Frequently Asked Questions

Neck Pain

Neck pain is a term usually used to describe pain that has been present for less than six weeks. The causes however are many. Neck pain can be felt anywhere between the base of the skull and the upper shoulder area. Often it can be felt in a very local area on the back or side of the neck, but it can also spread. When pain is coming from structures in the upper part of the neck it can spread to the head causing a neck-related headache, while pain coming from structures in the mid to lower part of the neck may spread to the upper back or into the arm. Neck pain can be acute (lasting less than six weeks) or recurrent (persisting longer than six weeks).

Acute neck pain describes a neck pain or ache when the head is still and which has been present for less than six weeks. The movements of the neck are frequently reduced and, in some circumstances, a sharp pain may be felt with certain movements such as turning quickly or looking up. For some people, it may be the first episode of pain and for others, it may be a subsequent or recurring episode.

There may be a specific incident or unusual activity that results in acute neck pain. It may come on suddenly from a trivial incident, such as a quick turn of the neck or sleeping in an awkward position. Sometimes the neck feels as though it is “stuck”. On the other hand, there may be a more substantial injury such as hitting the head on the side of a pool or tree branch while gardening, or a fall from a bike. In many other cases, the pain comes on gradually over hours or days, and is often related to unfamiliar activity like painting ceilings or working in a poor or awkward posture. As a result of the incident or unfamiliar activity, neck joints and ligaments become strained and painful and in response muscles usually react to restrict movement and become painful themselves.

Acute neck pain can range in intensity from mild to moderate, and is usually made worse by head and neck movements. The neck is usually tender to touch and sleeping may be uncomfortable. On very rare occasions acute neck pain may have a serious medical cause, eg pain felt running up the front of the neck which may be coming from the heart. A rapid onset and rapidly worsening upper neck pain, with a very unusual severe headache, may indicate a problem with an artery in the neck, and this will require immediate medical investigation.

Your physio will undertake a clinical assessment of your neck to identify the likely cause of your pain and how it affects movement of your neck joints and associated muscles (which may be in spasm or weak in response to pain). They will then determine which treatment approach would best help ease your pain and restore normal function of your neck.

During your treatment session your physio will:

  • explain the reason for the pain and provide assurance
  • apply gentle hands-on treatment
  • prescribe specific exercises
  • advise on self-management strategies to use at home such as application of soothing ice or heat, sleeping positions and activities to avoid


Physios often use manual therapy consisting of rhythmic movement (mobilisation) to treat your neck pain, but on occasions a manipulation (referred to as an “adjustment” by other manual therapists) may be deemed necessary. The evidence suggests both of these manual therapy methods are equally helpful. Soft tissue massage may also be incorporated into your treatment.

Your physio will most likely recommend gentle specific exercises that have several purposes:

  • ensuring the muscles supporting the neck continue to work
  • helping to ease pain
  • aiming to restore normal neck movements


The exercises are progressed as pain settles, in order to restore normal movement and muscle function after an acute episode of pain. X-rays are usually unnecessary but if you have sustained a forceful injury X-rays will likely be required to rule out fractures.

A neck condition is often called recurrent when a person has chronic mechanical neck pain which means they experience recurring episodes of neck pain, or chronic neck pain where the pain never really goes away. The word “mechanical” indicates that there is no specific disease process (as in rheumatoid arthritis for example).

Many people, after having one episode of neck pain, will have another episode some months or years later. Evidence suggests that this may occur over a person’s lifetime or for a good part of their life. About one-third of people with chronic or recurrent neck pain also report symptoms such as light-headedness or a dizzy feeling, some unsteadiness with balance and occasional visual symptoms.

There are many possible reasons why neck pain becomes recurrent or chronic in nature, but the most common is a build-up of repeated minor strain caused by poor or prolonged sitting postures at work which is made worse by prolonged “head-down” postures.

Other causes of neck pain include disc degeneration and osteoarthritis of the small joints in the neck. Osteoarthritis (OA) can occur in any age group but is more common in the middle-aged to older population. Arthritis may be secondary to injury or over-loading of the neck, but it also appears that some people have a genetic predisposition to developing osteoarthritis.

You will have recurrent neck pain if you experience repeated episodes over many months or years. Chronic neck pain is more continuous pain, although it may fluctuate in intensity on a weekly, monthly or annual basis. The pain will be felt in the back of the neck and may spread into the head if the upper joints are symptomatic, if it is a lower neck problem pain may spread down the back or into the arms.

The diagnosis is made on your symptoms rather than on X-ray findings as there is not a direct link between the severity of neck pain and what is seen on X-rays.

Your physiotherapist will first aim to fully understand your concerns about your neck and how your neck pain and other symptoms affect your daily activities and sleep. They will then undertake a comprehensive clinical examination to analyse your posture and the tasks and movements that aggravate your symptoms in order to determine their management and treatment approach, which may include:

  • education, advice, assurance to alleviate concerns about your disorder
  • manual therapy treatment which to help ease the neck pain and associated symptoms
  • exercises to ease pain, improve postural stability, and to improve movement, strength and endurance of neck muscles
  • advice for work and home where prolonged and/or awkward postures, poor lifting and carrying techniques may aggravate the condition
  • devise an individualised self-management program to help prevent future recurrences and how to manage symptoms if they do arise