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.
Common exam findings include lacking neck rotation (or range of motion deficits in other directions), headaches reproduced with provocation of the involved cervical segments, neck stiffness and/or deficits in strength/endurance/coordination of the neck muscles.
Treatments include mobilizations and/or manipulation to both the neck and upper back, strengthening/endurance exercises, motor control (coordination) training of the neck and upper back muscles and dry needling to relieve muscle tension.
- “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 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.
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?