Neck Pain
What’s the problem?
As with low back pain, neck pain can be a result of many different conditions. The good news is that most neck pain is NOT caused by a serious disease. There are a variety of clinical tests and prediction rules to determine the most likely cause of the issue and point us in the right direction. We use the term “mechanical neck pain” to generally describe neck pain coming from a problem with the joints and muscles. More good news- we can help!
How can PT help?
The strongest evidence for treatments that help to alleviate mechanical neck pain is a combination of manual therapy and exercise. Manual therapy comes in the form of mobilization of the joints, manual stretching of muscles to obtain mobility and soft tissue massage to loosen spasms. Here are some specific interventions that help dramatically to curb neck pain:
Mobilization:
The joints and muscles of the the neck are gently, repeatedly moved in order to restore normal range of motion.
Manipulation:
Delivering a single, quick movement to the joints of the upper back and/or neck to decrease pain and restore movement in hypomobile (i.e. “stuck”) segments.
Prolonged Stretching:
When the big muscles in your neck or upper back are tight/knotted and determined be limiting normal range of motion, your PT can instruct you on how to stretch specific muscles to ease this tension and lengthen muscles. One important aspect of this strategy is the prolonged part. Evidence tells us that in order to have a lasting, physiological effect on the muscle fibers, we need to hold the stretch at least 90 seconds.
Deep Neck Flexor Strengthening:
The true “core muscles” of your back are the tiny muscles that span between each segment and are responsible for stabilizing your spine while the big muscles bend, extend, and rotate your spine. In a similar set-up, there are many small muscles deep in your neck right along the vertebrae that help keep your chin subtly tucked and in proper position while the big muscles (such as your trapezius) bend, extend, or rotate your head. When these little muscles aren’t being adequately utilized, those big muscles tend to jump in to help provide stability. The result of this can be painful, recurrent tightness in the back of the neck, often when sitting still for a while and writing or using a computer.
Upper Back Strengthening:
A big part of keeping your head stacked efficiently above the rest of your body is having strong postural muscles in your upper back to keep your shoulders from rolling forward. In addition to deep neck flexor strengthening to pull your chin back, we use exercises like rows to train muscles like the lower trapezius and rhomboids to pull your shoulder blades down and back for improved posture and biomechanics. Proper supervision and guidance through these exercises is needed to prevent the compensatory mechanisms that make neck pain worse.
When to see your physician?
There are several important red flags that warrant referral to your primary care physician or other specialists for medical management like imaging or pharmaceutical interventions.
- dizziness, double vision, changes in hearing, difficulty speaking or swallowing, nausea, or loss of consciousness
- trauma such as a car accident in order to rule out fractures or brain injury
- bilateral numbness/tingling or severe weakness/paralysis
By Dr. Nicholas Chamley DPT
