Your Neck Is Stronger Than You Think

Believing the neck is fragile often leads people to fear moving the neck. Avoiding movement due to fear when neck pain starts predicts prolonged disability (Landers et al., 2008).

The below account from a patient interviewed as part of a study by Kragting et al. (2024) is a tragic example of how this process can affect people:

Whenever I turned my head, my neck made a cracking sound and I thought ‘this can’t be right’… I became afraid to turn my head and tried to move my neck as little as possible… I ended up losing my job. I became depressed because of this; I suffer from neck pain all the time and I really miss my job because I hardly have any social contact anymore… I couldn’t cycle or walk anymore because of my neck pain, while I always enjoyed these activities. The lack of distraction made me eat and smoke a lot… I thought ‘it probably won’t get any better’…If I always have to live like this, I’d rather die.

A grim historical reminder of how robust the neck actually is

The human neck is not a delicate structure.

Even with a sharp axe, significant force, and a trained executioner, separating the head from the body was not always straightforward. In 1587, the execution of Mary, Queen of Scots reportedly required two blows and additional sawing before her head was fully severed.

Aware of how stubborn the neck could be and determined to ensure a clean execution, Henry VIII hired a renowned headsman known as the "Executioner of Calais" and paid the equivalent of two to three years salary to ensure his ex-wife Anne Boleyn's neck was severed with a single sword stroke. Brutal though the examples are, they illustrate the point: the neck is not a fragile structure.

How serious neck injuries usually happen

By far the most common cause of serious neck injuries are motor vehicle accidents (49.4%) followed by falls (23.7%) (Passias et al., 2018). Serious neck injuries in sport usually occur when the neck is bent forwards and a large compressive force is applied to the top of the head (Bailes et al., 2007).

This is why certain sports situations are considered high risk.

For example:

Diving

If someone dives head-first into shallow water and their head strikes the bottom, the torso continues moving forward. This can produce very large compressive forces through the cervical spine.

Diving incidents are one of the most common causes of traumatic cervical spinal cord injury in young adults (Bailes et al., 1990).

Spear tackles in rugby

Rugby laws specifically prohibit “spear tackles”, where a player is lifted and driven head-first into the ground.

Under World Rugby Law, the tackler is responsible for returning the player safely to the ground rather than dropping them or driving them downwards onto their head.

These tackles are banned precisely because they recreate the high risk piledriver mechanism known to cause cervical spine injury.

What this means for everyday neck movement

The key point is that these injury mechanisms involve large forces and high-energy impacts. These situations bear little resemblance to the everyday movements many people with neck pain worry about.

They are very different from movements like turning your head, looking down at a phone, sleeping awkwardly or exercising.

In daily life, the loads acting on the neck are typically limited to the weight of the head (around 4–5 kg) and normal muscular forces.

For most people, the cervical spine is well adapted to tolerate these loads.

Structural injury therefore typically requires forces far greater than those encountered in normal daily activity.

The real danger of fragile beliefs

Despite this, many people with neck pain develop the belief that their neck is weak, damaged or vulnerable.

Research shows that higher fear of movement beliefs predict longer disability in people with neck pain (Landers et al., 2008).

When people believe their neck is fragile they often move less, avoid exercise, become overly concerned about posture and worry about everyday movements.

Ironically, this protective behaviour can increase sensitivity and reduce physical capacity over time.

Pain is real, but pain is not proof of damage

None of this means neck pain isn’t real or important.

Pain can be deeply frustrating and take a toll on your physical and mental health. It also does not mean all neck pain should be ignored. If your neck pain follows significant trauma, or comes with unusual symptoms such as progressive arm or leg weakness, numbness, pins and needles, balance or coordination problems, fainting, changes in vision, speech or swallowing, fever, unexplained weight loss, a history of cancer, bladder or bowel changes, or pain that is worsening and not eased by rest or lying down, it is important to seek medical assessment.

But pain does not automatically mean structural damage (for more, see --> Pain Does NOT Equal Damage: The Neuroscience Behind Chronic Pain).

The neck is generally a strong, adaptable structure capable of tolerating substantial movement and load across a lifetime.

Understanding this can help people move with more confidence and gradually rebuild capacity.

The bottom line

Serious structural neck injury usually requires substantial force, speed, compression, or trauma.

That is very different from turning your head, sleeping awkwardly, looking down at your phone, or starting to exercise again.

Your neck is a remarkably robust structure designed for movement.

Understanding that can be an important step towards recovery.

References

Bailes, J. E., Herman, J. M., Quigley, M. R., Cerullo, L. J., & Meyer, P. R., Jr (1990). Diving injuries of the cervical spine. Surgical neurology, 34(3), 155–158. https://doi.org/10.1016/0090-3019(90)90064-v

Bailes, J. E., Petschauer, M., Guskiewicz, K. M., & Marano, G. (2007). Management of cervical spine injuries in athletes. Journal of athletic training, 42(1), 126–134.

Kragting, M., Pool-Goudzwaard, A. L., Coppieters, M. W., O'Sullivan, P. B., & Voogt, L. (2024). Illness perceptions in people with chronic and disabling non-specific neck pain seeking primary healthcare: a qualitative study. BMC musculoskeletal disorders, 25(1), 179. https://doi.org/10.1186/s12891-024-07302-7

Landers, M. R., Creger, R. V., Baker, C. V., & Stutelberg, K. S. (2008). The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain. Manual therapy, 13(3), 239–248. https://doi.org/10.1016/j.math.2007.01.010 Passias, P. G., Poorman, G. W., Segreto, F. A., Jalai, C. M., Horn, S. R., Bortz, C. A., Vasquez-Montes, D., Diebo, B. G., Vira, S., Bono, O. J., De La Garza-Ramos, R., Moon, J. Y., Wang, C., Hirsch, B. P., Zhou, P. L., Gerling, M., Koller, H., & Lafage, V. (2018). Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World neurosurgery, 110, e427–e437. https://doi.org/10.1016/j.wneu.2017.11.011