Physical Therapist's Guide to Neck Pain
Neck pain is pain felt in the back of the neck – the upper spine area, just below the head. When certain nerves are affected, the pain can extend beyond the back of the neck to areas such as the upper back, shoulder, and arm. It is estimated that neck pain affects approximately 30% of the US population each year. Neck pain can be caused by sudden trauma such as a fall, sports injury, or car accident, or by long-term problems in the spine.
Neck pain most frequently affects adults aged 30 to 50 years. Some studies indicate that women are more likely to suffer neck pain than men. Poor posture, obesity, smoking, repetitive lifting, office and computer work, and involvement in athletic activity are all risk factors for developing neck pain.
People with neck pain can have difficulty performing activities such as working, driving, playing sports, or simply turning their heads. The majority of neck pain episodes do not require surgery and respond best to physical therapy. Physical therapists design individualized treatment programs to help people with neck pain reduce or eliminate pain, regain normal movement, and get back to their regular activities.
How Does it Feel?
People with neck pain may experience stiffness in the neck, and may describe the pain they feel as:
Neck pain caused by irritated nerves may extend into the upper back, shoulder blades, shoulders, arms, or hands. This condition is called “radiculopathy.” Your physical therapist can help determine if this condition is occurring, and will work closely with your physician and surgeon to determine the correct treatment.
Signs and Symptoms
The type and location of your symptoms depend on the tissue or structure that is affected, and the severity of the injury.
Neck pain can cause any of the following signs:
- Inability to bend or rotate the neck
- Difficulty looking up
- Difficulty looking over the shoulder
- Weak arm and shoulder muscles
- Muscle spasms
Neck pain can cause any of the following symptoms:
- Pain in the neck, upper back, shoulders, arms, or hands
- Numbness or tingling in the neck, shoulders, arms, or hands
- Weakness in the arms
- Increased pain when coughing, sneezing, reaching, or sitting
- Inability to stand straight or sit up straight
- Stiffness when trying to move, or a feeling of being "stuck" in a position such as stooped forward, or with the head leaning to the side
- Tight muscles
- Inability to remain in one position for a long period of time, such as sitting or standing, due to pain
- Pain that is worse in the morning or at night
- Difficulty sleeping due to pain
How Is It Diagnosed?
Your physical therapist will conduct a thorough examination that includes taking your health history. He or she will also ask you detailed questions about your pain or injury, such as:
- How and when did the pain start?
- What type of discomfort do you feel, and where do you feel it?
- At what time of day is it worse?
- What can’t you do right now in your daily life due to the pain?
Your physical therapist will perform tests on your body to find physical problems, such as:
- Difficulty moving
- Weakness or tightness in the muscles
- Loss of skin sensation (numbness) in some areas
- Loss of reflexes
- Joint stiffness
- Poor posture
- Difficulty walking
If your physical therapist finds any of the above problems, physical therapy treatment may begin right away to help get you on the road to recovery and back to your normal activities.
If more severe problems are found with any of the testing, your physical therapist may collaborate with a physician or surgeon to obtain special diagnostic testing, such as an MRI. Your physical therapist will work closely with physicians and other health care providers to make sure that you receive an accurate diagnosis and the treatment and care you need.
How Can a Physical Therapist Help?
Recent research has shown that physical therapy is a better treatment than surgery or pain medication (such as opioid medication) for relieving many cases of neck pain. Physical therapy treatments often can help people avoid the need for surgery or medication altogether.
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy can help you return to your normal lifestyle and activities.
The time it takes to heal each condition varies, but an individualized physical therapy program can be effective and efficient, and help heal neck pain in a matter of weeks.
Your physical therapist may advise you to:
- Rest the painful area by avoiding activity that causes worsening symptoms in the neck or arms.
- Stay active around the house, avoid prolonged bed rest, and go on short walks several times per day. Movement will decrease pain and stiffness, and help you feel better.
- Perform the simple neck movements he or she will teach you. These can help reduce stiffness and pain and restore normal motion of the neck.
- Apply moist heat or ice packs to the affected area for 15 to 20 minutes every 2 hours.
- Sit in firm chairs. Soft couches and easy chairs may make your problems worse.
- Consult with a physician for further services, such as medication or medical tests.
Your physical therapist will work with you to:
Reduce pain and other symptoms. Your physical therapist will help you understand how to avoid or modify the activities that caused the injury, so healing can begin. He or she may use different types of treatments and technologies to control and reduce your pain and symptoms. These may include gentle hands-on techniques, known as manual therapy, that he or she will perform for you; specific neck movements that you will be taught to perform yourself; and the use of technologies, such as electrical stimulation or traction, as required. Physical therapists examine each person individually to determine exactly what type of approach will help reduce pain.
Avoid surgery. In most cases, a physical therapist can design an individualized treatment program to help relieve neck pain—even severe radiculopathy (pain that travels from the neck down into the arm or hand)—to help individuals with neck pain avoid surgery. In rare cases, radiculopathy requires surgery to relieve its cause.
Improve posture. If your physical therapist finds that poor posture has contributed to your neck pain, he or she will teach you how to improve your posture so healing can occur.
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might include "passive" motions that the physical therapist performs for you to move your spine, or active exercises and stretches that you do yourself. You can perform these motions at home, in your workplace, and before your sports activities to help hasten healing and pain relief.
Improve flexibility. Your physical therapist will determine if any of the involved muscles are tight, and teach you gentle stretching exercises that you can perform at home. He or she also may supervise your performance of special stretches during your physical therapy treatments.
Improve strength. If your physical therapist finds any weak or injured muscles, he or she will choose and teach you the correct exercises to gently restore your strength and agility. For neck pain, “core strengthening or stabilization” is commonly used to restore the strength and coordination of muscles around your spine.
Improve endurance. Restoring muscular endurance is important for people with neck pain. Your physical therapist will develop a program of activities to help you regain the endurance you had before the neck pain started.
Learn a home program. Your physical therapist will teach you strengthening, stretching, and pain-reduction exercises to perform at home. These exercises will be specific for your needs. If you do them as prescribed by your physical therapist, you can speed your recovery.
Return to Activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. For spine problems like neck pain, your physical therapist may teach you correct ways to lift objects (called “body mechanics”) that will help protect your spine from further injury.
As your neck pain is improving, it will be important for you to continue your new posture and movement habits to keep your neck healthy and pain free.
In rare cases of neck pain, surgery is necessary to relieve pressure on a nerve or on the spinal cord. If you undergo surgery, your physical therapist will work closely with you and your surgeon to help you regain motion and strength more quickly than you could on your own, and help you return to your daily activities as quickly as possible.
Can this Injury or Condition be Prevented?
To prevent neck pain, people should:
- Maintain good posture (avoid slouching) at all times. That means keeping the spine and head in proper alignment during sitting, standing, and all daily activities.
- Keep your muscles strong and flexible. Participate in a consistent program of physical activity to maintain a healthy fitness level.
- Use proper body mechanics when lifting, pushing, pulling, or performing any action that puts extra stress on your spine.
- Maintain a healthy weight. This will reduce the stress on your spine.
- Stop smoking.
- Discuss your occupation with a physical therapist, who can provide an analysis of your job tasks and offer suggestions for reducing your risk of injury.
To prevent recurrence of neck pain, follow the above advice, and:
- Continue the new posture and movement habits that you learned from your physical therapist to keep your back healthy.
- Continue to do your home-exercise program as taught to you by your physical therapist. This will help maintain your improvements.
- Continue to be physically active and stay fit.
Real Life Experiences
Andi is a 54-year-old engineer for a public transportation department who frequently works in the city’s subway system. Andi sometimes experiences neck pain at work when she has to look upward for longer than 10 minutes to examine or repair overhead structures.
Recently, Andi helped her elderly mother paint her living-room ceiling, which forced her to look overhead for hours at a time. Right after finishing the project, she felt a sharp pain in her neck. She was barely able to sleep 2 hours that night due to the pain. The next morning, she felt aching pain from her neck to her shoulder blade.
The next day at work, the pain extends down through Andi’s shoulder. Her coworker recommends a visit to his physical therapist, who specializes in treating people with spine and neck pain.
At Andi’s first physical therapy session, the physical therapist asks her health history, and learns about her repeated episodes of pain at work. Andi describes her pain and says it is worse in the morning. She notes she is now unable to lift her head to look up for more than 1 minute at work without worsening the pain.
Andi’s physical therapist conducts a series of gentle physical tests to determine the severity of the condition, the strength of her muscles, the movement of the joints in her neck, and the skin sensation in her arms. He is able to find a specific movement that relieves Andi’s neck pain.
He concludes that Andi has a strained muscle and a sprained ligament in her neck, which have caused some irritation to the nerves. He explains that with physical therapy over the next few weeks, the muscle may heal quickly, the ligament may start to return to its normal length, and the swelling and nerve irritation should gradually disappear, which will relieve her pain.
During Andi's first treatment session, her physical therapist performs a manual (hands-on) therapy treatment for her neck that greatly relieves her neck pain. He also teaches her how to perform a specific movement that reduces the pain in her shoulder after a few repetitions. He instructs Andi to perform this movement each day at home, and whenever the pain seems worse. He also helps her learn how to improve her posture.
Over the next few weeks, Andi learns strengthening exercises for her neck muscles to better support her neck when she has to look overhead. Her physical therapist shows her how to manage her pain by making simple changes to how she performs her daily activities, such as correcting her own posture and movements when on the job.
He encourages Andi to begin a daily walking program, such as going on neighborhood outings with her mother after work.
Andi follows the advice of her physical therapist and, after 4 weeks, she is almost completely pain free and symptom free. She walks with her mother to a local nature trail and pond several times a week, and sticks to her program of regular exercise.
At her 6-week checkup, Andi is happy to report that she can move her head and neck freely, and the pain in her neck and shoulder is gone!
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat people who have neck pain. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist:
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with neck pain. During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of a neck pain. The articles report present research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Alpayci M, İlter S. Isometic exercise for the cervical extensors can help restore physiological lordosis and reduce neck pain: a randomized controlled pain. Am J Phys Med Rehabil. 2017 January 23 [Epub ahead of print]. Article Summary in PubMed.
Meziat-Filho N, Azevedo E Silva G, Coutinho ES, et al. Association between home posture habits and neck pain in high school adolescents. J Back Musculoskelet Rehabil. 2017;30:467–475. Article Summary in PubMed.
Bussières AE, Stewart G, Al-Zoubi F, et al. The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther. 2016;39:523–564.e27. Free Article.
Kim EK, Kim JS. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. J Phys Ther Sci. 2016;28:2929–2932. Free Article.
Ris I, Søgaard K, Gram B, et al. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain: a randomised control trial with a 4-month follow up. Man Ther. 2016;26:132–140. Article Summary in PubMed.
Zronek M, Sanker H, Newcomb J, Donaldson M. The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature. J Man Manip Ther. 2016;24:62–73. Free Article.
Halvorsen M, Falla D, Gizzi L, et al. Short- and long-term effects of exercise on neck muscle function in cervical radiculopathy: a randomized clinical trial. J Rehabil Med. 2016;48:696–704. Free Article.
Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90:284–299. Free Article.
Pierre Langevin, François Desmeules, Mélanie Lamothe, et al. Comparison of 2 manual therapy and exercise protocols for cervical radiculopathy: a randomized clinical trial evaluating short-term effects. J Orthop Sports Phys Ther. 2015;45:4–17. Free Article.
Peolsson A, Söderlund A, Engquist M, et al. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up. Spine (Phila Pa 1976). 2013;38:300–307. Article Summary in PubMed.
Keramat KU, Gaughran A. Safe physiotherapy interventions in large cervical disc herniations. BMJ Case Rep. 2012;2012:bcr2012006864. Free Article.
Boyles R, Toy P, Mellon J, et al. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011;19:135–142. Free Article.
Cook C, Hegedus EJ, Ramey K. Physical therapy exercise intervention based on classification using the patient response method: a systematic review of the literature. J Man Manip Ther. 2005;13:152–162. Article Summary in PubMed Health.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.
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