiculopathy affects the spinal nerve root, the part of the nerve that branches off from the main spinal cord. Usually, some form of pressure on the spinal nerve root causes symptoms such as pain, weakness, numbness, and/or electrical sensations down an extremity.
Myelopathy is a disease process that affects the spinal cord that comes on slowly over time. Symptoms include compressed spinal nerve roots, radiculopathy, pain, weakness, numbness, and/or electrical sensations in an extremity.
“Neck arthritis can become debilitating, especially if there is compression of the spinal cord, which can lead to loss of strength, coordination, and balance,” says Dr. Shah.
Types of Arthritis that Affect the Neck
Neck pain can have numerous possible causes. Still, many people with sore, stiff necks that don’t improve over time are diagnosed with a type of arthritis.
- Osteoarthritis in the Neck
Osteoarthritis in the neck is the degeneration of joints, vertebrae, and discs in the cervical portion of the spine. With less padding between them, vertebrae may rub against each other. That can cause tiny bone fragments to break off and float in the synovial fluid (a thick liquid that lubricates your joints and helps them move smoothly).
Sometimes this process stimulates the growth of bony projections along the edges called bone spurs, or osteophytes. Since the padding is now thinner, the vertebrae become closer to each other. That leaves less room for the spine nerves that stick out from the spinal cord.
Symptoms of neck osteoarthritis range from none to pain, stiffness, and inflammation. Osteoarthritis in the neck pain tends to worsen after activity. Complications such as loss of coordination can happen if the spinal cord becomes pinched.
- Rheumatoid Arthritis in the Neck
Rheumatoid arthritis is a chronic inflammatory disease where the body’s immune system mistakenly attacks the lining of the joints. It often starts in the smaller joints of your hands and feet and can spread to other parts of the body like the neck as the disease progresses. This typically doesn’t happen until years after the onset of arthritis symptoms.
Neck pain is the primary symptom of rheumatoid arthritis in the neck, with the severity varying from person to person. You may feel a dull or throbbing ache in the back of your neck around the base of the skull. Joint swelling and stiffness can make it hard to move from side to side.
The difference between rheumatoid arthritis neck pain and a neck injury is that stiffness and pain from an injury can gradually improve over days or weeks. Rheumatoid arthritis in the neck may not get better; it can worsen if left untreated. Even if symptoms improve, inflammation, swelling, and stiffness can return with rheumatoid arthritis in the neck.
- Spondyloarthritis in the Neck
Other types of neck arthritis include psoriatic arthritis and ankylosing spondylitis, which are both considered a type of arthritis called spondyloarthritis. It’s an umbrella term for inflammatory diseases that involve both the joints and entheses, the places where ligaments and tendons attach to the bones.
Psoriatic arthritis is a form of arthritis often accompanied by psoriasis, an inflammatory skin disease. For some people who have psoriatic arthritis, the condition involves the spine, which impacts the neck. Pain happens when inflammation strikes the joints between the vertebrae. This pain can occur on just one side of the body, the neck, and the lower and upper back. Read more about psoriatic arthritis symptoms.
Ankylosing spondylitis is a form of arthritis that strikes the bones in your spine and pelvis as well as peripheral joints. Early signs and symptoms might include pain and stiffness in your lower back and hips, especially in the morning and after inactivity. Fatigue and neck pain are common. AS symptoms might worsen, improve, or stop at irregular intervals.
How Neck Arthritis Is Diagnosed
Your doctor will start by taking a history and doing a physical exam. They’ll check the range of motion in your neck and test your strength, sensation, and reflexes to find out if there is pressure on your nerves or spinal cord. They’ll ask when your symptoms started, when the pain happens, and what makes the pain better and worse.
Your doctor may order an X-ray to assess alignment and look for arthritic changes, says Dr. Shah. If there is a concern of compression of spinal nerves or the spinal cord, you may need an MRI to look at the neutral structure and discs, says Dr. Shah.
A CT scan may be ordered to look at the bone more closely, especially to see if any bony outgrowths are causing compression. However, X-rays and MRIs are the tests that are usually ordered, says Dr. Shah. A CT scan with a myelogram (where dye is injected into the spinal canal to see the neural structures) may be used if an MRI can’t be done.
An electromyography, or EMG, may be ordered to assess for nerve compression, says Dr. Shah. An EMG tests the electrical conduction of the nerves in the arms. This test would be helpful if you have multiple nerves being compressed or compression of nerves at the neck and in the arm, he says.
Your doctor may order blood tests to see if you have any antibodies or systemic inflammation that would reveal inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
Treatment for Arthritis in the Neck
In most cases, treatment for neck arthritis is nonsurgical. Nonsurgical treatment options are listed below.
- Medication Options for Neck Arthritis
Analgesic and NSAID pain medication
Over-the-counter medications can be used to help address pain, inflammation, and swelling. NSAIDs like aspirin, naproxen, and ibuprofen can help relieve pain and reduce inflammation. Analgesics (such as acetaminophen) can help with mild to moderate pain. Your doctor can prescribe a stronger anti-inflammatory if OTC medications don’t provide relief.
Even though many commonly used NSAIDs are available over the counter, it’s important to talk to your doctor about side effects and drug interactions. NSAIDs can have significant side effects, including gastrointestinal complications, and are associated with an increased risk of heart disease.
Disease-modifying arthritis medication
Neck pain due to inflammatory arthritis is typically treated with a disease-modifying antirheumatic drug (DMARD), such as methotrexate for RA. Other conventional DMARDs include leflunomide, hydroxychloroquine, and sulfasalazine. Biologics are a newer type of DMARD that target specific immune system pathways. DMARDs help to reduce the immune system activity that is triggering inflammation and pain.
Steroid injections and nerve blocks
Steroid-based injections and nerve blocks can offer pain relief for arthritis in the neck. Both can be good for pain that radiates from the neck, says Carlo Milani, MD, an assistant attending physiatrist at Hospital for Special Surgery in the Department of Physiatry in and assistant professor of clinical rehabilitation medicine at Weill Cornell Medical College in New York City.
An epidural steroid injection is where doctors inject medicine directly into the epidural space of the spinal canal surrounding the nerve roots. The medicine is a combination of corticosteroids and a local anesthetic, which together reduce inflammation and relieve pain.
A facet joint injection is an injection of local anesthesia and corticosteroids that is placed directly into the affected joint. Facet joints connect the bones of the spine, allowing the spine to bend and twist.
The anesthesia offers temporary pain relief and the corticosteroids reduce inflammation in the joint.
A nerve block is the injection of a local anesthetic close to a targeted nerve or group of nerves to block pain. Different types are used depending on where you’re in pain. You may get relief from one injection or need several nerve block treatments.
- Exercise for Arthritis in the Neck
If you’re experiencing neck pain due to arthritis, your doctor may recommend physical therapy. Physical therapy for neck arthritis entails doing specific exercises to help strengthen and stretch weak or strained muscles. Physical therapy can improve range of motion. Sessions and programs vary in length and frequency and are tailored to your condition.
“The foundation of what we’re trying to do in physical therapy for the neck is often to help improve posture and the way people move,” says Dr. Milani. “Exercises in physical therapy tend to be focused on strengthening muscles of the back and neck, which puts less strain on structures of the cervical spine.”
You’ll do exercises during physical therapy and get instructions on ones to do at home.
Regular Physical Activity at Home
You may feel like you don’t want to move when your neck hurts. But being inactive may increase stiffness, which can cause you to lose even more mobility. “Aches and pains tend to respond better to continued movement than rest,” says Dr. Milani. “Exercise is often the foundation of treatment.”
Exercises that involve stretching, strengthening, and improving range of motion can help reduce pain and keep your neck limber. You want to move gently and smoothly when doing neck exercises, not jerk your neck or make sudden movements. You may feel discomfort at first. Stop if any exercise increases your neck pain.
Light exercise can help improve strength and flexibility. Walking, swimming, water aerobics, or biking fit the bill. Or go for yoga or Pilates. “Avoid overhead movement exercise or positions that exacerbate your symptoms,” says Dr. Milani. He says, for example, on a stationary bike, avoid a position that aggravates neck pain. Find a comfortable position while you are riding.
The military chin tuck helps with posture. Hold your chin to the neck for 10 to 20 seconds. Do this 10 times a day, says Dr. Shah.
Don’t forget about your shoulders. Exercising them will help strengthen the muscles that support your neck. Basic shoulder rolls will keep your shoulder and neck joints fluid.
- Radiofrequency ablation
If medication, physical therapy, or other treatments don’t work, a procedure called radiofrequency ablation that numbs the joints of the neck might be indicated, says Dr. Milani. In the procedure, a heated needle tip heats up a small area of nerve tissue to stop it from sending pain signals. That can offer long-term, but usually not permanent, relief for six months to two years, he says.
- Home Remedies for Arthritis in the Neck
While you can’t stop age-related joint degeneration from happening, you can try to slow its development or ease symptoms with simple lifestyle changes. Here are a few remedies you can try to manage neck arthritis pain.
Apply a cold compress to the neck to help reduce inflammation, stiffness, and swelling.
Sleep with a pillow and bed that support your sleep preference, says Dr. Shah. If you like sleeping on your back, get a firm mattress and pillow. Side sleepers should get a medium mattress and pillow. Stomach sleepers should go for a soft mattress and pillow. Dr. Milani says you may find it helpful to sleep with a cylinder-like pillow that sits in the curve of your neck.
Quit smoking if you’re a smoker. Smoking decreases the effectiveness of some drugs used to treat arthritis. And smoking can make it harder for you to do activities that relieve arthritis symptoms, like exercise. “It can worsen arthritis and also increase pain sensitivity,” says Dr. Bhatt.
Watch your computer stance
Support your back and neck while you sit at your computer. Keep your computer at eye level so you don’t have to change your neck position by looking up and down. “When using a computer and key board, have the monitor at eye level,” says Dr. Shah. “Use risers or an adjustable desk.” Your keyboard should be close to your body and your body should be close to your desk, says Dr. Milani. If your company offers it, an ergonomic assessment of your work station can help ensure that it’s set up properly, he says.
Use the phone correctly
When talking on the phone, use a headset. That will help prevent you from straining your neck. Smartphones have even launched the term “text neck,” which is a repetitive strain thanks to people hunching over their devices. This stance aggravates muscle pain in the neck. Instead of tilting your chin down to read your smartphone, put the device at eye level. That way your head isn’t constantly dropping and forced to strain.
Alter your posture
Changing your posture can help relieve neck pain from arthritis. Good posture, as it’s related to the neck, is when the ears are positioned directly above the shoulders with the chest open and shoulders back. Here, stress is minimized because the head’s weight is naturally balanced on the spine. “Correct posture is key,” says Dr. Shah. “With the use of computers and smartphones, we’re constantly being hunched forward. It’s demanding to the neck and applies harmful pressure to the structures of the neck.”
- Surgery for Neck Arthritis
“Surgery is usually a last resort for neck arthritis,” says Dr. Milani. Your doctor may recommend it if you have severe pain that isn’t relieved with nonsurgical treatment or if you have signs of neurologic injury. “Surgery may be needed if the arthritis causes instability, or more importantly, impingement of nerves and/or the spinal cord,” says Dr. Shah.