Physical Therapy for Neck Pain

Neck pain is one of the most common musculoskeletal conditions, affecting 30% to 50% of adults each year. While there can be numerous causes of neck pain, the most common source of neck pain is mechanical neck pain resulting from muscle strain or joint issues. Physical therapy is the most effective treatment for neck pain, reducing pain and stiffness, improving range of motion, and strengthening the postural flexibility of the neck through therapeutic exercise and manual therapy.

Causes & Symptoms of Neck Pain 

Neck pain can be a debilitating condition that affects 30-50% of adults each year and is most common among those ages 30-50 years old. Neck pain is commonly felt in the back of the neck just below the head, but can extend to the upper back, shoulders, and down the arm. The neck is particularly vulnerable to pain as it is a complex structure comprised of bones, nerves, muscles, ligaments, and tendons that house the spinal cord while also remaining strong, flexible, and mobile in multiple directions. The neck supports the head and is responsible for moving the head in various positions and directions. 

There are a number of possible causes of neck pain. The most common source of neck pain is mechanical neck pain resulting from muscle tension and strain from poor posture, sleeping in an awkward position, and repetitive movements, and overuse. An injury from a car accident, a fall, or a sports injury can cause neck pain, such as whiplash which is when there is a sudden acceleration or deceleration of the neck and head in relation to the other parts of the body, thrusting the head and neck forward or backward rapidly. Disease can also contribute to neck pain such as meningitis, cancer, and rheumatoid arthritis. Neck pain may also result from degenerative vertebral discs in the cervical spine like a herniated disc or bulging disc that results from age, osteoarthritis, or acute injury. Compression of a nerve in the cervical spine by a herniated disc can lead to radiculopathy, which is radiating pain from the neck down through the hands and fingers.

Symptoms of neck pain include:

• Pain in the neck, upper back, shoulders, arms, and hands

• Numbness or tingling in the neck, shoulders, arms, or hands

• Inability to bend or rotate the neck

• Difficulty looking up or over the shoulder

• Weakness in the arm and shoulder muscles

• Muscle spasms and pain in the neck

• Stiffness when trying to move or feeling stuck in a position (stooped forward)

• Tight muscles and headaches

• Increased pain when cough, sneeze, reach or sit

• Inability to stand straight or sit up straight

Physical Therapy Treatment for Neck Pain

Physical therapy is the most effective treatment for neck pain rather than surgery or the use of pain medication. Physical therapy can reduce and eliminate neck pain and stiffness, improve the range of motion of the neck and head, and strengthen the postural flexibility of the neck. During the initial physical therapy visit, the physical therapist performs a thorough physical exam and functional assessment to evaluate your neck mobility, strength, range of motion, and reflexes and assess the specifics of your pain and its effect on your neck function.

The therapist assesses your posture and any imbalances in the position of the spine that is contributing to your neck pain as well as evaluating the nerves of the neck, your response to sensation, and whether you are experiencing hypomobility (tightness in the muscles) or hypermobility (overextension of the muscles) in the neck. Based on the initial evaluation, the therapist then designs a treatment program that is tailored to your specific condition, utilizing the latest evidence-based research.

Research has shown that physical therapy is a better treatment option than surgery or pain medication for most cases of neck pain and that physical therapy improves posture, reduces pain, stiffness, and muscle spasms, and increases function of the neck. Current research suggests that for mechanical neck pain, the combination of manual therapy and exercise is effective in reducing pain and restoring function in the neck.

In one study, 64 mechanical neck pain patients were prescribed mobility exercises and received mobilizations of their necks by physical therapists. Half of the patients also received manipulation of the upper back. After one week, those who did exercises and mobilizations of the neck and upper back reported greater relief of their neck pain. In the group that received both manual therapy techniques (neck and upper back), 75% had significant pain reduction and 70% saw a noticeable improvement in their ability to perform daily activities.

Physical therapy treatment for neck pain can include:

• Pain management: ice therapy to control inflammation and ease pain and heat therapy to relax the neck muscles and bring fresh oxygen and nutrient-rich blood to help the injured area heal.

• Manual therapy: Gentle soft tissue mobilizations are performed by the physical therapist to relax and calm muscle spasms, e.g. myofascial release to restore better movement in the injured area. Joint mobilizations are graded pressures and movements that help to ease stiffness by lubricating joint surfaces and helping you move with less pain.

• Cervical traction: Either performed manually by the therapist or using a traction machine, the neck is gently stretched, separating the disc and joint surfaces in the neck to relieve pressure and pain, such as from a herniated disc compressing a nerve.

• Strengthening exercises: targeted strengthening of the muscles that support the neck and spine is critical to keep the neck and spine in a safe position. Strengthening exercises help to improve the stability of the neck, promote balance in the muscles of the neck, chest, and upper back, and enhance flexibility and coordination of the muscles. Aerobic conditioning is also an important aspect of treatment to improve overall fitness and help muscles become more efficient in obtaining nutrients and oxygen from the blood for healing.

Don’t let neck pain limit you and your daily activities. Begin working with a physical therapist today to relieve neck pain and regain function and mobility in your neck!