What is the best treatment for a neck crick (cervical strain)?

From the Guidelines

For a neck crick (cervical strain), the best treatment is a combination of rest, over-the-counter pain medications, and gentle stretching, as most cases resolve spontaneously or with conservative treatment measures 1. When treating a neck crick, it's essential to prioritize reducing inflammation, relaxing tight muscles, and gradually restoring normal movement patterns.

• Start with ibuprofen (Advil, Motrin) 400-600mg every 6 hours or acetaminophen (Tylenol) 500-1000mg every 6 hours as needed for pain relief, as recommended by recent guidelines 1.
• Apply ice for the first 48-72 hours (20 minutes on, 20 minutes off), then switch to heat therapy using a warm towel or heating pad for 15-20 minutes several times daily to help reduce pain and inflammation.
• Gentle neck stretches and range-of-motion exercises can help restore mobility once acute pain subsides, and it's crucial to maintain proper posture and consider sleeping with a supportive pillow that keeps your neck aligned with your spine 1. Most neck cricks resolve within 1-2 weeks with these conservative measures, but if pain persists beyond two weeks, worsens significantly, or is accompanied by numbness, tingling, or weakness in the arms, seek medical attention as these could indicate a more serious condition requiring professional evaluation 1. Key considerations in treatment include:
• Avoiding imaging unless red flag symptoms are present, as spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of neck pain 1.
• Monitoring for red flags such as trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, and neurological deficits, which may require more aggressive treatment or specialist referral 1.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions The best treatment for a neck crick (cervical strain) may include cyclobenzaprine as an adjunct to:

• Rest
• Physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, such as a neck crick 2.

From the Research

Treatment Options for Neck Crick (Cervical Strain)

• Exercise treatment appears to be beneficial in patients with neck pain 3
• There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm 3
• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat acute neck pain, with moderate quality evidence showing they are slightly more effective than placebo for short-term pain reduction 4
• Low-dose cyclobenzaprine has been shown to be effective in treating acute neck or back pain with muscle spasm, with significant improvements in patient-rated scales such as spasm, pain, and global impression of change 5

Management of Neck Pain

• A systematic review found 91 systematic reviews, RCTs, or observational studies that met the inclusion criteria for the treatment of non-specific neck pain, whiplash injury, and neck pain with radiculopathy 6
• The review presented information relating to the effectiveness and safety of various interventions, including acupuncture, biofeedback, drug treatments, early mobilisation, exercise, heat or cold, manipulation, and physical treatments 6
• Another study found that combination therapy with cyclobenzaprine and ibuprofen was not superior to cyclobenzaprine alone in adult patients with acute neck and back pain with muscle spasm 5

Diagnosis and Prognosis

• History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology 3
• Magnetic resonance imaging may be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment 3
• Neck pain is defined as pain perceived between the superior nuchal line and the spinous process of the first thoracic vertebra, and can be referred to the head, trunk, and upper limbs 7