Physiotherapy for Neck Pain

Neck pain can have a profound and debilitating effect on daily life. Apart from the pain in the neck itself (pun intended) , it can cause headaches, affect our mood and disturb our sleep, which then flows on to impact our relationships and and productivity at work. Neck pain is one of the most common problems we see at Lilyfield Physiotherapy. 30% of us will experience at least one episode of neck pain every year and it is the fourth leading cause of disability in Australia.

Why do I have pain in the neck?

Neck pain can often be caused by a combination of factors including increased muscle tension, lack of inactivity, poor posture and poor sleep positions. It is rarely related to structural damage or degenerative changes that are often seen on scans. These findings are mostly just normal age related changes and not related to your pain.

More likely, your neck pain develops from an accumulation of factors over weeks, months or even years, and your pain is telling you that you need to change something. Experiencing neck pain can be very debilitating and starting gentle exercises early are very important in your recovery.

Many different structures in the neck can be the cause of neck pain, and often, there is a combination of factors driving your symptoms. Neck pain refers to pain originating from the cervical spine, in which there may be mechanical or inflammatory irritation of structures such as vertebral discs, facet joints, ligaments or muscles that support the neck.

Most neck pain presents as localised neck pain, which is pain felt mostly around your neck and may radiate into your head and shoulders. Sometimes there may be damage or irritation of your cervical nerves, this can result in radicular pain. Radicular pain is often severe pain which travels along a spinal nerve root, down into your arms and you may also experience pins and needles, numbness or paresthesia.

What are the different causes of neck pain

Neck pain can be a common symptom of many different injuries and medical conditions. There are many causes of neck pain, ranging from acute to chronic in nature. Acute is a sudden onset of neck pain involving an injury, such as cervical whiplash. Chronic pain often develops later in life from general wear and tear of our neck, where bony spurs develop or discs start to degenerate and lose height. Below is a list of the common causes of neck pain:

Physical strain (overuse)

Undertaking an unusual activity like painting the ceiling, sitting in an awkward position, straining your neck to view a computer screen for long periods are common examples of neck pain. Overuse your neck muscles during repetitive or strenuous activities can lead to muscle pain and stiffness, resulting in neck discomfort or pain.

Poor posture and weak postural muscles can affect your spine’s alignment, places excessive pressure on spinal structures and contribute to neck pain.

Degeneration (ageing)

In life, there is natural wear and tear with ageing, which can cause parts of your cervical spine to degenerate, causing neck pain. Degenerative conditions such as osteoarthritis in the cervical vertebrae cause wearing down of joint cartilage and formation of osteophytes (extra bony growth).

Cervical spondylosis may develop, where discs lose height and fluid over time. This change, coupled with the stress of repeated movements, can cause the discs in your spine to weaken, resulting in bulging or herniated discs possibly pinching nerve roots and causing radicular pain.

As our spines deteriorate, spinal stenosis may occur. This is where narrowing of the space in your spinal canal can lead to spinal cord compression and to neck pain. If spinal cord compression develops with symptoms such as loss of bladder control, it is important to seek medical attention immediately.

Injury

Acute neck pain may result from trauma and other injuries, and causes damage to muscles, ligaments, discs, vertebral joints and nerve roots.

Whiplash

Whiplash is neck injury caused by sudden, vigorous head movement in one direction, then back again quickly. You may just experience uncomfortable symptoms on the day of the injury, while your neck pain, swelling and bruising may worsen over the following days. Whiplash can occur in a road traffic accident or in a sports collision.

Wry Neck

Wry neck is a term often used to describe a condition where your neck temporarily becomes stiff and painful. It is more common in teenagers and young adults, where turning your head to the side and looking up can produce an acute pain. It is possible for one or both sides of the neck to go into muscle spasm, and pain may be felt from the top of the neck down to the shoulder blade and across to the top of the shoulder.

Mental stress

When we get stressed our neck muscles often tighten and we hold tension in our shoulders. Being overly stressed can lead to neck pain and stiffness. Many people who tighten their neck muscles when they are stressed or agitated do so without realising. It is not until they start to get neck pain they notice the tension and tightness in their neck, by then it is often too late as stiffness and pain develops.

Growths

A growth is a mass that increases in size. The typical growths in a neck could be benign or malignant tumour, cysts or bone spurs. Any of these growths can put pressure on your spinal cord or the nerves in your neck, causing severe neck pain and other symptoms. As we age bone spurs are common due to osteoarthritic change in the facet joints.
other medical conditions

Neck pain can also be a symptom of many other health conditions such as meningitis, rheumatoid arthritis and cancers. Medical conditions of an infection or inflammatory nature can cause neck pain.

How is your neck pain diagnosed?

A physiotherapist will take you through a thorough assessment to determine the cause of your neck pain. This will involve taking a full history of your pain, a medical history and then a physical examination . Your physiotherapist will exclude any serious causes of neck pain, and any serious underlying pathology such as pressure on your spinal cord, myelopathy, an infection or cancer.

In your medical history, you will be asked about any previous neck injuries that may have caused a whiplash or a herniated disc. You will be asked about the nature and intensity of your pain, including where it starts and is located, how long it lasts and how painful it can be. You will be asked questions about what activities or positions make your pain worse.

Your physical examination will involve observation of your neck posture and spinal alignment and how you move your neck. Your physiotherapist will feel your neck and supporting muscles to check for tenderness and signs of strain.

Imaging tests are not usually necessary to identify what is causing neck pain, but can be useful to exclude severe pathology, serious injury or if your symptoms are not improving.

In rare instances, additional tests, including electrodiagnostic tests such as nerve conduction studies or a myelogram may be undertaken to check the function of nerves and your muscle response.

Laboratory tests may be required to exclude infections, rheumatological conditions or cancers, that may be causing pain. Medical care could include a full blood test, urinalysis and test of raised inflammatory blood markers.

What to expect with physiotherapy for neck pain?

Neck pain often requires a management with regular changes of position, manual therapy and active exercises, including strengthening. Physiotherapy may involve gentle massage, joint mobilisation or manipulation. Hands-on therapy is often aimed at improving your tissue mobility and keeping your spine flexible. Then you will be taught exercises and movements that strengthen the muscles and tendons in your neck.

The neck is the top part of a flexible spine that is designed to move. Getting stronger and regaining natural movements of your body, including your upper back, shoulders, will help your neck recover.

The good news is most episodes of acute neck pain will be short in nature and resolve without any intervention, but nearly half of people will continue to experience some degree of pain or frequent reoccurrences throughout their life. This is where seeing a skilled physiotherapist can help to prevent recurrence and promote resolution.

Most people with neck pain do not have any significant damage to their spine and the pain is often coming from soft tissue structures such as muscles and ligaments. A common cause of neck pain is related to prolonged poor posture, often as the result of many consecutive hours sitting at a desk. The head and neck rely on good support from the middle and lower back.

Other treatments for your neck pain

The aim of treatment is to relieve your pain and improve the movement in your neck. Generally, most neck pain will eventually improve and can be managed at home. If your neck pain is persistent, you may need to see a medical practitioner. They will suggest treatments to help manage your neck symptoms, including the following:

Pain medications and muscle relaxants:
Over the counter pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs) to ease neck pain and inflammation, and muscle relaxants to help your muscles relax, are common first line medical treatments for a painful neck.

If you are already taking over the counter medication and you feel your neck pain is not improving, then seeing a medical practitioner for stronger medications may be required.

Steroid injections:
If you have persistent neck pain or severe radiating pain, which is not settling with conservative management, your physiotherapist may refer you to your doctor for an opinion as to whether an injection of cortisone near the nerve roots, may be indicated to help reduce inflammation and relieve pain.

Alternative therapies:
Your healthcare professional may recommend acupuncture to relieve long term neck pain, or suggest massage to help loosen tight muscles contributing to your neck discomfort. Alternatively, you may see an osteopath or chiropractor to align your spine to help reduce your neck pain and stiffness.

Surgery:
Most causes of neck pain do not require surgery. In rare cases, where severe herniated disc encroaches on the spinal canal with other symptoms developing, then surgery may be indicated. Surgery is also indicated when the spinal column demonstrates severe structural change, that is unlikely to improve with conservative management.

If conservative management makes your neck pain worse, you may need to work with a spine or pain specialist.

What can you do to relieve your neck pain at home?

There are a few things you can do at home, in addition to taking pain relief medications, neck pain may reduce by using the following modalities:

Cold therapy:
Place a cold ice pack wrapped in a thin towel (to protect your skin) for 15 minutes every few hours on the area of neck pain. Neck pain may reduce as the cold narrows your blood vessels, reducing inflammation and swelling. Always apply cold ice packs for the first 48 to 72 hours post injury.

Hot therapy:
After a few days post injury, wrap a heat pack on the site of your neck pain for up to 20 minutes, or take a hot shower to relax your neck muscles. Chronic neck pain may be helped as the heat helps to loosen your muscles and promotes blood flow to the area.

Stress reduction techniques:
Meditation, mindfulness and diaphragmatic breathing exercises can help relieve tension in your body and shoulders, that may be contributing to your neck pain.

Exercises:
Your physiotherapist will often prescribe exercises, which will help relieve your neck pain and improve your range of motion. Do not attempt exercises if you have a serious neck injury or a pinched nerve without seeking advice from a healthcare professional.

Best exercises for neck pain
Gentle chin tuck.
Lying with your head supported on a pillow. Gently tuck your chin and push your shoulders away from your ears. Feel a stretch through your upper neck and sides of your neck as you let your shoulder blades relax.

Levator scapulae stretch
Sitting upright, place one hand under your bottom and the other hand on the back of your head. Then slowly tilt your head towards your armpit, then gently apply pressure with your hand behind your head. You will feel a stretch up the side of your neck.

Backward shoulder rolls
Sitting upright, perform gently rolls of your shoulders in a backward direction. This will help open your chest and stretch your neck muscles.

How to avoid getting neck pain

Prevent neck pain by taking the following steps to help stop build up of neck muscle tension and stiffness, which can lead to persistent pain and neck stiffness. It is better to be proactive to prevent neck pain and stiffness with effective self management strategies.

Practice good posture
Try to get good ergonomic position  with electronic devices, such as computers and phones, avoiding too much slouching or strain on your neck when using them. Keep your chest open and shoulders aligned when seated, so you do not strain your neck. Adjust the seats in your car to stop over reaching, helping you maintain good posture while traveling.

Adjust your sleep position
Try to maintain a neutral and well supported neck position when you sleep. If you sleep on your back or side, ensure your pillow supports your head in a neutral position, so your head and neck are aligned with the rest of your body. Try to avoid sleeping on your stomach with your head turned to one side.

Stay and keep active
Exercise is great for increasing your postural tone. Many of the same neck exercises can be used to relieve neck pain or to prevent it. If your job involves sitting for long periods, take regular breaks to move around, change position and stretch your entire body.

Do not carry heavy weight on your shoulders
Try to avoid carrying heavy objects like book bags or suitcases over your shoulder. May be consider using luggage or bags with wheels, especially when you travel for work regularly.

Exercise your upper back extensor muscles
It is normal to lose strength in your body and upper back as you age. Often as a result, people tend to slouch and shoulders will round forward. This in turn causes your head to move forward, placing additional strain on your neck and upper back.

Preventative Exercises
Performing strengthening exercises may help prevent neck problems. especially exercises that can help strengthen your upper back extensor muscles. The following are good examples of exercises:

Roll your chest open
Practice gently opening your chest as you roll your shoulders back. This will switch your mid back muscles on to hold you in a much more balanced posture.

Standing push-ups
Perform push-ups on a wall, allow your shoulders to feel connected to your chest wall. This helps strengthen your serratus anterior, which controls your shoulder blade movement helping to reduce tension in your neck.

Theraband rows
Wrap a theraband around a door handle. While standing, grab each end and then pull your elbows back to your side. Then slowly return forward, whilst maintaining an open chest. This will help strengthen your mid back muscles to hold a good posture for neck support.

In Summary

Neck pain is a very common and debilitating condition. Many of us lead very sedentary lives, not moving enough to provide our muscles with the strength to support our bodies.

At Lilyfield Physio, we understand how troublesome and persistent neck pain can become. We also understand the causes of neck pain are as unique and varied as the patients we treat. We can help you recover from neck pain, working with you to determining the cause of it in your life. We can show you how to manage and prevent it returning, so you are able to get on with life!