When does pain in one’s neck no longer get considered normal? Well, that is a difficult question to answer. The quick of it is if the neck feels stuck and you are unable to move it for more than a day and/or if you have had absence of improvement in global neck pain and stiffness for 48-72 hours, you should seek higher-level intervention. If you notice loss of coordination in your hand and difficulty gripping and dropping small objects, this may warrant more immediate attention by an orthopedic or neurologist.
As therapists, we look at neck pain on a spectrum. Do you have mobility deficits, simply put is your motion limited in any direction (Blanpied et al., 2017). If you can’t look up or down fully, check your blind spot, or talk to someone next to you without shifting your whole body or lean your head from side to side you are missing some amount of motion. Now the limited mobility could be the joints in your neck not moving correctly and/or tight muscles/ligaments. Do you have movement coordination impairments, this includes whiplash and activities in which fine control and stabilization of the cervical spine are difficult/painful (Blanpied et al., 2017). In this situation, it is hard to hold your head up, there is pain at middle of motion that increases as you get to the end of your available range (Stanley, 2021). This is likely a combination of mobility restriction at the joints, proper awareness of head in space, and altered recruitment patterns to assume normal upright posture. Do you have neck pain with headaches, this is the type of headache you feel starting at the top of your neck or base of your skull (Blanpied et al., 2017). This can be attributed to decreased joint mobility and altered strength and endurance in cervical stabilizers (Stanley, 2021). Do you have neck pain with radiating pain, is there pain coming from your neck and traveling down your shoulder/arm or shoulder blade (Blanpied et al., 2017). You can have one or a combination of these symptoms and many people fall into more than one category.
So you know you have neck pain, what do we do with that?!
The treatment for neck pain varies based on symptoms, presentation, acuity of injury and response to given interventions. But what has been shown in research to be most effective is the combination of both manual (i.e. hands-on approach) and exercise as well as getting the person back to normal activity as quickly as possible (Coulter et al, 2019). Now manual can come in the form of many different things, we as therapist can work on the soft tissue, mobilize and or manipulate the joint, provide stretching, cupping, dry needling - to name a few. The question we often get is should I go see a chiropractor or is it okay to get my neck cracked. The evidence shows that when it comes to recovery, manipulation or “cracking” your neck in combination with exercise is as effective/similar response pattern to exercise in combination with mobilization, which is a repetitive low-velocity variable amplitude movements directed in the direction of the cervical joint (Blanpied et al., 2017).
Some Exercises That Can Assist with various forms of neck dysfunction:
Peanut Mobilization of Cervical Spine
Upper Trap Mobilization with Lacrosse Ball
Chin Tuck with Resistance, Chin Tuck with Rotation + Resistance (same patterns can be done without resistance)
Y, T, I
*You can check out Ground to Overhead Physical Therapy You Tube channel, https://www.youtube.com/@groundtooverheadphysicalth2915/, for more exercise and mobility guides.
Does this article overwhelm you, have you suffered from neck pain, headache, or symptoms that travel up/down your arm, feel like you are in this vicious cycle of wake up, pain, manage? Contact us for an individualized assessment and treatment protocol that addresses you as a whole person. We find the pieces to what feels like the illusive puzzle of your pain, and help bring you to the strongest version of yourself. We use a 3-step process to help athletes feel better and move better:
1. Fixing your pain.
2. Figuring out the root cause.
3. Providing you the necessary tools to get back to being active and not dealing with this
again.
References:
Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy, 47(7). https://doi.org/10.2519/jospt.2017.0302
Coulter ID, Crawford C, Vernon H, Hurwitz EL, Khorsan R, Booth MS, Herman PM. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70. PMID: 30921975; PMCID: PMC6800035.
Stanley, B. (2021, February 15). Clinical practice guidelines for neck pain. Upstream Rehab Institute. https://upstreamrehabinstitute.com/blog/clinical-practice-guidelines-for-neck-pain/