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A Physio’s Guide to Neck Pain: Understanding, Preventing, and Treating

Unlike the lumbar spine, which is intended to carry a load, the neck is designed for movement. This ensures a greater visual field for primitive times when we were hunters and gatherers. The neck is affected by the cervical joints down to the thoracic spine (T3-T4). The first two cervical joints contribute approximately 50% of your total rotation. The rest happens between C2-C7. However, the end of the position is achieved with the thoracic spine movement. The neck is home to the muscles of the neck itself and the origin of the upper thoracic and shoulder muscles.

Psychological (anxiety/fear) and social (sport and training requirements) contribute to the athlete's disorder and recovery. However, the biggest contributor to common neck pain is posture. Both sitting, standing and posture for the sport. As these positions are particularly important for office workers, it can be 40+ hours spent not including the time on weekends and evenings for seated meals and TV.

The neck should be able to extend the whole bay back with the face looking flat at the ceiling. If the neck can not extend to this range of motion, there is either a stiff joint or motor control abnormality. Bending the head to the side is the most useful movement for the physio to differentiate between muscle, neural and joint pathology.

It is important to find the postural driver of the neck pain as opposed to treating purely the symptoms. For example; if it is the office sitting. The neck moves forward closer towards the screen, placing the neck extensors under more tension. As a result, they tighten and so do the joints around them. The Shoulders then roll forward to compensate, tightening up through the chest muscles. This results in tight fixed flexed positions, causing recurring aches in the neck.

Management must include correction of the neck posture and maintaining the neck regions in a neutral position during office work. This may require a temporary reduction in the duration of sitting doing office work to allow the neck to settle and rehabilitation of the neck muscles to be effective so that there is adequate muscular support of the cervical region. Changing the screen set-up, using multiple screens, stand-up desks and kneeling chairs will all help reduce the overall load on the neck.

Secondary to work modification, pain management is critical. Pharmacotherapies, manual therapy, exercise, dry needling, and trigger point therapy are also great pain reliefs. Neural tissue mobilisations are also an emerging therapy used to slide the nerve and nerve bed leading to a reduction in symptom response. The muscles are tight for compensation for weakness. The tightness is an involuntary contraction of the muscle. Certain chemicals make up the contraction of muscle tightness. Using the manual techniques helps to disturb the chemical makeup, forcing the muscle back into a relaxed state. Dry Needling and trigger point treatment are commonly applied to the upper traps, levator scapula, posterior cuff and cervical multifidus.

The technique that elicits an immediate symptom improvement on reassessment is a good predictor of an effective treatment modality moving forward. For any range of motion improvements, it is important to exercise through the extra range of motion. The idea is that the short-term improvements from manual therapy are then prolonged by client participation in their specific home exercise program.

Exercise is prescribed in two stages:

1. Training to enhance motor control. This stage increases the activation/endurance of the muscles as well as the coordination between the muscles.

2. Commence resistance training once adequate motor control of the region is achieved. The exercises should be challenging yet be performed with the correct technique and without aggravating symptoms. Examples of typical exercises given to neck pain patients include: chest stretches, back rows, shoulder backward circles, thoracic openers, and cervical extensions in 4-point kneeling.


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