Neck Pain Over 60

If you have had an x-ray or scan of your neck, you have probably been handed a word. Spondylosis. Degeneration. Arthritis. Wear and tear.

Here is what is worth knowing from the start. Essentially everybody your age has those findings, including the people who feel perfectly fine. The word on the report is not the reason your neck hurts.

Neck pain does get more common with age. But it is not a normal part of being sixty, seventy or eighty. Plenty of people your age have necks that give them no trouble at all, and their scans do not look meaningfully different from yours.

This guide is not saying your pain is in your head. Your pain is completely real.

One thing before you start. This guide assumes I have examined you. That matters here, because two of the problems in section 13 get considerably more common after sixty, and with both of them acting early changes the outcome. If nobody has examined you yet, read section 13 first.

Read it in chunks. There is no test at the end.

The short version

• Pain is an alarm. It protects you. It does not measure damage.
• There is a gate in your spinal cord. It controls how much of the warning signal reaches your brain.
• When pain lasts a long time, the alarm gets more sensitive. That is learned, so it can be unlearned. There is no age limit on that.
• Nearly 9 in 10 people with no neck symptoms at all have disc bulging on a scan. Degeneration on a report is normal ageing.
• Necks are strong. Building strength is one of the better treatments there is, at any age.
• Two things do get more common after sixty and need acting on early. Section 13 covers both.
• Dizziness in later life has many causes. Most are not the neck, and most are treatable.

1. Pain is an alarm, not a damage meter

It feels obvious that pain comes from your neck. It does not, quite.

Your neck has danger sensors. They fire when tissue is stretched, squashed or irritated. They send warning signals to your spinal cord, and then to your brain. None of that is pain yet. It is just information.

Then your brain weighs that information against everything else it knows. What were you doing? What happened last time? What do you think this means? How stressed are you? Did you sleep?

Then it decides: how much danger am I in, and how much pain does this person need to feel to keep them safe?

Pain is the answer. Your brain produces it.

That is why damage and pain match up so badly:

• A paper cut really hurts. There is almost no damage.
• Soldiers get badly hurt and feel very little until they are safe.
• People who have lost an arm can still feel pain in it.

So how much pain you feel does not tell you how much damage there is. It tells you how protective your body is being right now.

2. The pain gate

In 1965, two researchers called Ronald Melzack and Patrick Wall came up with an idea that changed pain medicine. It is still one of the most useful pictures we have.

Picture a gate in your spinal cord. Warning signals from your neck have to pass through it to reach your brain. When the gate is open, lots get through and you feel more pain. When it is closed, fewer get through and you feel less. Your neck has not changed at all. Only the gate has.

What closes the gate

• Touch, rubbing, heat and hands-on treatment. Touch signals travel on bigger, faster nerves than danger signals, and they crowd them out. It is why you rub your elbow after you bang it.
• Moving and exercise. They release your body's own painkillers.
• Feeling safe and calm.
• A decent night's sleep.
• Company and conversation. Being lonely genuinely makes pain worse.
• Understanding what is going on. Reading this counts.

What opens the gate

• Stress and worry. Especially about your independence, or about your driving.
• Broken sleep, and the pillow experiments that follow.
• Low mood, and feeling written off because of your age.
• Checking how far you can turn your head, over and over.
• Being afraid of a movement, usually turning or looking up.
• Being told frightening things about your neck. Arthritis and degeneration are the two words that do the most damage here, and they get used carelessly.

Here is the key bit. Your brain does not just receive signals at that gate. It sends signals down and changes the settings. That is why an identical week is fine one month and unbearable the next.

3. When the alarm gets too sensitive

When a pain system has been busy for months or years, it does not wear out. It gets better at its job. The sensors fire more easily. The spinal cord turns the signal up. The brain decides there is danger more quickly.

Think of a car alarm. When it was fitted, it went off if someone tried to force the door. Years later it goes off when a cat walks past.

The alarm is not broken. It is not lying. It is just set far too sensitive for the actual level of threat.

That is what long lasting neck pain usually is. And because your body learned it, your body can unlearn it. There is no age limit on that.

4. What scans show at your age

Researchers scanned the necks of 1,211 people who had no neck symptoms at all.

Nearly 9 in 10 of them had disc bulging somewhere in the neck. The number of bulging discs, how bad they were, and how many levels were affected all went up with age, in people who felt completely fine. By your age these findings are close to universal.

The same goes for the words that come with them. Cervical spondylosis just means age related change in the neck. Narrowed discs, bone spurs and worn facet joints are all extremely common in people with no symptoms at all.

If degeneration caused neck pain, every person your age would have neck pain. They do not. Your scan describes your age, not your problem.

There is a second reason this matters. Frightening words raise threat. Threat opens the gate. People told their neck is arthritic and worn out move it less and guard it more. Guarding a neck is a reliable way to make it hurt more, and to lose the range you need for driving.

If you have had a scan and been given frightening words, bring the report in. We will go through what it actually says.

5. The one that matters most: pressure on the spinal cord

This is the section I would most like you to read carefully. It is the thing most worth catching early at your age, and the early signs are subtle enough to get put down to just getting older.

As the neck ages, the space around the spinal cord can slowly narrow. In a small number of people, that narrowing starts to affect the cord itself. The medical name is degenerative cervical myelopathy.

It is not common. But it is the most common cause of spinal cord trouble in older adults, and treatment works far better when it is caught early.

The early signs are usually not pain. In fact the neck may barely hurt at all. What people notice is:

• Hands getting clumsy. Dropping things. Struggling with buttons, zips, coins, jar lids or keys.
• Handwriting changing, getting smaller or messier.
• Feeling unsteady on your feet, or needing to watch where you are walking.
• Legs feeling heavy or stiff, or walking becoming an effort you cannot quite explain.
• Numbness or tingling in both hands.
• Later on, changes in bladder control.

These get put down to age, to arthritis in the hands, or to simply slowing down. Sometimes that is exactly what they are. But if several of them are new, or getting worse over months, they need looking at properly.

Please tell me or your GP if you recognise this pattern. Do not wait for a routine appointment. I check for this as a matter of course, and if I suspect it I will refer you rather than treat you.

6. Dizziness, balance and falls

A lot of people with neck pain also feel dizzy, and assume the two must be connected. Sometimes they are. Often they are not.

This is worth being careful about, because dizziness in later life has many causes, and most are treatable once you know which one it is.

Worth ruling out before blaming the neck:

• Crystals in the inner ear. Brief, intense spinning set off by rolling over in bed, lying down, or looking up. It is very common with age. It can often be fixed in a single appointment with a simple head movement. If your dizziness spins and is triggered by changing head position, say so, because it is worth testing for.
• Blood pressure dropping when you stand. Feeling light headed or grey on standing, especially if you take blood pressure tablets, water tablets, or prostate medication.
• Medication. A very common and very fixable cause. A pharmacist review is worth an hour of anybody's time.
• Heart rhythm problems, especially with palpitations, breathlessness or blacking out.
• Inner ear conditions, and reduced vision or hearing.

Dizziness that really does come from the neck tends to feel like unsteadiness or floating rather than spinning. It usually comes with neck pain and stiffness rather than on its own, and it improves as the neck does.

Whatever the cause, dizziness raises your risk of falling, and falls matter more at your age than at any other. It is always worth investigating rather than accepting.

7. What turns your pain up and down

• Sleep. Poor sleep is one of the strongest signs of a bad pain day ahead, and neck pain is very good at wrecking sleep.
• Stress. Bereavement, caring for a partner, health worries. The neck is where a lot of people hold tension.
• Mood. Low mood and pain feed each other. Depression is often missed in older adults, and it is very treatable.
• What you believe. Believing your neck is worn out and nothing can be done is linked to worse outcomes. It is also not true.
• Activity. Too much too soon turns it up. So does too little for too long.
• Staying still. Long drives, long stretches of reading or television, a night on the wrong pillow.
• Being isolated. This genuinely matters.

8. Moving is safe, and strength is treatment

Your neck is not a delicate stack of crockery. It is a strong structure that carries and balances your head all day, surrounded by a lot of muscle. That is still true at seventy.

Guarding and avoiding make neck pain worse. Muscles get weaker, the range you use shrinks, and your nervous system gets more protective. Collars used to be standard. They were dropped for exactly this reason.

Some soreness while you build back up is expected. It does not mean damage. A good rule: pain that rises while you move and settles back to normal within about a day is fine. Pain still up the next day means you did a bit too much, not that you did harm.

Building strength in your neck and shoulders is one of the better treatments for long lasting neck pain, and it is badly underused in older adults, because loading something that hurts feels wrong. Start light and build. Neck and shoulder strength also helps you control your head, which helps your balance, which matters for falls.

Two things worth protecting on purpose at your age:

• Turning your head, for driving. Being able to check a blind spot is a skill worth keeping deliberately. If it is limited, we should work on it rather than accept it. If it cannot be improved, mirrors and technique can be adapted.
• Looking up. Needed more often than people expect. Hanging washing, reaching a top shelf, going up stairs, watching for a bus.

9. Pacing, and the boom and bust trap

A good day comes. You seize it. Then you pay for three days. Over months the trend quietly goes down.

• Work out what you could manage on almost any day, including a bad one.
• Do that amount every day, good and bad.
• Once it feels easy, add about a tenth more each week.
• Break long drives, long stretches of reading, and long spells in one chair into chunks. Take breaks before you need them, not after.

Annoyingly slow for a few weeks. Over a few months it is the fastest route there is.

10. Flare-ups

Flare-ups are normal, and they do not mean new damage.

• Keep moving gently within a comfortable range. Do not stop, and do not wear a collar.
• Drop back to your baseline for a few days, then build again.
• Use whatever settles it: heat, gentle movement, changing position often, medication as advised.
• On pillows: most people do best with the neck roughly in line with the spine, rather than propped up high. Try one change, then leave it alone. Endless pillow swapping usually reflects worry rather than a pillow problem.
• Remind yourself that this has settled before and will settle again.
• Get in touch if it is not settling as it normally does, or if anything in section 13 applies.

11. A word about painkillers

I am not your prescriber, and this is not prescribing advice. But one thing is worth knowing.

Anti-inflammatory tablets like ibuprofen and naproxen carry noticeably higher risks after sixty. Stomach bleeding, kidney problems and raised blood pressure. They interact with several medicines commonly taken later in life. Anti-inflammatory gels rubbed into the skin carry much less risk.

Anything that makes you drowsy or light headed feeds straight into falls risk.

If you are taking painkillers regularly rather than now and then, talk to your GP or pharmacist. A pharmacist medicines review is free and genuinely useful.

12. What treatment does, and what it does not

Hands-on treatment works through everything above. It closes the gate. It calms the sensitivity. It relaxes muscles that have tightened to protect you. It gives you a spell where moving feels easier and safer. That is a real effect and it is worth having.

What it does not do is reverse arthritis or put anything back in place. Nothing is out. The clicks and pops you sometimes hear are gas moving inside a joint. Same as cracking a knuckle. Not the sound of anything being moved back.

I will adapt what I do to you. Technique, positioning and force all change depending on your bone strength, your blood pressure, your medicines, whether you get dizzy, and your other health conditions. I will always ask.

Please tell me if you have osteoporosis, take blood thinners, have had a stroke or a mini stroke, have had neck surgery, or get dizzy when you move your head. All of those change what is right for you. There are plenty of effective approaches, and I will pick ones that suit you.

One note on progress. A better question than your pain score is: what can I do now that I could not do three months ago? Can you reverse the car? Turn to talk to someone at the table? Hang the washing? Sleep through the night?

13. When to get urgent help

Almost all neck pain, including a bad flare-up, is not an emergency. A few things are, and two of them get more common after sixty.

Call 999

• Any sign of stroke. Face drooping on one side. Weakness in one arm. Slurred or muddled speech. Think FAST and call 999 straight away.
• Sudden severe neck pain or headache unlike anything you have had before. Especially with double vision, slurred speech, trouble swallowing, veering when you walk, sudden severe dizziness, numbness down one side of your face, a drooping eyelid with a small pupil, or a collapse.
• Neck pain after a bad fall or a blow to the head, especially with weakness, numbness or trouble moving.

Contact your GP or NHS 111 today

• New headache with tenderness of the scalp or temples, aching in the jaw when you chew, or any change in your vision. Including blurring, double vision, or brief loss of sight in one eye. In people over fifty this can mean giant cell arteritis. It is treatable, but it can threaten your sight if it is not treated quickly. Do not wait on this one. If your vision is affected, go to A&E or an eye casualty department.
• Any of the spinal cord signs in section 5. New or worsening clumsiness of the hands, dropping things, trouble with buttons or coins, changed handwriting, unsteadiness on your feet, heavy legs, or new bladder problems.
• Weakness in an arm or hand that is getting worse, not better.
• Neck pain with fever, shivering, or feeling generally unwell.
• Neck stiffness with fever, severe headache, dislike of bright light, or a rash that does not fade when you press a glass on it.
• Neck pain with weight loss you cannot explain, night sweats, or a past history of any cancer.
• A new lump in the neck, trouble swallowing, or a hoarse voice that will not go.
• Sudden severe neck pain after even a minor fall or knock, if you have osteoporosis or take steroids long term.

Worth mentioning at a normal appointment

• Any fall, even one that did not hurt you.
• Dizziness of any kind, so we can work out which of the causes in section 6 fits.
• Aching and stiffness in both shoulders and hips, worst first thing and lasting more than an hour, especially if it came on over days or weeks. In people over fifty this can mean polymyalgia rheumatica, which is easily treated once it is spotted.

Everything else, including a bad flare-up, can wait for a normal appointment.

14. If you want to read or watch more

Start here

• Tame the Beast. A five minute animation by Professor Lorimer Moseley. tamethebeast.org
• Flippin' Pain. A UK campaign about long lasting pain. flippinpain.co.uk
• NHS advice on neck pain. nhs.uk/symptoms/neck-pain-and-stiff-neck
• NHS activity guidelines for older adults. nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults

Practical help

• The Pain Toolkit, by Pete Moore. paintoolkit.org
• Recovery Strategies, by Greg Lehman. A free illustrated workbook. greglehman.ca/recovery-strategies-pain-guidebook
• Myelopathy.org, if section 5 rang any bells. A charity run resource. myelopathy.org
• Age UK, on staying steady, and strength and balance exercises. ageuk.org.uk

Books

• Explain Pain, by David Butler and Lorimer Moseley.
• The Explain Pain Handbook: Protectometer, by the same authors. The research behind this guide
• Melzack R, Wall PD. Pain mechanisms: a new theory. Science, 1965. The original pain gate paper.
• Nakashima H et al. Abnormal findings on MRI of the cervical spine in 1211 asymptomatic subjects. Spine, 2015. The scan figures in section 4.
• Kuijper B et al. Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care. British Journal of General Practice, 2018.
• Davies BM et al. Degenerative cervical myelopathy. BMJ, 2018.
• Smith SS et al. The prevalence of asymptomatic and symptomatic spinal cord compression on MRI. Global Spine Journal, 2021.

Bring any of this to your next appointment. Especially the parts that did not sit right, or that felt uncomfortably familiar.

This guide is general information. It does not replace the advice I give you in clinic.