The neck, or cervical spine, is the most mobile segment of the spine and is stabilised by many layers of surrounding soft tissue. Neck pain and stiffness can develop gradually over time, particularly in people who spend prolonged periods of time in a fixed posture. Neck conditions can also develop acutely, for example following a bad night’s sleep or a rear-end car accident.
In many cases, the pain and stiffness being experienced is often associated with significant tension throughout the muscles of the neck, shoulder and thoracic spine. With appropriate massage, manual therapy and strengthening exercises, many neck conditions can recover quickly.
See below for common neck conditions.
Posture-related Pain or Tension
Poor posture can have a significant influence on strength, pain, mobility and function throughout the body. Due to their close proximity to the neck, the position of the shoulders and thoracic spine often contribute to neck pain and stiffness.
For example, people who tend to slouch will often demonstrate increased curvature of the thoracic spine and shoulders that are rolled forward. This position places more load on the structures surrounding the neck and may cause them to become painful. Poor posture can also lead to weakness and deactivation of particular muscles, increasing the likelihood of developing neck pain.
Posture-related neck pain is common in occupations requiring prolonged periods of sitting or standing. Office workers are often prone to developing neck pain and stiffness, especially when they have a poor workstation setup. Postural abnormalities associated with sports and hobbies can also lead to neck pain and stiffness.
Posture-related neck pain can be prevented and treated effectively with physiotherapy. While treatment may vary between patients, it often involves a combination of manual therapy, massage, strengthening exercises and posture correction.
Acute Wry Neck
Acute wry neck involves a sudden onset of sharp neck pain and stiffness, typically following a sudden, quick movement or after sleeping in an abnormal position. Often, patients will have pre-existing abnormal postures or muscle deconditioning prior to the onset of pain. Acute wry neck can affect joints and discs in the cervical spine and may result in a protective tension response in surrounding soft tissues, further exacerbating pain.
Treatment of acute wry neck often involves the use of heat, passive mobilisation of the cervical spine, gentle range of motion exercises, release of surrounding soft tissues and strengthening exercises for muscles that support the neck. Education about the importance of movement in treating acute wry neck is also essential to successful and timely recovery.
Whiplash
A whiplash injury occurs after a sudden acceleration-deceleration incident, such as a rear-end collision or a tackle in football. A whiplash injury can affect multiple structures in the cervical spine, including muscles, ligaments, joints and neural tissue. Common symptoms of whiplash include neck pain, headaches and neck stiffness. In more severe cases, neurological symptoms or a cervical spine fracture may be present.
Early treatment of a whiplash injury is very important for recovery and should include education about the condition and gentle neck movements within a comfortable range. Following this, treatment should include a combination of specific exercises, manual therapy and ongoing education.
Cervical Radiculopathy
Cervical radiculopathy, more commonly known as a pinched nerve, arises as a result of compression on a nerve root in the neck. This compression can be caused by osteophytes, disc changes, spondylosis or inflammation of a nearby structure. Symptoms may include pain, pins and needles, numbness or sensation changes in the shoulder and arm.
Initial treatment may include use of heat, traction, neural tissue mobilisation and passive mobilisation of the cervical spine. Following the acute phase, treatment is aimed at preventing recurrences and may include posture correction and muscle strengthening.
Cervicogenic Headaches
Cervicogenic headaches, or cervical headaches, are caused by tension or abnormalities in the structures of the neck. These structures can include joints, muscles, fascia and neural structures. Symptoms of a cervicogenic headache can also be influenced by posture, poor upper body biomechanics and emotional stress.
Typically, cervicogenic headaches are described as a dull ache on one side of the head, however they can also be bilateral. Physiotherapy treatment for cervicogenic headaches varies between patients, but may involve soft tissue therapy, passive mobilisation of the cervical spine, correction of any postural or biomechanical abnormalities and strengthening of the deep neck muscles.
