Neck pain is a serious problem that can limit your ability to perform normal, everyday tasks. It can cause you to lose range of motion in your neck, and it may also be a source of pain in your shoulder, arm, or hand.
Anatomy of the Neck
The neck, or cervical spine, is comprised of 7 bones called vertebrae which are stacked on top of one another. Between each bone is a spongy material called the intervertebral disc. Each vertebra has two joints towards the back that connect it to the vertebra below it.
The bones of your neck protect your spinal cord and allow for normal motion to occur. The neck is very flexible, allowing for forward, backward and side bending, as well as rotation. This helps enable you to look and move in many directions.
Causes of Neck Pain
There are many different causes of neck pain. Occasionally, poor sitting posture puts your neck in an awkward position and causes pain (think about your neck position while texting on your smartphone). Other times trauma, like a motor vehicle accident or a sports injury, may cause a painful condition called whiplash. Wear and tear from arthritis or disc problems may also be a cause of your neck pain.
Where Is the Pain Felt?
The pain that comes from your neck may be felt in different locations, which can make your condition confusing and difficult to treat. Pain may also be felt directly in your neck, or just on one side of the neck. Pain from your neck can also often be felt in your shoulder blade, and other types of shoulder pain could also be coming from your neck.
If a nerve in your neck is irritated or pinched, you may feel pain traveling down your arm and into your hand. Weakness, numbness or tingling may sometimes be felt in your arm and hand as well. Be sure to discuss all of your symptoms with your healthcare provider or physical therapist so that they may understand your condition and find the best treatment options for you.
What to Do First
If you start having neck pain, don’t panic. Oftentimes neck pain gets better in just a few days, and in many cases, the pain subsides greatly in four to six weeks. When pain strikes, gentle neck exercises may be beneficial, and heat or ice can also help control symptoms. If symptoms persist, visit your healthcare provider to see if a prescription medication will help your condition. Physical therapy may also be prescribed.
What to Expect From Physical Therapy
If you have neck or arm pain that’s coming from your neck, your healthcare provider may refer you to physical therapy. When setting up your first appointment, ask plenty of questions so you can find a therapist who specializes in neck pain, and so you’ll understand what to expect from your therapist.
Your first appointment with a physical therapist will be an initial evaluation in which the therapist will gather information about you and the nature of your problem. They will then perform an examination, during which the following are commonly measured:
- Range of Motion (ROM), which refers to how far your neck moves in various directions. Your physical therapist may use a goniometer to measure your ROM. They will also look at the quality of your motion.
- Strength. If you’re feeling arm pain that’s originating in your neck, you may be experiencing weakness in specific muscle groups in your arm. Your physical therapist may measure your strength to determine the nature of this weakness.
- Tenderness to Palpation. Palpation is when a physical therapist touches the body with his or her hands to determine if the muscles are tight or sore. Your physical therapist may also push on your spine to measure spinal mobility. Caution should be used in palpation since many studies indicate that the ability to accurately identify problem areas in the spine by palpation is poor.
- Posture. Your physical therapist may analyze your posture to determine if this could be a cause of your neck pain. They may measure your resting posture and then have you sit with correct posture to determine if postural correction can also help improve your symptoms.
- Functional Mobility. If you have neck pain, your physical therapist may ask you about things that you’re unable to do as a result of your pain. They may also ask you to perform certain tasks to assess your overall functional mobility.
After your physical therapist gathers the necessary measurements and information about your condition, they will work with you to develop a plan of action to help with your neck pain.
Your physical therapist will work with you to help you decrease and eliminate your neck pain. They should also help you devise strategies to help prevent future episodes of neck pain. Some common treatments offered by physical therapists for neck pain include, but are not limited to:
- Exercise. Many studies indicate that exercise can be your main tool in the treatment of neck pain. Your physical therapist may prescribe specific exercises to help you improve the ROM of your neck and to help decrease your pain. Strengthening exercises may be prescribed if the weakness was identified during your initial evaluation.
- Traction. Occasionally, cervical traction may be used at your physical therapist's office, or upon the recommendation of your orthopedist or neurosurgeon, to help treat your neck pain. Traction is used to separate the joint surfaces in the neck, which may be beneficial if you have neck arthritis. If you have a bulging or herniated disc, traction may help to give your irritated nerves some space, so that your pain is decreased.
- Postural Correction. If poor sitting posture is thought to be a cause of your neck pain, your physical therapist may work with you to correct it. They may use a special lumbar support roll to help you improve your sitting posture.
- Joint Mobilizations. Joint mobilization techniques may be used to help improve your neck ROM and to decrease your neck pain. Neck mobilization and manipulation can carry with it some risks. These risks, although rare, should be discussed with your physical therapist before proceeding with neck spinal mobilization.
- Massage. If tight and sore muscles are considered to be a cause of your neck pain, your physical therapist may use massage techniques to help decrease tension and pain in these muscles.
- Therapeutic Modalities. Sometimes therapeutic modalities such as ultrasound or TENS are used to help treat neck pain. These treatments may feel good temporarily, but remember that you should be an active participant in your neck rehabilitation. Also, TENS and ultrasound have been proven to offer little in the treatment of neck and low back pain, so these treatments should be used infrequently, if at all. Be sure to discuss the use of these treatments with your physical therapist.
- Thermotherapy and Cryotherapy. Heat and ice are also treatments that may be used to help relax muscles and to decrease inflammation. Again, these passive treatments may feel good, but they should not take the place of active exercise and postural correction in the treatment of your neck pain.
With proper treatment, your neck pain should be gone in four to six weeks. For serious cases, you may have symptoms lasting eight weeks or more. If your pain and symptoms don’t improve at all after a few weeks of treatment, you may need to return to your healthcare provider. More invasive treatments like spinal injections may be an option. If the damage in your neck that’s causing your pain is severe, you may require neck surgery to help eliminate the pain.
If you have neck pain, be sure to see your healthcare provider and ask if physical therapy is right for you. Your physical therapist can help decrease the pain and can provide you with strategies to prevent future episodes of neck pain. By working hard in physical therapy, you may be able to quickly eliminate the pain and return to normal activity and function quickly and safely.
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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.
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