When Neck Pain Signals Something More Serious: Red Flags to Watch

Neck pain can be annoyingly common. You may wake up with it. You probably get it after sitting at your desk all day. Maybe you overdid it at the gym. Neck pain is incredibly common, and for good reason.

Typically, your neck pain is mechanical. Tight muscles or poor posture pulls on your spine and joints causing pain. Fixing improper mechanics through physiotherapy and self-care alleviates this pain.

But there are exceptions to every rule. Learn about neck pain red flags that mean you should seek medical attention. Keep reading to learn when you can feel confident ignoring your neck pain and when you should worry.

No Neck Pain Should Ignore Completely, But…

It's important to remember that your body communicates with you. A lot of neck pain comes with symptoms that tell you exactly what is wrong.

Mechanical Neck Pain Symptoms

If your neck pain is mechanical you'll notice:

• It feels stiff but loosens with movement
• It's an achy feeling in your muscles
• Moves up/down your neck or when looking over your shoulder
• Gets better when resting or changed positions
• Hurts when you press on the muscles (not bones)
• Gradual onset or related to an obvious event

As a bonus, this pain typically resolves with physiotherapy, restoring movement, and specific exercises. Mechanical pain isn't fun, but it's rarely serious.

Serious Neck Pain Symptoms (Neck Pain Red Flags)

Neck pain that requires medical attention is usually quite different. If your neck pain is radiating to your arm, see numbness or weakness, consider seeking care. These neck pain red flags mean you should probably see a doctor:

• Sharp, constant pain that doesn't improve with rest
• Pain that awakens you at night and disrupts sleep
• Weakness or numbness down your arms or legs
• Unexplained weight loss accompanied by neck pain
• Neck pain due to recent trauma (car accident, fall, etc.)

"5 Ds" of Vertebrobasilar Insufficiency (VBI)

Your neck contains major arteries which supply blood to your brain. If these arteries are compressed or narrowed, blood flow to your brain becomes limited.

Vertebrobasilar insufficiency (VBI) describes this condition. Learn about what happens when your neck arteries are compromised below:

"5 Ds" of Vertebrobasilar Insufficiency

If you experience any of the following symptoms, especially with neck pain, call 911. Symptoms indicate blocked blood flow to your brain:

• Dizziness
• Double vision (diplopia)
• Difficulty speaking (dysarthria)
• Difficulty swallowing (dysphagia)
• Sudden collapse (drop attack)

Other Symptoms You Shouldn't Ignore

• Intense headache like never before
• Numbness or loss of sensation around mouth and face
• Nausea/vomiting accompanied by neck pain
• Loss of coordination

These symptoms accompanying neck pain may mean you are experiencing a stroke or arterial dissection. Both conditions require emergency medical attention to minimize brain damage.

The Rest of the Neck Pain Red Flags

Trauma

After severe trauma: motor vehicle collisions, falls from significant height, contact sport injuries, diving accidents: warrant emergency care if:

• Extreme pain in the hours after injury
• Unable to move neck without significant pain
• Numbness/tingling in the arms or legs
• Weakness in the arms or legs
• Loss of bladder or bowel control

Do not twist or turn your neck after significant trauma. Wait for medical professionals to assess you for potential spinal injuries.

Symptoms of Infection, Cancer, or Other Illnesses

Occasionally severe infections, cancer, and inflammatory conditions can present as neck pain. Seek care if you notice:

• Fever with an inability to move your neck: Known as nuchal rigidity, this serious symptom along with severe headache and light sensitivity can indicate meningitis.
• Unexplained weight loss of >10 lbs
• Night sweats accompanied by pain
• History of cancer and new neck pain
• Immunocompromised (HIV, Diabetes, Immunosuppressants)

Neck Pain Radiating Down Your Arm

It's also important to pay attention to where your neck pain travels. Some circumstances require emergent care:

• Neck pain radiating down one arm with numbness: Can mean a pinched nerve. This condition is typically very painful, but responds well to physiotherapy.
• Neck pain radiating down BOTH arms with weakness: Could mean spinal cord compression. Seek emergency care.
• Neck pain radiating to the jaw, left arm, or chest: Could mean a heart attack. Call 911.

Where to Go with Neck Pain: ER vs. Physio

Ok, now that we know the neck pain red flags. You're wondering where you should go if you have neck pain. Should you go to the doctor? Urgent care? Try physiotherapy?

If you have any of the above symptoms, you should go straight to the emergency room. These are clear neck pain red flags. ER neck pain symptoms warrant emergent evaluation to rule out life-threatening conditions.

I Should See a Physiotherapist When…

• Pain started gradually and there was no major trauma
• Pain gets better when moving around/resting/changing positions
• You don't experience any neurological symptoms (numbness, weakness, bladder problems, etc.)
• Neck pain is not associated with fever or other signs of infection
• Pain started within the last 6 weeks or you know it's mechanical

When in doubt, seeing a physiotherapist can keep you out of the emergency room. Here in Austin, TX we recommend stopping by Carter Physiotherapy for an assessment.

Our fantastic physiotherapists can assess to ensure there are no red flags and develop an individualized plan to improve your pain.

How Can Physio Help Relieve Neck Pain?

Well-trained physiotherapists can treat your neck pain with:

• Movement assessment to rule out serious conditions
• Manual therapy to restore joint mobility
• Strengthening exercises to stabilize your neck
• Education on proper posture and ergonomics
• Movement retraining to restore function

Treating the cause of your pain ensures long lasting relief. Unlike taking unnecessary medication, physiotherapy treats the underlying problem instead of masking pain.

Ready to ditch that annoying neck pain? Contact Carter Physio for excellent care in Austin, TX.

Neck Pain FAQs

Can stress cause really bad neck pain?

Yes! Stress can cause your muscles to tense up all over your body, especially your neck. Stress can cause your neck pain to feel terrible. But you'll know it's from stress if you don't experience any neurological symptoms (weakness, numbness, etc.). Pain from stress usually resolves with relaxation techniques, massage, and physio.

What does it feel like when you have a pinched nerve in your neck?

Pinched nerves in the neck usually cause sharp pains that radiate from your neck down one arm. You may experience numbness or tingling in certain fingers down that arm. Pinched nerves (cervical radiculopathy) often feel worse when turning your head to the side. While they can be painful, most respond well to physiotherapy. If you start to experience weakness or it affects both arms, get it checked immediately.

Should I get an MRI done for neck pain?

Not necessarily. Remember, many people have "abnormal" MRI scans despite no neck pain. Just because yours shows something does not mean that's what's causing your pain. The majority of mechanical neck pain will respond to treatment. You likely need an MRI if your symptoms are persistent (>6 weeks) despite treatment, you have neurological symptoms, or there are red flags for serious conditions. Your physiotherapist can help you know for sure.

Can high blood pressure cause neck pain?

High blood pressure rarely causes neck pain. If it does, it's usually due to severe hypertension causing headaches which extend to your neck. More importantly, if you're experiencing neck pain with a sudden, severe headache, you could be having a stroke. Both are emergencies. Seek immediate care if this is the case.

How long should I wait to see a doctor for neck pain?

There's a three-part rule that we like to share with patients: seek further evaluation if your pain lasts longer than 6 weeks, is severe/worsening (not improving), and/or you have any concerning features. That being said, if you notice ANY red flags for serious neck pain (see above), seek care immediately. For typical neck pain, starting physio within the first few weeks will likely allow you to recover fastest.