Most Neck Pain Doesn't Need A Scan — But These Four Situations Do
Most people with neck pain don't need a scan. I know that's not what people expect to hear, especially from a physio, but it's true. And in a minute I'll explain why getting one too soon can actually make things worse for you.
But there are four situations where you absolutely do need one, and these are the ones I don't want you to miss.
Here's the quick version. If you've got dizziness, blackouts, double vision, or slurred speech alongside your neck pain, that needs urgent imaging. If you've landed on your head — any impact straight down through the top of the head or the neck — that needs urgent imaging. If you've got progressive weakness, complete numbness, or loss of sensation anywhere, that needs imaging. And if you've had three or four treatments and it hasn't changed at all, or it's getting worse, that needs imaging too.
Let me take you through all four properly.
My name's Joe. I'm an ex-professional football head physio and multi-clinic owner here in the UK. As with all my videos, this is a guide to help you understand what's going on. It's not a diagnosis.
The Four Situations Where You Actually Need A Scan
Dizziness, blackouts, double vision, or slurred speech. Most people don't connect any of that to their neck. But we take it very seriously as medical professionals, because those symptoms alongside neck pain — along with difficulty swallowing or numbness around the face and mouth — can point to a problem with the blood supply that runs through your neck. That's not something you sit on, and it's not something you generally book in to see a physio for. It usually needs urgent medical assessment and imaging. If that's you, act on it today.
Axial load. This one's really important. Axial load just means force going straight down through the top of your head into your neck. Landing on your head in a rugby tackle gone wrong, coming off a bike or a horse and landing on your head, diving into shallow water, or a fall during a football match where you've come down on your head — if you've had neck pain after an impact like that, you need it investigated urgently. That's the mechanism that can fracture a neck, and it's very serious. I'll be blunt with you here: this is not one to wait and see with. Don't move it about, don't test it, don't tough it out. Get it imaged.
Neurological symptoms. These are worth repeating from previous videos. Weakness that's getting worse — actual weakness, not just pain — so losing your grip or struggling to lift your arm. Complete numbness anywhere, a genuinely dead numb patch where you've lost sensation entirely. Or symptoms in both arms, clumsy hands, or changes to your walking or balance. If any of that's going on, we need to see what's happening, and it needs imaging as soon as possible. With those symptoms, we're not treating pain anymore. We need to know exactly what's pressing on what.
No change after three or four treatments. This one's a bit different, and it's the one people don't expect. If you've had a course of treatment — three or four sessions of good, hands-on work plus your rehab exercises — and you feel exactly the same, or you're getting worse, that's often the point where you need to image it and have a look at what's going on. Here's the thing: necks do respond to treatment. Two or three sessions into the soft tissue of the neck, they usually get better quite quickly. So when a neck is treated properly, you should see some change — in symptoms, in movement, in headaches, something. If there's been no response at all after three or four treatments, it usually tells you something. It usually means there's something structural in there that we need to actually see, and a scan will tell us exactly what we're dealing with. That doesn't mean you'll need injections or surgery — often you won't. It just means we need to look.
Why Getting A Scan Too Soon Can Make Things Worse
If you're not in one of those four categories, you very probably don't need a scan. And I'd go further than that: getting one anyway can actually make things worse for you.
Here's why. If we scan your neck, we're very likely to find something. There'll be some wear and tear, some degeneration, maybe a bit of a disc bulge. The truth is loads of people have all of that with no pain whatsoever. What happens with a lot of people is they get a report full of scary-sounding words. It might have nothing to do with why they're actually in pain, but they've read it and now they're frightened. They're googling it, and they've stopped moving because they think they're damaging something. That's how a scan can make people worse, and I've seen it happen in clinic more times than I can count.
What A Scan Can And Can't Tell You
A scan tells you what your neck looks like on an image. It doesn't tell you what's driving your pain. And for most neck pain, the reality is it doesn't change what we do or how we treat it anyway. The treatment's the same either way.
So to sum it up: you need a scan if you've got dizziness, blackouts, double vision, or slurred speech; if you've had an axial load and landed on your head; if you've got progressive weakness, complete numbness, or loss of sensation; or if you've had three or four treatments with no change at all. Outside of those four, you very likely don't need one, and chasing one can frighten you into doing all the wrong things.
Get Properly Assessed First
Get a good assessment. That's what will actually tell you whether you need imaging or not — not guesswork, not googling, not jumping straight to a scan because it feels like the thorough thing to do.
This article is a guide to help you understand what's going on with your neck pain. It's not a diagnosis. If you're experiencing any of the red flag symptoms covered above — particularly dizziness, blackouts, double vision, slurred speech, or an injury from an impact to the head — seek urgent medical assessment through your GP, 111, or A&E rather than waiting.
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