Exercise plus joint mobilization and/or joint manipulation (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders. Neither mobilization or manipulation without exercise however has been found to be helpful. Mobilization is equivalent to manipulation. Ultrasound has been shown not to be efficacious.

Analgesics such as acetaminophen or NSAIDs are recommended for pain. Muscle relaxants such as cyclobenzaprine have not been found to be useful and are therefore not recommended. Over the counter topical creams and patches containing counterirritants have little evidence to support efficacy.

and severe causes of neck pain include:

• Carotid artery dissection
• Head and neck cancer
• Referred pain from acute coronary syndrome
• Infections: retropharyngeal abscess, epiglottitis, etc.
• Spondylosis - degenerative arthritis and osteophytes
• Spinal stenosis – a narrowing of the spinal canal
• Spinal disc herniation – protruding or bulging discs, or if severe prolapse.

The more common and lesser neck pain causes include:

• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on sofas and chairs and wake with sore necks
• Minor injuries and falls – car accidents, sporting events and day to day minor injuries
• Referred pain – mostly from upper back problems
• Over-use – muscular strain is one of the most common causes
• Whiplash
• Herniated disc
• Pinched nerve