Causes of Neck Pain and How Physiotherapy Can Help

Our head weighs up to 5kg. This is balanced and supported by our neck, which consists of seven vertebrae. From the second vertebrae onwards, each of them is separated from each other by discs. Other than that, we have muscles that support our head and neck for movement and proprioceptive purposes. These muscles could spasm or inflame which can cause pain as well. In most cases, traumatic injuries and postural problems are the main causes of neck pain. Besides that, as we age, degeneration in the joints between each vertebrae and discs would arise and this may also cause neck pain.

Where do we feel pain when we have acute neck pain?

Neck pain is normally felt in a very localised area with moderate to severe intensity. It can either be at the back of the neck or on the side. However, in some occasions, neck pain may spread, especially when pain is coming from different parts of the neck. For example, if pain comes from structures (muscles, ligaments, disc or joints) in the upper part, it may spread to the head which can be called cervicogenic headache or neck related headaches. When pain is coming from structures in the middle to lower part of the neck, then pain may spread to the upper back region or in the upper arm or shoulder area.

Additionally, neck pain can worsen with neck movements, usually worse on one side than the other. The neck can be tender to touch and may cause night pain while sleeping.

How can physiotherapist treatment help with neck pain?

Firstly, a physiotherapist will consider a few factors, such as the mode of injury from presenting history and possible mode of injury. We will assess your neck and determine the reason of pain and how it affects the movement of your neck. This then leads to identifying affected muscles that may be sore and spasm, as well as joints that may be affected. Besides that, we will assess which muscles are not functioning as properly as they should be.

There are usually a variety of treatment methods used by a physiotherapist to help ease pain and restore the normal function of the neck. This may include:

• Explanation of cause and reason of neck pain, as well as providing assurance
• Gentle manual therapy, joint mobilisation, and dry needling (if suitable)
• Gentle and specific exercises to help with symptoms. It is important that these exercises are practised to assist with return to normal function.
• Provide self-managing strategies for neck pain. This could include heat or ice packs.
• Provide advice on sleeping positions. Usually, sleeping on your back or on your side with your head well-supported by one or two pillows is recommended. Sleeping on your stomach is usually not recommended, as it puts your neck at almost end rotational range positions for long periods of time.

A randomised controlled trial research article (Zebis et al 2011) shows that the implementation of neck and shoulder exercises is beneficial for neck pain. This includes strength training exercises performed in progressive overload, which is shown to result to significant reductions in neck and shoulder pain. Therefore, it is very important to have an exercise program that is tailored to your daily activity needs and is prescribed by a physiotherapist in order to effectively manage your neck pain.

Do you need an investigation scan?

Generally, if you do not have a traumatic injury, investigation scans such as X-rays are not required. In some rare cases, rapidly increasing severe neck pain with other unusual symptoms, like severe dizziness and headache, will require immediate medical investigations and consult.

How long until neck pain gets better and what should you do during recovery?

Time of recovery for each person usually varies. Some acute episodes may only last a few days, while some could go up to 12 weeks or even longer. Physiotherapists usually recommend to try to resume normal activities as soon as possible to assist with normal neck function. Other than that, continuing a home exercise program for at least 3 months more after neck pain has gone is recommended to ensure your neck regains normal function and range of movement.