Neck grinding and cracking (crepitus): causes and when to worry

Arthritis UK describes “clicking and grating noises” as one of the common neck symptoms. You may hear or feel clicking or grating as you move your head, and this is called crepitus. It can be a single click when you turn your head or a more continuous grinding sensation as you look up or down.

To understand why the noises occur, it helps to know how the neck is built. The top seven bones of the spine form the neck and are called the cervical vertebrae. They are linked by small facet joints that, together with the neck muscles, allow you to move your head in any direction, and discs of cartilage between the vertebrae act as shock absorbers and give the spine its flexibility.

According to Arthritis UK, crepitus can be caused by air bubbles popping or by tissues and bones moving over each other in the joint. Many joints do the same, but neck noises tend to seem louder because they are closer to your ears, and people often notice them more at night when it is quiet.

The NHS adds another possible background factor. Cervical spondylosis happens when ageing causes wear and tear to the bones in the spine and the soft cushions of tissue (discs) in the neck, and many people over 40 get it as part of getting older. It is a normal part of ageing and many people have no symptoms. The sources read do not say that every neck noise is caused by spondylosis, only that it is a common condition in the same area that can cause neck pain and stiffness.

Noises alone do not usually need treatment. Arthritis UK advises seeing a healthcare professional if your neck pain lasts more than a few days. It also says to speak to them if you have symptoms other than pain and stiffness, pain, tingling, numbness or weakness in your arms or legs, sudden severe pain after a fall or injury, or if you suddenly develop neck stiffness along with difficulty lifting both arms above your head.

The NHS says to see a GP if neck pain or stiffness does not go away after a few weeks, if painkillers have not worked, or if you are worried, or if you have other symptoms such as pins and needles or a cold arm, which could be something more serious. For cervical spondylosis it advises seeking an urgent GP appointment or NHS 111 for severe neck pain that starts suddenly, pain getting worse quickly, heaviness or weakness in the arms or legs, or pins and needles in an arm with neck pain.

The NHS’s cervical spondylosis page says to call 999 if you have any of these: new problems walking, loss of bladder or bowel control, sudden lack of co-ordination such as difficulty buttoning a shirt, a face that droops on one side, being unable to lift both arms and keep them there, or difficulty speaking with slurred or garbled speech. It describes these as possible signs of a medical emergency.

Arthritis UK also notes that if you feel dizzy when looking up or turning your head, this may be due to pinching of the arteries alongside the spine, which can occasionally cause blackouts, and that because blackouts can have other causes it is important to seek medical advice if this is happening to you.

Arthritis UK says most neck problems can be diagnosed and treated based on your symptoms and a simple examination, and it is unlikely that you will need any special tests. Occasionally a doctor may ask for an X-ray, a blood test or an MRI scan to rule out other important causes of neck pain.

For cervical spondylosis the NHS says a health professional examines your neck and shoulders, may test your reflexes and watch you walk, and depending on symptoms may arrange X-rays or scans.

Painless clicking does not need treating, but if it comes with neck pain the same self-care applies. The NHS suggests taking paracetamol or ibuprofen, using a low firm pillow, using heat or cold packs and trying neck flexibility exercises, and says not to wear a neck collar because it is better to keep your neck moving unless a doctor tells you otherwise. It also suggests that you avoid anything dangerous if you cannot move your neck, such as driving or cycling.

Arthritis UK says simple self-help treatments and a day or two of rest are often enough to clear up a spell of neck pain, and that physiotherapists, chiropractors and osteopaths are all trained to treat neck problems, with treatment and home exercises often being all that is needed. It stresses that any physical treatment should be given by a qualified practitioner registered with the relevant body, and that manipulation is not suitable for everybody, so you should seek advice from a healthcare professional first.

• Keep your neck moving gently rather than holding it still.

• Use heat or cold packs and simple painkillers if the neck is sore.

• Avoid staying in one position for a long time, for example at a desk.

• Sit upright, and sleep with your head at the same height as the rest of your body.

• Ask about physiotherapy if pain persists; many areas allow self-referral to NHS musculoskeletal services.

The NHS says that in many areas you may be able to get help such as physiotherapy from community musculoskeletal (MSK) services without a GP referral, and that waiting times for NHS physiotherapy can be long. You can also pay to see a registered physiotherapist privately.

If you pay for private help, check that the practitioner is registered with the relevant professional body, as Arthritis UK advises. Noises on their own are described by the charity as not serious.