I'm 35, fit, and have never had neck problems before. But then I strained my neck three weeks ago doing leg-lifts while lying on my back. The pain got worse each day and moved up the back of my head to the top. I've ended up with bad head and neck ache. I saw a GP who gave me anti-inflammatories and a muscle relaxant. I've seen a chiropractor and a physiotherapist who both think it's just muscular. They helped me do gentle movements and stretches and massage, but the pain is still unbearable at times. Is there anything else I can do? -Mitchell
The first step would be to let your GP know that the standard treatment course that works for most people isn't yet working for you. It might just be that your aching muscles and ligaments just need more time to heal.
A doctor's first consideration would be to make sure your neck and head pain isn't from something more serious, like a spine tumour, a herniated disc putting pressure on a nerve, or a problem with your brain or spinal cord. Though the odds are good that if you're healthy and have a normal neurological and general physical exam it really is just musculoskeletal. One option that's gaining support is neck injections. Brothers Larry Mellick and Gary - one a neurologist; the other an emergency physician - have done a lot to raise awareness among doctors that this treatment option even exists. Their technique involves injecting a local anesthetic into the muscles of the lower neck. Pain relief, often within minutes, was experienced by 95 per cent of patients.
One theory is that the anaesthetic interrupts the pain signal from nerves to brain, another is that needling the muscle causes inflammation, stimulating anti-pain signals from the brain. Acupuncture might also work this way, but we don't know for sure.
In your case, a trial of cervical injection by your GP costs little, carries minimal risk of harm, and is not significantly painful. Many doctors might not have heard of it yet or done one themselves, but the technique is well-described and very easy to learn. It might be worth discussing this one with your doctor.