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A Physical Therapy Guide to Neck Pain (Cervicalgia)

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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.

Table of Contents

What is Cervicalgia (Neck Pain)?

Cervicalgia is a broad term that refers to pain in the neck. Most often, it is used to describe pain that is felt specifically 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 spine consists of the top 7 vertebrae of the spine between the skull and top of the shoulder blades.2 Since the cervical spine houses and protects delicate tissues of the spinal cord, paying attention to symptoms and neck health are very important. Thus, being able to recognize and differentiate symptoms will help you decide if it's time to get medical help.

Symptoms of Cervicalgia (Neck Pain)

The symptoms of cervicalgia 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 may include:

  • Muscle stiffness or spasms
  • 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:

  • Tingling or numbness in the arm
  • Shoulder, arm, wrist, or hand pain
  • Arm weakness or loss of grip strength
  • 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 medical help, particularly if you are having neurological symptoms (as indicated by the section above). A healthcare professional, such as a physical therapist, will be able to diagnose the underlying cause and provide you with treatment options. While the causes are most often related to ergonomic factors and imbalances, occasionally there is a more sinister issue that needs to be addressed, such as 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?

There are a wide range of underlying causes that 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 Cervical Spine

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

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 spine, it's more common to see a compression fracture in the thoracic spine.

Herniated Disc

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 with degeneration over time. If the herniated disc presses on a nerve, it can cause pain, numbness, or weakness.

Hyperkyphosis

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, which can lead to pain, muscle spasms, and stiffness.

Radiculopathy

Radiculopathy occurs when a nerve is compressed, pinched, or irritated as it exits the spine, 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

An acute injury to the neck or head is one that happens suddenly, such as whiplash or a concussion from a car accident, sports injury, or a fall. Whiplash or a concussion can lead to chronic lingering dysfunction.

Facet Joint Syndrome

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

Myofascial Pain

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

Cervical 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

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

Infection

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 they are in an optimal position. 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

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 risk of sustaining an injury from falling.

Stress, Anxiety, or Depression

These conditions can cause muscle tension and pain. Neurochemical changes in the brain lead from stress, anxiety, depression, and other mental health concerns 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

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

Inflammatory Illness

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 physical therapist 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 history of your symptoms and perform a physical examination. 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 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 make sure all underlying causes of pain 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. Additionally, choose a provider that will be able to 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 utilizing virtual physical therapy for accessing above-standard care from the comfort of your own home.

Treatment Options for Cervicalgia

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

What You Can Expect from Physical Therapy for Neck Pain4

  • Pain Management: A physical therapist can help initially manage your 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 are passive treatments that use heat, cold, 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 important part of physical therapy. They can help to stretch, strengthen and balance the muscles of the neck, 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 that is specific to your needs and goals.

  • Education: Perhaps the most important part of physical therapy 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 you with information on 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 as well, such as sleep, ergonomics, and diet. These will all help you get down to the true root cause of your pain.

The Goal with Physical Therapy

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 can always troubleshoot with your physical therapist as needed too.

This can help you potentially avoid unnecessary interventions that are invasive, costly, and disruptive to your body's chemistry, such as addictive prescription medication,3 injections, and surgery. Even if these interventions cannot be avoided, physical therapy 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. These include:

  • Take care of your neck by avoiding activities that cause excessive strain.
  • Take 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. 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)!
  • Learn how to sleep in an optimal position with the spine in a neutral position.
  • Avoid the use of 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.
  • Make healthy lifestyle choices. Adequate sleep, a nutrient-dense diet, stress management, hydration, and not smoking all boost your body's tissue health, reducing the risk of injury and pain.

Don't Suffer Through Your Neck Pain

If you are struggling to find pain relief, consider reaching out to a physical therapist. They can help you maintain and improve the quality of your life without having to suffer excessive pain.

Ready to feel your best? 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


  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