Neck Osteoarthritis (Cervical Spondylosis)
Age-related changes in the neck’s discs and joints. Very common after 40, and many people with it have no symptoms at all. When it does cause trouble, it’s usually neck stiffness and pain that come and go. Rarely, it presses on a nerve or the spinal cord, which needs prompt care.
Symptoms. Neck pain and stiffness that come and go, often with headaches starting at the back of the head. A pinched nerve can cause pain, pins and needles, numbness or weakness down one arm. Pressure on the spinal cord (much rarer) causes clumsy hands, trouble with buttons or handwriting, and unsteady walking.
Who gets it. Mostly a normal part of ageing. Earlier in people who’ve had a neck injury or when it runs in the family.
How it’s diagnosed. From your story and an examination of your neck, arms, reflexes and walking. X-rays or an MRI are only needed for nerve or spinal cord symptoms, or pain that isn’t settling. Neck changes on scans are common in people with no pain, so a scan alone doesn’t explain symptoms.
The neck arthritis ladder
Most flares settle with movement and time. The higher steps are mainly for a pinched nerve or pressure on the spinal cord.
- Step 1 · Self-careKeep moving, plus gentle neck exercisesRegular gentle neck movement, shoulder and upper-back strengthening, and staying as active as you can.
- Works
- The main treatment in NHS advice. Trial figures for neck arthritis specifically are limited
- Cost
- Free
- How long
- A few weeks to help; symptoms can return, so keep going
- Watch for
- Stop and get checked for arm weakness, clumsy hands or unsteady walking.
Your neck was designed to move, not to be held perfectly still over a phone.
- Step 2 · PharmacyAnti-inflammatories or paracetamol, short termIbuprofen or similar for a few days in a flare; heat packs for comfort.
- Works
- Can take the edge off a flare; no strong trial data for neck arthritis
- Cost
- About $5–15; heat packs about $10–30
- How long
- A few days
- Watch for
- Anti-inflammatories: Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
Helps you keep moving, which is the real treatment.
- Step 3 · Allied healthPhysioFor pain that isn’t improving after a few weeks: tailored exercises and advice.
- Works
- Recommended in NHS advice when symptoms don’t improve; no precise trial figures for neck arthritis
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- A few sessions, then keep going at home
- Watch for
- Choose someone who gets you exercising, not just cracking.
Homework is the treatment. The appointment is the coaching.
- Step 4 · SpecialistSpinal surgeon or neurosurgeonFor a pinched nerve with weakness or pain that won’t settle, or for spinal cord pressure.
- Works
- Surgery is not always a cure, but can stop nerve or spinal cord symptoms getting worse
- Cost
- Free in the public system; private specialist and surgery costs vary
- How long
- Depends on the operation
- Watch for
- Spinal cord pressure needs prompt referral, not waiting.
Rarely needed, but important to recognise when it is.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Scans “just to see”Neck changes are a normal part of ageing and show up in people without pain. A scan rarely changes treatment unless there are nerve or spinal cord symptoms.
- GlucosamineNICE advises against it for osteoarthritis. No good evidence for the neck.
- AcupunctureNICE advises against it for osteoarthritis because the benefit is too small or uncertain.
What you can do
- Move your neck gently through its range a few times a day.
- Break up long spells at a screen; raise the screen to eye level.
- Use one supportive pillow that keeps your neck level with your body.
- Follow our neck exercise handout: one printable page of movement and strengthening.
See your GP if
- Pain, pins and needles or numbness spreads down an arm
- Pain is getting much worse, or isn’t improving after a few weeks
- Pain between the shoulder blades, or pain that’s worse at night
- You also have fever, weight loss or a history of cancer
Get urgent help (call 000 in Australia, or your local emergency number) for new trouble walking, loss of bladder or bowel control, sudden loss of coordination, a drooping face, being unable to lift both arms, or difficulty speaking.
See a doctor within a day or two for new arm or leg weakness or heaviness, clumsy hands, or poor balance. These can mean pressure on a nerve or the spinal cord.
Common questions
Is cervical spondylosis serious?
Usually not. It’s a normal part of ageing and many people have no symptoms. Most flares of neck pain settle with movement and time. Only a small number of people develop nerve or spinal cord pressure.
Do I need an X-ray or MRI?
Not usually. Scans are for nerve or spinal cord symptoms or pain that isn’t settling, because neck changes on scans are common in people with no pain.
Can it cause arm pain?
Yes. Narrowed spaces can pinch a nerve, causing pain, tingling, numbness or weakness down one arm. See your GP, and get urgent help for weakness in both arms or legs, or clumsy hands.
Should I wear a neck collar?
Not routinely. Keeping the neck moving is the main treatment, and NHS advice focuses on exercise and staying active.
Helpful resources
- Neck exercise handoutPrintable, one page: neck movement plus shoulder and upper-back strengthening. Free, from us.
- NHS 111 Wales: Cervical spondylosisPlain guide to symptoms, self-care and the warning signs that need urgent help. Free, UK.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
Evidence and more information
maladywise.com/neck-oa/