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June 10, 2022
Updated June 10, 2023

A Physical Therapy Guide to Neck Pain (Cervicalgia)

Man standing up straight against a mirror

Introduction

Neck pain is a common problem that can occur for many reasons. If you are experiencing neck pain, also known as cervicalgia, there are steps that you can take to manage the symptoms and improve your quality of life.

There's a reason why the expression "pain in the neck" is so common. Neck pain is the 4th leading cause of worldwide disability. Approximately 50% of individuals will experience a significant episode of neck pain in their lifetime.1

Let's dive into the causes of pain, symptoms, and the best ways to manage cervicalgia. Working with a CityPT physical therapist is a great way to manage your neck pain effectively.

Table of Contents

What is Cervicalgia (Neck Pain)?

Cervicalgia is a broad term that refers to pain in the neck. It is often used to describe pain that is explicitly felt in the neck, also known as the cervical spine. However, it can also include headaches and pain that "refers" down the shoulder and arms when nerve tissue is involved.

Illustration of the cervical spine including the bones, nerves, and blood vessels
The bones, nerves, and blood vessels of the cervical spine

The cervical (upper) spine consists of the top 7 vertebrae of the spine between the skull and the top of the shoulder blades.2 Since the spine houses and protects delicate tissues of the spinal cord, paying attention to symptoms and neck health is essential. Thus, recognizing and differentiating symptoms will help you decide if it's time to get medical help.

Symptoms of Cervicalgia (Neck Pain)

The symptoms of cervicalgia (neck pain) can vary depending on the underlying cause. However, the most common symptom is pain that is felt in the neck. This pain can range from a dull ache to sharp or throbbing pain and be acute or chronic in nature.

Other symptoms associated with neck pain include:

  • Stiffness or spasms of the neck muscles
  • Headache
  • Difficulty moving the head or neck (turning the head, tilting the head, or looking up or down)
  • Discomfort when bending forward, lifting, coughing, straining, etc.
  • Tenderness to touch in the surrounding musculature
  • Pain with neck and head position in bed

Symptoms that might indicate nerve involvement include:

When the health of neural tissue in the neck is compromised or over-sensitized, it can lead to the following cervicalgia symptoms:

  • Tingling or numbness in the arm
  • Radiating pain into the shoulder, arm, wrist, or hand
  • Arm weakness or loss of grip strength
  • Difficulty with coordinated use of the arm or neck muscles, such as with reaching or turning the head
  • Dizziness or feeling off-balance
  • Nausea
  • A change in bowel or bladder control

What's Next?

If you are experiencing any of these symptoms, it's important to seek immediate medical attention, particularly if you are having neurological symptoms, such as tingling, shooting pain, sudden weakness, or changes in bowel or bladder control.

A healthcare professional, such as a physical therapist, can help diagnose the underlying cause and provide you with treatment options. While the reasons are most often related to ergonomic factors and imbalances, occasionally, a more sinister issue needs to be addressed, such as the compression of nerve tissues.

Illustration of the bones and muscles of the cervical spine, thoracic spine, and shoulder
The bones and muscles of the cervical spine, thoracic spine, and shoulder

What Are the Most Common Causes of Cervicalgia?

A wide range of underlying causes can lead to neck pain. Knowing the causes of your neck pain, with the help of your healthcare provider, will help you manage your pain effectively.

Age-related Changes of the Spine (Arthritis)

This includes degenerative disc disease, where the shock-absorbing discs of the neck lose their normal height and elasticity. Ultimately, this can lead to the onset of osteoarthritis (loss of joint cartilage and mobility), cervical spondylosis, and radiculopathy. (See these conditions below.)

Osteoporosis

Illustration of a cervical osteoporosis
Detail of cervical osteoporosis, which is a deterioration of bone tissue in the neck

Osteoporosis is a condition where the bones of the spine become thin and porous. This can cause compression fractures of the vertebrae and lead to pain, deformity, and height loss of the spine. While this can happen in the cervical (upper) spine, it's more common to see a compression fracture in the thoracic (mid) spine.

Herniated Disc

Illustration of a herniated disc injury
Detail of a herniated disc, where the outer layer of the disc leaks or protrudes, irritating spinal nerves

A herniated disc occurs when a weak spot or tear in its outer connective tissue causes the gel-like center of a spinal disc to shift. This can happen from an injury or degeneration over time. If the herniated disc presses on a nerve, it can cause pain, numbness, or weakness.

Hyperkyphosis

Illustration of a before and after view of a spine with hyperkyphosis
As time passes, the spine may gradually deform into an exaggerated, head-forward posture

Hyperkyphosis is a condition that affects the spine and can cause a "humpback" appearance. This happens slowly over a long period of time. The exaggerated curvature of the spine can put pressure on the nerves and muscles in the neck and back, leading to pain, muscle spasms, and a stiff neck.

Radiculopathy

Illustration close-up of cervical vertebra, spinal cord, and a pinched nerve causing cervical radiculopathy
Cervical vertebra, spinal cord, and pinched nerve causing radiculopathy

Radiculopathy, sometimes referred to as pinched nerve, occurs when one of the spinal nerve roots is compressed or irritated as it branches from the spinal cord, most often due to bone spurs or disc degeneration. It can cause pain that radiates down the shoulder and arm.

Acute Injury to the Neck

Illustration of the whiplash injury occurring
Whiplash injury may occur if the head is thrust suddenly forward and then backward

An acute injury to the neck or head happens suddenly, such as whiplash (neck strain) or a concussion from a car accident, sports injury, or a fall. Whiplash, concussion, or other previous neck injury can lead to chronic lingering dysfunction.

Facet Joint Syndrome

Illustration of facet joint syndrome anatomy and action
Cartilage inside facet joint breaking down and causing pain

The facet joints are the small joints between each vertebra that allow for spine movement. Facet joint syndrome is a general term that describes the pain and inflammation of these joints.

Myofascial Pain

Illustration of neck muscle anatomy with myofascial pain
Myofascial pain is commonly associated with trigger points in the neck and upper back

Myofascial pain is characterized by chronic muscle pain and tenderness. Trigger points, also known as muscle knots, can form in the muscle tissue and lead to pain.

Cervical stenosis

Illustration of the cervical stenosis
Detail of cervical stenosis, a degenerative compression of the spinal cord and nerve roots

Cervical spinal stenosis is a condition where the spinal canal narrows and puts pressure on the spinal cord. This can cause pain, weakness, and numbness in the arms and legs.

Tumors

Illustration of a cervical tumor
Detail of abnormal growths or masses that may occur within the spinal column

Both benign and malignant tumors can grow in the neck and cause pain.

Infection

Illustration of an osteomyelitis infection
Detail of Osteomyelitis infection from bacteria or fungi invading the bone, and forming an abscess

Infections of the spine, such as osteomyelitis, can cause cervicalgia.

Poor Posture and/or Muscle Imbalances

The muscles and surrounding connective tissue of the neck work best when in an optimal position. To avoid what is considered "poor posture," the head and neck should be held in a neutral position that allows the muscles to work in balance with less amount of strain.

BPPV

Illustration of vestibular and inner ear anatomy
Example of vestibular and inner ear anatomy causing BPPV

BPPV stands for Benign Paroxysmal Positional Vertigo. It is a condition that causes dizziness and nausea when you move your head in certain positions. It is thought to be caused by debris that collects in the fluid-filled canals of the inner ear. It also increases the risk of sustaining an injury from falling.

Stress, Anxiety, or Depression

Illustration of chemicals changes from stress and anxiety leading to physical pain
Stress and anxiety can make pain feel more significant, intensifying the experience of neck pain.

These conditions can cause muscle tension and pain. Neurochemical changes in the brain from stress, anxiety, depression, and other mental health concerns can lead to physical symptoms that need to be properly addressed. Treatment may include physical therapy, psychological intervention, medicine, lifestyle changes, and processing of trauma.

Muscle Strain

Illustration of person holding box at chest level showing neck muscle strain action and anatomy
Strenuous activities that are unusual for you may cause muscle strain

The injury occurs with repetitive motions (at work or with daily activities), lifting something too heavy, sleeping in an awkward position, or prolonged poor posture.

Inflammatory Illness

Illustration of meningitis infection
Detail of meningitis, which is an inflammation of the protective membranes surrounding the brain and spinal cord

Acute illness, such as a bacterial infection like meningitis, can lead to symptoms of redness, heat, swelling, fever, and stiffness that affect the neck.

Chronic Conditions

Chronic health-related conditions, such as rheumatoid arthritis (RA), lead to systemic inflammation in the body. RA can cause neck pain but is most commonly associated with bilateral (both sides of the body) hand, knee, hips, and ankle pain.

These are the top potential causes of neck pain. A CityPT clinician can help differentiate where your pain is coming from to offer the best possible treatment and recovery (and refer out when needed). It's always best to get care sooner than later to prevent or manage the onset of debilitating chronic pain.

Diagnosing the Cause of Your Neck Pain

Ready for some answers related to your neck pain?

For standard care, a healthcare provider will take a medical history of your symptoms and perform a physical exam. They may ask questions like:

  • When did your pain start?
  • What activities make your pain worse?
  • Does anything relieve your pain?
  • What activities are you avoiding or modifying right now due to pain?
  • Do you have any other symptoms, such as headache, dizziness, or numbness?

They may also order imaging tests, such as an X-ray, MRI, or CT scan, to further assess the cause of your neck pain. These tests can help to rule out serious causes of back and neck pain, such as a herniated disc or spinal stenosis. However, it's important to note that imaging does not always indicate the severity of pain or dysfunction. It must be taken into context with your current symptoms and how you're moving.

For above-standard care, a CityPT clinician will also talk to you about your lifestyle, habits, and mental state to ensure all underlying pain causes are adequately addressed.

How to Choose a Physical Therapist for Neck Pain

If you're looking for a physical therapist to help you with your neck pain, first find a board-certified PT care provider with experience in orthopedics and treating neck pain. Also, choose a provider that can spend around 45 minutes with you for every visit (you'll be surprised that many therapists will see you for 60 minutes at your first visit and then 10 to 20 minutes for subsequent visits).

Finally, consider the many advantages of virtual physical therapy for accessing above-standard care from the comfort of your home.

Treatment Options for Cervicalgia

The best treatment for cervicalgia is often a combination of self-care and physical therapy (PT). PT can help to address the true cause of your neck pain, not just the symptoms.

What You Can Expect from Physical Therapy for Neck Pain3

  • Pain Management: A physical therapist can help initially relieve pain and reduce discomfort (acute or chronic neck pain) with a combination of manual therapy techniques, modalities (ice, heat, etc.), exercises, and education.

  • Manual Therapy: Manual therapy is a type of treatment that uses the hands to expertly manipulate the soft tissues and joints of the body. It can help to release muscle tension, increase range of motion, and reduce pain when needed.

  • Modalities: These passive treatments use hot and cold packs, electrical stimulation, ultrasound, and other methods to help manage pain and promote healing. These can help alleviate pain initially but should never be the primary focus for a sustainable recovery.

  • Personalized Exercises: Exercise is an integral part of PT. They can help stretch, strengthen and balance the neck muscles, increase muscular endurance — particularly of key postural muscles — improve range of motion, and promote neural tissue health and healing. A physical therapist will work with you to design a personalized exercise program specific to your needs and goals.

  • Education: Perhaps the most important part of treatment is education. A great physical therapist will teach you about your condition, how to manage your pain, and what you can do to prevent future injuries. They will also provide information on stress reduction techniques, posture, activity modification, ergonomics, and proper body mechanics.

  • Addressing the Whole Body: They may also provide you with tools or refer you to a specialist for managing other areas of your health, such as sleep, ergonomics, and diet. These will help you get down to the root cause of your pain.

The Goal with Physical Therapy for the Neck

Ultimately, your physical therapist will help you feel in control of your neck pain and other related symptoms with an independent home program. If your symptoms change, you have severe pain, or you continue to experience neck pain long-term, you can troubleshoot with your CityPT clinician as needed.

This can help you avoid unnecessary invasive, costly, and disruptive interventions to your body's chemistry, such as addictive prescription pain relievers or muscle relaxants,4 steroid injections, and surgery. Even if pain persists and these interventions cannot be avoided, PT for neck pain can help maximize your outcomes and reduce your dependence.

How to Prevent Neck Pain

Like any condition that elicits pain, not all cases of cervicalgia can be prevented. Yet, some strategies can reduce the risk of this condition so that you can avoid neck pain. These include:

  • Take care of your neck by avoiding activities that cause excessive strain (this will differ for each individual and their activity level).
  • Take frequent breaks from awkward positions (if your work or hobby requires such positions).
  • Take breaks from prolonged static positions such as sitting.
  • Modify aggravating moves or positions with better biomechanics and posture when possible.
  • Make good posture a top priority. Although posture is dynamic and changing, try to set up your desk, car, and couch to promote optimal spine alignment to reduce strain and avoid "poor posture" habits. Choose places to sit that offer adequate lumbar support and keep the entire upper body erect and aligned. Imagine the head is a golf ball that needs to be balanced on a tee (your spine)!
  • Lie in an optimal sleep position with the spine in neutral to ease the common onset of muscle tension and stiffness.
  • Avoid using bifocal and trifocal lenses that put your neck in a suboptimal position.
  • Ditch the heavy diaper bag, backpack, purse, or briefcase that puts uneven pressure on your spine- especially if they are resting over one shoulder.
  • Move your body regularly. Your muscles and other connective tissues thrive on consistent exercise and movement. Try to get in some form of exercise every day if possible.
  • For the neck, exercises that regularly addresses the chest muscles and shoulder muscles is essential.
  • Make healthy lifestyle choices. Try simple lifestyle changes like adequate sleep, a nutrient-dense diet, stress management, hydration, and not smoking. These boost your body's tissue health via adequate blood flow to boost healing potential, reduce inflammation and decrease the risk of injury and pain.

Don't Suffer Through Your Neck Pain

If you struggle to find pain relief, consider contacting a CityPT clinician. They can help you maintain and improve your life's quality without suffering excessive pain.

Ready to feel your best and feel in control of your neck pain? Contact us today to book an appointment. We would be more than happy to help you.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References

Footnotes

  1. Physiopedia. Epidemiology of Neck Pain. Physio-pedia.com Accessed May 3, 2022. https://www.physio-pedia.com/Epidemiology_of_Neck_Pain ↩

  2. Slosar, Paul. Cervical Spine Anatomy. Spinehealth.com. Accessed May 3, 2022. https://www.spine-health.com/conditions/spine-anatomy/cervical-spine-anatomy ↩

  3. Steven P. Cohen. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings. Volume 90, Issue 2, 2015, Pages 284-299, ISSN 0025-6196. https://doi.org/10.1016/j.mayocp.2014.09.008 ↩

  4. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718095 ↩