Most cases of neck strain are never officially diagnosed because the pain typically starts going away within a few days. However, if the neck pain occurs after a major impact or persists or worsens several days after the injury, it is important to see a doctor for an official diagnosis.

Reaching a Neck Strain Diagnosis

Collecting a medical history and performing a physical exam are typically enough to reach a neck strain diagnosis.

A medical history

A medical history includes any known medical conditions and family history, as well as how and when the current symptoms started and any accompanying symptoms. Information may also be collected about current lifestyle habits, such as work, hobbies, stress levels, exercise, nutrition, and sleep.

A physical exam

A physical exam involves observing and palpating (feeling) the neck for any abnormalities, such as tenderness or muscle spasms. Range of motion is also tested by moving the head up, down, and rotating side to side. If nerve root compression in the cervical spine is suspected of causing pain, tingling, and other symptoms to radiate into the arm, a Spurling’s test may be administered by gently pushing down on the head to see if symptoms can be reproduced.

See Diagnosing Neck Pain

If the medical history and/or physical exam suggests that something more serious than a muscle strain is causing any of the symptoms, more advanced diagnostic testing may be needed.


Advanced Diagnostics for Neck Pain

While rarely used to examine neck strains alone, some common imaging techniques to explore the possibility of other problems in the cervical spine include:

  • X-ray. Also called a radiograph, an x-ray is good at showing the bones and possible fractures or spinal degeneration. An x-ray is typically the first imaging study used when neck pain occurs after a major accident, such as a car crash or fall from a ladder.
  • MRI. This imaging method creates a series of cross-sections of the soft tissues and bones by using radio waves and a strong magnet to view variations in the different types of tissues. When used to view the cervical spine, an MRI scan is typically the best option for assessing potential damage to soft tissues, such as muscles, tendons, ligaments, nerves, the spinal cord, and others.
  • CT scan. Using x-rays in conjunction with a computer, a CT scan creates a series of cross-sections for enhanced viewing of the bones. Especially if MRI is not an option, a CT scan may be combined with a myelogram (dye injected via spinal tap) to get a view of the soft tissues in addition to the bones.

Several other advanced diagnostic tests, such as electrodiagnostic testing or nerve conduction studies, may also be considered to help diagnose conditions that cause neck pain.


Severity of Neck Muscle Strain

In general, muscle strains are classified in the following categories:

  • Grade I. A mild strain that only involves a relatively few muscle fibers partially tearing. There is some pain but no noticeable muscle weakness.
  • Grade II. A moderate strain occurs when more muscle fibers have torn and some muscle weakness occurs in addition to pain.
  • Grade III. A severe strain when the muscle has completely torn and the pain is usually severe and debilitating.

Most neck strains are either Grade I or II. If a Grade III neck strain occurs, it is likely in conjunction with a serious injury to the cervical spine and is not primarily referred to as a neck strain injury.

Dr. D’Mitri Sofianos is an orthopedic surgeon specializing in spine care. He is trained in minimally invasive spine surgery and practices at Memorial Spine and Chatham Orthopaedic Associates. Dr. Sofianos helped AOSpine, a global research community, to develop a software database designed to report and improve patient care.