Neck pain: call 999 or go to A&E
- Call 999 or go to A&E: a headache that came on suddenly and is extremely painful; numbness or weakness in the face or body; a drooping face, or being unable to lift both arms and keep them up; difficulty speaking, swallowing, balancing, walking or remembering; double vision or loss of vision; drowsiness or confusion. A torn neck artery often starts with headache and neck pain, sometimes with dizziness or tingling, so head or neck pain unlike any you have had before needs checking.
- Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
- Call 999 or go to A&E: a stiff neck and you can't look at bright lights; a very painful headache; a very high or very low temperature, feeling hot or cold to the touch, or shivering; confusion, slurred speech or not making sense; a rash that does not fade when you press a glass on it; or a first seizure (fit). These can be signs of meningitis. Call too for any other symptoms you're worried might be meningitis.
- Call 999 or go to A&E after a neck injury if the person is unresponsive, has severe neck pain or cannot move their head, has fallen from a height such as 5 or more stairs, or is drunk or has taken recreational drugs. Do not drive yourself. Being 65 or over, a dangerous fall or crash (from more than 1 metre or 5 stairs, diving, a high-speed or rollover crash, being thrown from a vehicle, a bicycle collision or an accident on a motorised recreational vehicle), or tingling in the arms or legs after an injury puts you at high risk of a broken neck: get checked.
- Call 999: chest pain that spreads to your arm, neck or jaw, especially with breathlessness, sweating or feeling sick. It could be a heart attack.
Sources 1, 24, 68, 69
Shoulder or arm pain: call 999
- Call 999: shoulder or arm pain with chest pain that feels tight or squeezing, or chest pain that spreads to your arms, neck or jaw, especially with shortness of breath, sweating or feeling sick. It could be a heart attack.
- Call 999: you suddenly can't fully lift both arms and keep them there, because of weakness or numbness in one arm, especially if one side of your face droops or you slur your words or sound confused. It could be a stroke. Call even if the signs have stopped.
- Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.
Sources 70, 71, 72, 2, 24
Pain that comes and goes with effort
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
Source 71
Headache, jaw pain or sight problems
Contact a GP immediately, go to 111.nhs.uk or call NHS 111: a new or frequent headache that usually comes on suddenly (your scalp may also feel sore or tender), pain in the jaw muscles or tongue when eating or talking, or problems with your sight, such as double vision or loss of vision in 1 or both eyes. With pain and stiffness around the shoulders, these can be signs of temporal arteritis (giant cell arteritis), which up to 1 in 5 people with polymyalgia rheumatica develop. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E.
Sources 73, 74
Neck pain with numbness or pins and needles in an arm: the same day
- Same day (urgent GP appointment or NHS 111): severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in the arms or legs; pins and needles in an arm along with neck or arm pain; or pain between the shoulder blades.
- Same day: clumsiness in your hands, or numbness, pins and needles or weakness in one or both arms, that is getting worse; problems with balance or walking since the neck pain started; or neck pain with a severe headache.
- Arm weakness or numbness that keeps getting worse, severe pain that painkillers and rest do not touch, or an unexplained fever.
Sources 1, 24, 68, 69
A hot, swollen or suddenly weak shoulder: the same day
- Same day (GP or NHS 111): the shoulder or arm is hot, swollen or red, or you have a high temperature (although not everyone has one) or feel unwell. A joint infection needs same-day care.
- Same day (GP or NHS 111): sudden or very bad shoulder pain; you cannot move your arm; the arm or shoulder is badly swollen or has changed shape; pins and needles that do not go away; no feeling in the arm; the arm is hot or cold to the touch; pain that started after an injury such as a fall; or severe pain in both shoulders.
- Same day (GP or NHS 111): sudden weakness lifting the arm after an injury or fall. A rotator cuff tear caused by an injury needs urgent referral to a shoulder specialist. After a dislocation in anyone over 40, the rotator cuff should be checked: about 40% have a tear.
Source 2
See a GP or physiotherapist
- Neck pain or stiffness that has not eased after a few weeks, or after 8 weeks of looking after it yourself; painkillers are not helping; or you are worried. In many areas you can refer yourself to NHS physiotherapy.
- Neck pain with feeling generally unwell, or that started while you were ill with another condition such as rheumatoid arthritis or cancer; or neck pain with blurred vision, ringing in the ears or dizziness.
- Severe pain that is constant or disturbs your sleep, a fever or unexplained weight loss, or a history of cancer, inflammatory arthritis, TB, a weakened immune system, neck surgery or a violent injury. Serious causes are very rare, but these need checking.
Sources 24, 1
Shoulder pain, arm symptoms or stiffness that isn't settling
- Pain that is getting worse or has not improved after 2 weeks of looking after it yourself, or it is very hard to move your arm. In many areas you can refer yourself to physiotherapy.
- Your shoulder has partly or fully come out of joint, or you worry it might.
- Pins and needles or a cold arm alongside neck pain, or a new loss of strength or feeling in the arm that you cannot explain (a possible nerve problem).
- No improvement after 6 weeks of exercise, or arm symptoms still there beyond 6 to 12 weeks.
- See a GP if you have pain and stiffness for more than a week, especially if you're over 50, it's in both shoulders (often the neck and hips too) and the stiffness lasts longer than 45 minutes in the morning. It can be polymyalgia rheumatica.
Sources 2, 24, 73
During neck exercises
NHS inform's neck exercise advice: rate your pain from 0 to 10. During exercise, 0 to 3 is minimal and 4 to 5 is acceptable; 6 or more is too much. If it goes higher, do fewer repetitions, move more slowly or rest longer between movements.
Exercise should not make your neck worse overall. Soreness from a new exercise should ease quickly, and your neck should be no worse the next morning. Stop any exercise that makes your symptoms worse or causes new pain.
Arm symptoms are the exception, as in our neck pain guides. If a pose sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or leave it out.
Stop and get checked for dizziness, double vision, slurred speech, trouble swallowing or any of the warning signs above.
Source 22
Dizziness in a pose
If a pose that tips your head back or turns it hard brings on dizziness, blurred vision or a sudden headache, come out slowly and sit down. If it doesn't settle within a few minutes, treat it as one of the urgent signs above, and don't repeat that pose (our suggestion, from case reports).
Sources 75, 21
Neck circles
Stop if neck circles bring on dizziness, light-headedness or tingling into an arm. Make the movement smaller, with separate turns and nods, and see a GP if it keeps happening. Our neck pain guide has more.
Strengthening a sore shoulder
During shoulder strengthening, pain up to about 5 out of 10 is acceptable, and a little is expected. By your next session it should be back to where it was before. If it isn't, use a lighter band or weight or a smaller range next time, not nothing.
Source 76
Tell the teacher
Before a class, tell the teacher about neck pain, arm symptoms, or a past neck injury or operation. NCCIH advises people with health conditions to talk with their health care provider and the yoga teacher about their needs.
Source 65
During yoga
A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.
You can say no to any hands-on adjustment, and a teacher registered with Yoga Alliance must get your explicit consent each time.
Sources 21, 60, 65, 66
Head-down poses, bones and pregnancy
With glaucoma, or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds. With osteoporosis, swap deep forward folds for a flat-back hinge from the hips, and twist smoothly. In pregnancy, our yoga in pregnancy guide covers the changes. NCCIH advises beginners to avoid headstands, shoulder stands, the lotus position and forceful breathing.
Sources 64, 65
Before you start
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
If you have a heart, lung or joint condition, are pregnant or have recently been unwell, start gently and read our guide for your condition. Muscle soreness for a day or two after a new exercise is common and fades as you repeat it.
If you have a heart condition, follow your cardiac team's advice on how hard to work, and stop for the warning signs above. People with long-term conditions may wish to ask their specialist before starting. With uncontrolled high blood pressure, avoid straining against a held breath; the high blood pressure guide has more.