03 / Understand the area
Base of the neck
Pain at the base of the neck, where it meets the shoulders, often gets called tension. When it comes on, and what it does to how you move, is the more useful story.
An educational guide that covers the left and right sides alike. Where it hurts is a useful clue, but only a clue.
A useful starting point
What this area can tell you.
Desk work, driving and lifting each give different clues, but whatever you were doing when the pain showed up isn't automatically the cause. How long a position stays comfortable, and what happens when you switch tasks, say more than the activity itself. After a collision, the details of the injury and how your symptoms developed matter, so we don't just assume it's ordinary muscle soreness. The exam may take in the neck, shoulders and arms, especially when symptoms travel past the base of the neck.
Notice the pattern
Three questions to bring with you.
You don't need to know what it is before you come in. These are details that help when you tell us what you're feeling.
- Does the pain build while driving, at a desk or lifting, and how fast does it settle?
- Can you turn your head far enough for everyday things like checking traffic?
- Did it start after a collision, and have headaches, arm symptoms or sleep changed since then?
When to get help sooner
Severe neck pain after a significant collision or fall needs urgent medical assessment. New weakness, difficulty walking or loss of bladder or bowel control needs emergency care.
Follow the connection
Possible explanations. Better questions.
These guides cover conditions and patterns that may overlap with this area. Think of them as a place to start our conversation: no body map can tell you which one, if any, you have.
Neck pain
Stiffness, referred pain and nerve symptoms, and the questions our exam sets out to answer.
Read the guide Condition guideWhiplash
What to watch for after a crash or any sudden jolt to the neck, and how recovery is checked.
Read the guide Condition guideWork-related pain
How your job, any past injury and a practical plan for getting back to work and activity fit together.
Read the guideWhat the studies found, and where they stop
How the research fits this area.
The neck study and the chronic whiplash trial looked at different groups of patients. In neither one did more intensive care turn out to be automatically better than the exercise or advice it was compared with.
How we select and explain sources ↗Follow the evidence
Research, with context.
Selected published sources behind what we've written, each with what it found and what it can't tell us. We give you both halves because no paper can diagnose you or predict how your own care will go.
Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial
272 adults with nonspecific neck pain lasting 2 to 12 weeks.
What it foundManipulation performed better than medication at several follow-ups, but there was no important pain difference between manipulation and home exercise with advice.
What it can't tell usTreatment was unblinded. The study doesn't cover every cause of neck pain, instability after trauma, or an unexplained neurological problem.
Publication details & citation
Bronfort et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012. DOI: 10.7326/0003-4819-156-1-201201030-00002.
Read the publication recordComprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial
172 people with grade I or II whiplash lasting more than three months.
What it foundAn intensive exercise program did not improve pain more than an advice session with telephone support at the measured follow-ups.
What it can't tell usIt compares two specific approaches to chronic whiplash. It isn't evidence that all exercise is useless, and it doesn't cover every acute injury.
Publication details & citation
Michaleff et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. The Lancet. 2014. DOI: 10.1016/S0140-6736(14)60457-8.
Read the publication record
Our editorial policy explains how to read these sources and what our clinical-review labels mean.
Your next step
Bring your questions.
We’ll start there.
Your answers to those three questions are where we start. We go over your history and symptoms, examine you, and explain what we found before we recommend anything. If it turns out to be something another doctor should look at, we'll tell you.
Anatomy: BodyParts3D, © DBCLS, CC BY 4.0. Model & rendering credits. Return to the full body explorer.