Neck pain and mobility deficits
We often see patients with both neck pain and difficulty moving (often turning) their necks. The first question we ask is whether this person truly stiff or are their muscles guarding as a protective mechanism, limiting neck motion? Often, patients with hypermobility (more flexible joints) have limited neck motion as their nervous system is sending signals to their neck to guard as a protective mechanism. In these cases, we figure why muscles are guarding and take appropriate action.
In other cases, people have stiff necks. Often these patients have central and/or one-sided neck pain and limitations in neck motion that consistently reproduces symptoms. This pain is referred to the shoulder girdle or upper extremity.
Depending on the cause, treatments include:
- manual therapy to the neck and upper back to increase mobility
- spinal manipulations as a “control/alt/delete” for the nervous system to decrease muscle guarding, reduce pain and improve strength
- strengthening/motor control (coordination) exercises
- dry needling to decrease muscle tone
- “Neck Pain Guidelines: Revision 2017: Using The Evidence To Guide Physical Therapist Practice,.”. Vol 47, no. 7, 2017, pp. 511-512. Journal Of Orthopaedic & Sports Physical Therapy (JOSPT), https://doi.org/10.2519/jospt.2017.0507.
When is someone with neck pain not a candidate for PT?
There are conditions that may result in neck pain and/or headaches that are medical emergencies and not candidates for PT. These are cervical artery dissections (stroke), upper cervical instability and cervical myelopathy.
Neck pain with headaches
Neck pain often times occurs with headaches which maybe on one side or both sides of the head and are precipitated/aggravated by neck movements and/or sustained positions/postures.
Neck pain and motor control impairments
While neck pain is the most common sign, patients frequently have dizziness, nausea, headaches, concentration difficulties in addition to neck pain. This often occurs following motor vehicle accidents (whiplash) and sports injuries, even when several years ago.