What the heck is wrong with my neck?!

Personally, neck pain can be some of the most distracting pain out there. We often take a pain-free neck for granted until we wake up stiff and cranky. While neck pain sufferers are not the most common population we treat, it does make up a portion of our caseload and sometimes disguises itself as shoulder pain.

Our body has a number of “referral” patterns.

This means that we can have pain in one location of our body when the source of that pain is actually somewhere else. The joint and discs in our neck have relatively common referral patterns, one of the most common being the back of the shoulder blade. If you are dealing with shoulder pain of any kind, your physical therapist should first establish if the neck is involved so that treatment can be tailored to the root cause.

During your initial evaluation, your physical therapist should also screen for the presence of “red flags,” which are signs that your neck pain could be coming from another source i.e. fracture, infection, or tumor. At MOTION RX, we are well trained in the ability to screen patients and refer to other providers if necessary. We even start this process over the phone before the first visit to help you find the right care!

If all signs and symptoms point to a musculoskeletal origin of neck pain, then we can get into a physical examination to determine which classification of neck pain you have. Research has found time and time again that trying to diagnose the exact structure causing pain is unnecessary (and usually impossible). Instead, it has us place you into a treatment category. Let’s talk about them!

First up: Neck pain with mobility deficits.

When you suddenly wake up with that “stiff” and achy feeling, this is usually the culprit. Symptoms are normally recent onset and present with an asymmetry in range of motion. Manual mobilizations to the neck and upper back have a high level of evidence, which should also be followed up with self-mobilization and range of motion exercises. Before providing a manipulation to your neck, your physical therapist should do a thorough history screen for vascular risk factors, get your consent, and do a pre-manipulative hold, where they take your neck to end-range rotation and assess for any unwanted symptoms.

Second: Neck pain with movement coordination impairment.

This group typically has a longer duration of symptoms, but lower pain and disability. These people tend to be more mobile and benefit from strength and endurance exercises of the neck and upper body.


Third: Neck pain with radiating pain is associated with symptoms going into the shoulder and arm.

Your physical therapist will perform a series of tests that can pretty confidently establish involvement of a nerve in your pain. Those in this category typically respond well to traction and can progress with repeated movements of their neck in a specific direction. Nerve sliders are a great way to decrease the irritability of nerves and lessen the discomfort that patients are feeling.

Four: Neck pain with headaches.

There are LOTS headache types but the one that we can treat is called a cervicogenic headache. These headaches are normally preceded by neck pain and patients present with restricted range of motion, joint mobility limitations in their upper neck joints, and impairments in the musculature around the neck. Addressing these impairments are the name of the game for treatment for these individuals.


Five: Whiplash.

Whiplash most commonly occurs with car accidents. Those with whiplash tend to have moderate to very high levels of pain and disability which is where physical therapy for whiplash comes in. They can have referred symptoms to their upper quarter, very limited mobility due to muscle guarding and just general sensitivity. These individuals require personalized approaches as interventions should be progressed and regressed as needed based on tissue irritability levels. Your physical therapist should also screen for potential structural involvement of the neck and refer for imaging if needed.

So what the heck is wrong with your neck?!

Well it could be a number of things, but thankfully we have the examination skills and research to back these categories of neck pain and treatment for them. Reach out for a more individualized assessment and plan of care and let’s get rid of that dang neck pain!

Neck Pain: Revision 2017. J Orthop & Sports Phys Ther. 2017; 47 (7): A1-A83.