Dear Ask The Doctor: I woke up with a slight stiff neck yesterday morning, and as the day went on it got worse. By bedtime I could not turn my head without serious pain. I could not lay down to sleep without pain, and I ended up sleeping in the recliner. I also have had a low grade fever and some nausea during the night. I have an ice pack on my neck now, and it seems to be helping a little. What could be causing this? Should I see a doctor? I have never had neck pain like this before, except with a whiplash injury 20 years ago.
Dear Patient: The most frequent cervical injuries in athletes and young and active people are probably acute strains and sprains of the musculature of the neck, as well as soft-tissue contusions. The neck is an area where stability has been sacrificed for mobility, making it particularly vulnerable to injury. A strain refers to an injury to a muscle, occurring when a muscle-tendon unit is stretched or overloaded. A sprain refers to a ligamentous injury, and the diagnosis of cervical sprain implies that the ligamentous and capsular structures connecting the cervical facet joints and vertebrae have been damaged. Practically, a cervical sprain may be difficult to differentiate from a strain, and the 2 injuries often occur simultaneously. Cervical spine strains and sprains frequently occur as a result of a whiplash injury, which often occurs as the result of motor vehicle accidents, falls, sports-related accidents, or other traumatic events that cause a sudden jerk of the head and neck. Cervical injuries may develop over a time period as well (e.g., prolonged unusual posture, chronic repetitive strains of the neck). People with occupations requiring repetitive or prolonged neck extension (microtrauma) may develop neck strain injury. Picture someone sitting at a computer keyboard, for example, straining to see a monitor that is not adjusted properly for the person's posture. Also, the person may be trying to see the monitor through poorly adjusted bifocal lenses and must tip the chin upward to view the screen. Now tuck a telephone into the person's shoulder for much of the day, and you have a formula for neck strain. Seeing a doctor is vital for all strains with a significant mechanism of injury or for severe, persistent, or unexplained symptoms or problems. As with other conditions, supportive self-care is often enough for you to have a complete recovery. If your symptoms do not go away as expected or if new symptoms appear, you should seek medical attention without delay.