- Neck Pain Facts
- Learn about your Neck
- What are the main causes of Neck Pain?
- What increases the chances of getting neck pain?
- How is neck pain diagnosed?
- Do I need a scan? Do I need to see a specialist?
- What treatment options are there for each type of problem?
- What can I do to help my neck pain?
- Our best advice and tips for helping your neck pain
- I have seen a specialist or surgeon and they have recommended surgery, what should I do now?
- What can you do to give yourself the best chance of not developing neck pain?
- The latest research on neck pain
Neck Pain Facts
So, you are struggling with neck pain? Well you’re not alone! Neck pain is surprisingly common:
- it is the fourth leading cause of disability in Australia
- over 30% of us will have an episode of neck pain this year
- approximately 50-75% of us will have a significant episode of neck pain in our lifetime
It’s not all doom and gloom! For the vast majority of people who have an episode of neck pain, symptoms settle within a few weeks.
Thankfully, less than 1% of neck and back pain presentations are serious.
Learn about your Neck
Unless you’ve got a sore neck, you probably haven’t given all that much thought to this remarkable and complex structure and the vital role that it plays in our lives.
Our neck forms the major connection between the head, the trunk, and our limbs. It has to be strong and robust to house and protect vital nerves, blood vessels and organs and support the weight of our heads (as heavy as a bowling ball!).
Yet our neck must be very mobile to allow movement in an array of different directions to support our vision.
Our spine consists of 33 irregularly shaped bones called vertebrae which stack one on top of the other.
The top seven vertebrae of our spine form the neck, or cervical spine. You may have heard these vertebrae numbered from one to seven, which simply refers to the bones position in the ‘stack’.
One is at the very top, seven is at the bottom. Incredibly, a giraffe’s neck is approximately 1.8 metres long, yet it has the same number of vertebrae as you!
Each of the cervical vertebrae are securely connected to the vertebrae above and below by two facet joints and an intervertebral disc.
The spine is further supported by a network of tough connective tissues that connect from one bone to another, called ligaments.
Overlaying the bones and ligaments, there are 26 muscles that support, protect and provide movement to our neck.
What are the main causes of Neck Pain?
The wonderful complexity of the anatomy and function of our neck, and the broad array of neck pain presentations can mean it is often difficult narrow down the cause of our pain to one very specific structure.
In order to help understand and communicate a diagnosis, your health professional may categorise your neck pain in the following ways:
- The most likely structures involved with neck pain are:
- muscles and ligaments that support the neck
- cervical facet joints
- cervical discs
- neural (nerve) structures
Traumatic or atraumatic:
- simply referring to the degree of force that was required to cause injury.
Acute, chronic or episodic:
- Acute pain refers to pain episodes that have lasted for a period of less than 6-weeks.
- Chronic or persistent pain refers to episodes that have lasted beyond 12-weeks.
- Episodic pain refers to recurrent episodes of the same type of pain and injury.
Neck pain conditions that we most frequently see presenting to myPhysioSA Physiotherapy include:
- Acute wry neck
- a stiff and painful neck related to a sprain or strain to neck muscles and ligaments. It commonly occurs after sleeping in an awkward position or turning the head in an awkward direction.
- Postural neck pain
- sustained and awkward postures, such as long periods working at a computer or looking at phone and tablet screens, increase strain on the muscles and joints of the neck.
- Cervical spondylosis
- Cervical spondylosis is a general term for age-related degenerative changes that may affect your neck.
- Spondylosis is characterised by the thinning of the intervertebral discs and osteoarthritic changes in the joints if your neck.
- Typically, spondylosis may present as persistent stiffness and soreness of the neck, particularly in the morning.
- Whilst it is very normal for see spondylosis on scans such as x-rays in an older population, thankfully, the vast majority of people do not experience any symptoms associated with the changes that can be seen on the scans.
- Whiplash is a general term for a neck pain and stiffness that develops after a sudden and forceful movement of the head and neck which may cause strain to the muscles and ligaments.
- Whiplash is commonly associated with motor vehicle accidents, but can also be a result of other forms of trauma such as falls and sporting collisions.
- People who sustain a whiplash injury often report that pain develops and increases in the hours after their incident, but generally settles within days to weeks.
Did you know that your neck might be causing pain to refer to other places?
Headaches can be caused by upper neck issues.
Most headaches or migraines are now thought to be as a result of an over-excited lower brain stem.
Specifically, part of the brainstem called the trigeminocervical nucleus (TCN).
Upper neck dysfunction including poor posture, stiffness, joint inflammation and strain and lack of muscle control can overly excite the TCN.
More information on headaches:
Other factors separate to upper neck dysfunction that can cause over excited TCN are over-activation of nerves of the face, mouth, ears and teeth. A lack of chemicals that usually suppress some of these messages to the brain and also an imbalance of a specific chemical called serotonin.
For this reason, it is important to be able to reproduce your headache by influencing your upper neck to check if your symptoms are actually coming from your neck and not one of the three other factors listed above. In the clinic we will specifically assess the upper three vertebrae and where they articulate with each other at their facet joints and discs. Different levels of the upper three vertebrae have common referral patterns.
The location of your headache, ie. forehead, behind the eye, temple or the back of the head will help guide us where to begin the assessment. We then aim to reproduce your headache and then we can use a variety of techniques to alleviate it. We will also assess for tightness of the muscles around the neck, which may be contributing to a tension headache.
If we determine that poor posture, habits or weaknesses are contributing to your upper neck dysfunction we will advise on any postural or ergonomic changes and provide specific exercises.
Arm pain can be caused by a problem in the neck and you may or may not have stiffness in the neck.
The problem arises when the nerve root of one or more of the nerves coming out of the neck area (cervical spine) is compromised as it passes through a gap between vertebrae (intervertebral foramen). This can be as a result of:
- bony spurs off the surrounding neck joints
- disc changes
- inflammation of a nearby structure
Muscle tension and specifically myofascial trigger points around the neck can also cause arm pain. Trigger points can result from overuse of certain muscles or from muscles in an overly lengthened position. Muscles close to the neck that can refer pain to the arm include:
- seratus muscles
- terres major
Pins and needles in your hand and arm
Pins and needles in your hand and arm can occur as a result of the same changes mentioned above. With pins and needles or numbness the parts of the nerves that control sensation are affected.
With sensory changes we have to be mindful of the potential for nerve root compression from a bulging disc.
The location of the pins and needles or numbness gives us an idea to the level of the nerve root involvement, ie. which vertebrae of the neck.
Tight upper back
A tight upper back can occur due to referred pain resulting from changes in the lower neck joints. This includes:
- Stiffness of the facet joints (outside part of the vertebrae that moves against the vertebrae above and below)
- Inflammation of the discs
- Wear and tear of these joints
Tightness in the upper back can also occur due to trigger points developing. This can be either indirectly as a result of the above joints changes or directly due to overuse of the muscles due to bad posture or an unusual task.
These muscles include:
- levator scapulae
Sinus type pain can also be caused by neck related trigger points. Specifically, the sternocleidomastoid and upper trapezius muscles. Tension here can refer into the sinus area producing pain which feels similar to sinusitis.
If you have any one of the above problems and you also have a stiff or sore neck then you should get your neck checked.
Our Physio’s at myPhysioSA see these problems all the time and can quickly help you.
By Anthony Sheridan
myPhysioSA Associate Physiotherapist Mount Barker Adelaide
What increases the chances of getting neck pain?
Many factors are associated with an increased risk of the development or persistence of neck pain.
- Occupation: particularly demanding or particularly sedentary work environments.
- Lifestyle: poor general health and fitness (overweight, smoking), sedentary behaviours.
- Age: most common in middle age.
- Sex: more common in females.
- Genetics: many diseases and disorders that contribute to back pain run in the family.
- Previous injury: if you have had a previous episode of neck pain then you are more likely to experience neck pain.
- Mental health: neck pain is more common and likely to be more persistent in those that suffer with mental health disorders such as anxiety and depression.
How is neck pain diagnosed?
In most instances, a bout of neck pain may come and go within a few days without the need for thorough assessment and diagnosis. However; when an episode is severe, persistent, or recurring; a thorough assessment and diagnosis is important to direct an appropriate treatment plan.
Different types of injuries tend to have particular ‘patterns’. Being able to recognise these patterns enables your health professional to form a diagnosis and direct you to appropriate management.
Watch Cameron, A spinal physiotherapist discuss how a physiotherapist will assess and treat neck pain:
When you seek help from your myPhysioSA Physiotherapist, they are likely to ask a range of different questions about you and your neck pain.
These questions help to uncover details of the nature of the injury and the impact that it is having on you.
Typical questioning may include:
- Where and when does it hurt?
- How did the injury occur?
- What makes the pain worse?
- What makes the pain better?
- Have you had this problem before?
- How does this injury effect your work, sport, social life?
Guided by the answers that you have provided, your myPhysioSA Spinal Physiotherapist is then likely to perform a number of assessments, known as a physical examination.
Typically, this would include:
- Observation: looking at postures that may contribute to pain, looking for any abnormalities.
- Palpation: feeling the muscles and joints around the neck and shoulders for areas of stiffness, tightness or tenderness.
- Movement assessment: moving the neck in a range of different directions, looking for restriction and pain.
- Strength assessment: assessing the strength of the muscles of the neck, shoulders and arms.
- Neurological assessment: testing sensation, muscle strength, and reflexes gives information about the function of your nerves.
- Functional assessment: when a patient describes pain or problems with performing a specific task (for example; backing the car out of the driveway), the health professional may choose to look more closely at the way that the task is performed.
In the vast majority of cases, thorough questioning and physical examination is sufficient to provide you with a diagnosis. However; in some instances, you may be referred for scans or investigations to provide further information.
It is important to recognise that scans need to be used judiciously because they can often show up all sorts of little issues in the neck that are completely age appropriate and unrelated to your symptoms.
When not used judiciously or explained thoroughly, scans can often result in confusion and unnecessary anxiety for the patient.
Do I need a scan? Do I need to see a specialist?
As mentioned previously, in the majority of cases, scans and investigations are not required to diagnose and manage your neck pain. Likewise, the vast majority of neck pain presentations resolve without the need to consult a specialist.
Check out this interesting article that explains what a doctor will consider before referring you for scans, as well as the pitfalls of unnecessary scanning:
Scans may be needed if you have:
A/ Red flags
Red flags are signs and symptoms that indicate possible serious pathology and the need for further investigation and, possibly, specialist referral.
Red flags include:
- Possible fracture
- Major trauma
- Minor trauma in elderly or osteoporotic patient
- Possible tumour/infection
- Age < 20 or > 50 years
- History of cancer
- Constitutional symptoms (fever, chills, weight loss)
- Recent bacterial infection
- A history of IV drug use
- Pain worse at night or when supine
- Possible significant neurological deficit
- Severe or progressive sensory alteration or weakness
- Bladder or bowel dysfunction
B/ Deteriorating neurological signs
Worsening numbness, weakness and tingling or inability to normally use your bladder or bowel are classed as deteriorating neurological signs.
If any of the above worsen then medical advice is needed ASAP. Especially if you lose bladder or bowel function, it can be a medical emergency. Seek urgent medical care.
C/ Symptoms not improving over time despite good conservative management
In general, if you have had symptoms persisting greater than 6- 12 weeks despite help from your GP or Physio then it can be warranted to get an XR to help rule out any red flags or other structural issues.
Have a talk to your GP or Physio and discuss a plan for investigating your back pain further. Often these tests are all clear, which is great! It will mean that your back pain will just take a little more time to improve with the right guidance and advice from your medical team.
What treatment options are there for each type of problem?
A/ Conservative Management including exercise:
Physiotherapy is an excellent choice for conservative (non-surgical) management of your neck pain symptoms
Physiotherapist’s are highly trained medical practitioners.
myPhysioSA Physiotherapist’s Tim Bass, Matthew Ash, Cameron Dickson and Deb Wadham, and Exercise Physiologist’s Courtney Wharton, Lara Watts and Jack Elsworthy have all completed specialised training with Neurosurgeon and Spinal Surgeon Mr YH Yau, interventional radiologists, psychologists, pain specialists and other specialist physiotherapists from interstate and overseas.
How do myPhysioSA Spinal Physiotherapists help?
Physiotherapists trained in spinal conditions are experts in the assessment and treatment of movement. Often patients with a spinal condition have maladaptive movement patterns that are significantly contributing to their pain. Changing these movement patterns using a multi-disciplinary approach has been shown in recent research to be very effective in improving patient’s symptoms (O’Sullivan, 2005).
Read more about our Spinal Physiotherapy services in Adelaide here:
B/ Medication is commonly prescribed to help manage neck pain
Pain Medication Options by Neal Fitton, Mount Barker myPhysioSA Physiotherapist
There are many types of pain medication. In general, all pain medications are referred to as ‘analgesics’. Some analgesics are better for a particular problem then another. With all these different types of pain medication it can be difficult to know what medication works the best for a particular condition.
Therefore, this blog will give some general advice about the most common analgesic and what they are used for. This blog is not giving medical recommendations, rather it is providing general information.
Medication is only one way to manage pain and usually can be enhanced by using physical and/or cognitive therapy.
Analgesic Pain Medications
So one of the most common analgesic is Paracetamol (eg. Panadol, panama etc). This medication has been shown to be effective for mild to moderate pain. It is typically used for headache and generalised pain. It also has a fever reducing capability. Paracetamol works by reducing the nerve signals sent to the brain.
Opioids are a stronger form of analgesic (eg. Vicodin, Oxcycodone, Codeine). These drugs are typically used for moderate to severe pain. Opioids work by binding to opioid receptors in the brain and spinal cord. Our bodies can also form its own natural opioids, called endorphins. Opioids reduce pain by reducing the nerve signals to brain. They also effect the regions of the brain that control emotion.
The body can develop a dependence on opioids in just a few weeks. Opioids have significant side effects including sedation, and reduced breathing rate. Because of these factors opioids are a prescription medication that are given cautiously and need to be taken under medical advice.
Anti-inflammatory Pain Medications
NSAIDs (Non-steroidal anti-inflammatory) are commonly used to manage pain relating to inflammation. Therefore, these medications work by changing the body’s response to swelling and pain at a local tissue level. These drugs are effective for muscle strains, and sprains, arthritis, and back or neck pain.
There are many types of NSAIDs.
Common NSAIDs include aspirin, voltaren, nurofen and ibuprofen, which are available over the counter at Pharmacies. Your GP can also supply prescription anti-inflammatories such as Mobic, celebrex, naproxen or stronger voltaren or brufen tablets.
NSAIDs are generally safe in short periods. However, long term use may cause issues with your stomach and liver. Most importantly, NSAIDs should always be taken under the direction of your GP.
Nerve Pain Medications
Nerve pain (also called neuropathic pain) is different from other types of pain. It is typically a result of damage to the peripheral or central nervous system. Common conditions where people experience nerve pain include shingles, diabetes, stroke, and HIV. Typical pain medication has little effect, however, low doses of medication that are used to treat depression and epilepsy have been shown to be effective. Typically, a combination of medication is used.
Anti-depressants are normally used when other analgesic have not been effective. They work by reducing pain signals sent to the brain. They also correct the imbalance of chemicals in the brain (noradrenaline and serotonin). Amitriptyline (eg. Endep), a type of anti-depressant, has been demonstrated to be effective at reducing pain for diabetic neuropathy, facial pain and postherpetic neuralgia.
Pregabalin (Lyrica) is a type of anti-epileptic. It is used to treat damaged nerves in conditions such as diabetic neuropathy, stroke, spinal cord injury and multiple sclerosis. It has been shown to improve pain and sleep in some patients with diabetic neuropathy or herpetic neuralgia.
C/ Injections and interventions
An injection of a steroid (synthetic cortisone) medication into the epidural space is called a foraminal epidural injection.
There are two types of these injections.
They both involve injecting steroid into the epidural space to decrease inflammation and alleviate pain. The main difference is that one spreads the medication into the back of the epidural space and along a more diffuse pattern, hitting multiple levels during a single injection.
Alternately, a transforaminal injection spreads the medication into the front of the epidural space, and is more specific to certain levels and certain affected nerve roots.
These injection options use cortisone, which has a strong localised anti-inflammatory effect, to target where the spinal nerves are being irritated or compressed as they are coming out of the spine.
The injection can be useful in settling the local area and reducing leg symptoms, and occasionally low back pain as well.
Remember though, injections aren’t usually recommended prior to the 12-week mark.
The steroid medication begins to take effect in one to two days at which point you should start to see some benefit. The steroid will continue to improve with the peak effect occurring at about two weeks.
Thereafter, the effect will stabilize and should last several weeks to months.
Typically, the pain relief experienced from this procedure lasts 3-6 months, but there is significant variability from patient to patient and from one procedure to another.
A GP or specialist may refer you for a steroid injection, but what is it?
A steroid, or cortisone/corticosteroid, injection contains a strong anti-inflammatory medication that may help to settle pain that is not changing with physiotherapy management or that is hindering you from completing an exercise program or functioning with daily life. A cortisone injection may be administered for certain conditions to relieve pain, such as for bursitis, mild trigger finger or low back pain, but injections of cortisone and an anaesthetic such as lidocaine can sometimes be used to confirm a diagnosis.
For example, corticosteroid injections given in the shoulder may reduce localised soft-tissue inflammation or bursal inflammation. Epidural injections in the lumbar spine are cortisone injections inserted into a specific location in the spinal canal of the low back by a specialist under X-ray guidance. These injections may help relieve back pain and sciatica. Epidural injections can also be given in other areas of the spinal canal to relieve upper back and neck pain.
How are they administered?
Corticosteroid injections are commonly delivered by a specialist under a guided ultrasound to ensure the correct structure is targeted. Corticosteroid, as well as a local anaesthetic (such as lidocaine), may simultaneously be drawn into a syringe, which is then inserted into the tissue where the solution is injected. The needle is withdrawn and a sterile bandage is applied to the injection site. At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take up to 14 days for someone to notice a change in symptoms.
Short-term complications are uncommon but include:
- Shrinkage (atrophy) of the subcutaneous fat/ tissues
- Lightening of the of the skin at the injection site
- Local infection
- Local bleeding
- Soreness at the injection site
- Aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (post-injection flare)
- Tendons can be weakened by corticosteroid injections administered in or near tendons. Tendon ruptures as a result of steroid injection have been reported
Long-term complications of corticosteroid injections depend on the dose and frequency of the injections.
With higher doses and frequent administration, potential/rare side effects include:
- Thinning of the skin
- Thinning of the cartilage
- Ligament weakening
- Tendon rupture
- Arthritis due to crystallisation of the steroid
- Elevation of blood pressure
- Cataract formation
- Thinning of the bones (osteoporosis)
- Avascular necrosis or osteonecrosis
How Long Does A Cortisone Injection Work For?
A steroid injection can be used to help reduce inflammation in the short term, but for longer term benefit physiotherapy and active management strategies are most important. With some conditions, the symptoms of the condition recur after a few weeks or months. In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.
To find out whether we can help you with your pain or dysfunction, before or after a steroid injection, contact us now!
By David Wilson
myPhysioSA Physiotherapist Mount Barker Adelaide
D/ Surgical Management (Discectomy and Decompression, Fusion)
Cervical Discectomy and Decompression
Discectomy literally means “cutting out the disc.”
A discectomy is done anywhere along the spine from the neck to the lower back.
The surgeon reaches the damaged disc from the back of the spine. They need to cut through the muscles and bone.
The surgeon accesses the disc by removing a portion of the lamina (a section of your vertebra). The lamina is the bone that forms the backside of the spinal canal and makes a roof over the spinal cord.
Next, the spinal nerve is retracted to one side.
A variety of surgical tools and techniques can be used to perform a discectomy.
An “open” technique uses a large skin incision and muscle retraction so that the surgeon can directly view the area.
A “minimally invasive” technique or a micro discectomy uses a small skin incision. A series of progressively larger tubes, called dilators, are used to tunnel through the muscles.
Special instruments help the surgeon see and operate in a smaller space. A minimally invasive incision causes less disruption of the back muscles and may decrease recovery time.
Surgeons will recommend the technique most appropriate for your specific case.
For more detailed information check out the rest of the article here:
Cervical Fusion Surgery
The below information and images have been taken from https://www.mayfieldclinic.com/pe-fusionpreparing.htm.
Spinal fusion is a surgery that permanently joins together one or more bony vertebrae of the spine.
Fusing the bones together prevents movement at that level, gives back the normal disc space between the bones, and helps prevent future damage to the spinal nerves and cord.
Spinal fusion is usually a ‘last resort” and done only if all other treatments have been explored.
It will not “fix” your back problem or provide complete pain relief.
It will stop the motion in the painful area of your spine allowing you to increase your function and return to a more normal lifestyle—though one that may not be totally pain-free.
Neck pain usually responds well to physical therapy and exercise, so make sure you have done your bit towards a successful rehabilitation before considering surgery.
What you do before and after surgery can help get you back on your feet sooner. It’s important to have realistic expectations and prepare properly for your recovery.
What is spinal fusion?
At each level of the spine, there is a disc space in the front and paired facet joints in the back.
Working together, these structures define a motion segment.
Two vertebrae need to be fused to stop the motion at one segment.
For example, an C4-C5 fusion is a one-level spinal fusion. A two-level fusion joins three vertebrae together and so on.
Bones can be fused together by using your body’s natural healing process, using bone from another place in your body (autograft), using bone from a bone bank (allograft), or with the aid of cage devices.
For fusion to occur between two vertebrae, a bone graft is needed to serve as a bridge.
The bone graft must be placed in a “bed” where the disc nucleus has been removed and the cortical bone drilled to expose the blood-rich cancellous bone inside.
And lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses.
The fusion area is often immobilized and held together with metal plates, rods, screws, or cages.
After surgery the body begins its natural healing process and new bone is formed.
After 3 to 6 months, the bone graft should join the vertebrae above and below to form one solid piece of bone.
With spinal instrumentation and fusion working together, new bone will grow around the metal implants – similar to reinforced concrete.
See the below illustration:
What can I do to help my neck pain?
In most instances neck pain will settle down within a few days without the need for appointment with your doctor or physio!
Try these self-management tips to get you back on track sooner:
- Take it easy, but don’t stop!
- We physiotherapists refer to this as ‘relative rest’. Try to keep performing your usual routines but you might need to take things a bit slower, have more frequent breaks and get a hand with any demanding physical tasks.
- Keep moving
- Try to keep your neck moving in all its different directions. There’s no need to be forceful, but move regularly within your limits.
- Check out these simple mobility exercises: https://www.csp.org.uk/system/files/4_neck_pain.pdf
- Some more general exercise, such as a gentle walk, can do you wonders and help reduce your pain and increase your movement.
- Neck collars and braces are rarely of any use and should be avoided unless you have been advised otherwise by your health professional.
- Heat and/or cold packs
- Hot or cold packs are often a great way to relieve pain and reduce muscle spasm. Many people find that standing under a hot shower is a great place to get their stiff sore neck moving.
- Check out this blog from David, Director and myPhysioSA, about when to choose hot or cold and how to apply it safely: click here to view the heat or ice blog post
- There are a range of easily available (non-prescription) pain medications that may be effective in reducing neck pain. Common examples include paracetamol, ibuprofen, diclofenac, and aspirin.
- Just because a medication is freely available, it does not mean that it is safe or suitable for you. Always discuss your medications with a pharmacist or doctor.
- Massage is a great way to relax tense, sore muscles.
- If you are lucky enough to have a loved one at home who will help you out, try these easy massage techniques from Michael, myPhysioSA massage therapist:
- Get informed
- Usually neck pain is nothing to worry about, but your neck pain might leave you feeling stressed, anxious, or fearful. Searching ‘Doctor Google’ can often leave you even more worried! These feelings can drive us towards behaviours, such as avoiding movement, that hinder a quick and complete recovery.
- In this situation it is important that you get informed by making an appointment with a trusted health professional to put your mind at ease and get you on the path to a speedy recovery.
Our best advice and tips for helping your neck pain
Try this very easy Physio tip to relax your tight neck and upper back muscles
These are the muscles that can cause neck tightness, neck pain and headaches.
If your shoulder blades sit up too high, these muscles will stay tight and just won’t be able to relax.
Simply, you need to remember to bring the shoulder blade back and down gently.
You can then feel the top shoulder/neck muscles instantly relax.
If you are struggling to comfortably turn your neck or your neck just feels stiff, try this easy self treatment technique.
David, a Partner Physiotherapist at our Mount Barker clinic, teaches you a simple self-treatment technique.
It’s easy just use your own hand to help get your neck turning further.
3 exercises for neck pain relief
Sore or stiff neck? Headaches?
Try these 3 exercises every day to give neck pain relief, and improve your posture and neck strength.
David, a Partner Physiotherapist at myPhysioSA, teaches each exercise, and explains how it can benefit your neck.
If your neck pain is affecting your life then get in touch with us and let’s get it sorted.
Headache advice & exercises for helping headaches
What could be causing your headaches? Headache advice.
David, a Partner Physiotherapist from myPhysioSA Adelaide, explains the main types of headaches and what causes each.
After watching this video you should have a good idea of what type of headaches you are getting and how to start helping ease them. At the end David shares his 3 best headache exercises if your headaches are neck or posture related.
There are many types of headaches and David briefly explains each , so you can identify which type you may be suffering from. These include: neck related headaches, tension headaches, migraines, cluster headaches, and headaches from your jaw and surrounding muscles.
Headache & upper neck pain?
Try this great stretch to get some relief from headache & upper neck issues.
myPhysioSA Partner Physiotherapist, David Wilson, shows a simple stretch that can be very effective if done regularly.
Do you have persisting neck pain or headaches? You should get it checked and sorted. Don’t just keep putting up with it!
How to exercise your key support neck muscles to reduce neck pain
If you have neck pain or get headaches then you should be doing this neck muscle exercise to help relieve your pain.
Cameron, an Associate myPhysioSA Physiotherapist, explains how to correctly strengthen your key support neck muscles.
These neck muscles are called your Deep Neck Flexors, and they get long and weak with poor or prolonged posture. The muscles over the top will then get overworked and start to tighten, worsening your posture even more.
Learning how to re-activate these deep neck flexors is crucial to supporting your neck again, they are like your core trunk muscles are for your lower back. Research has proven that if you strengthen these deep neck muscles your neck pain and headaches will improve.
Cameron teaches a patient how to correctly exercise the deep neck support muscles in this video. After watching this video, you can start doing this exercise twice per day for a few minutes is all that is needed and usually after 4-6 weeks your ongoing neck pain and headaches should start to improve.
The difficult part of this exercise is learning to isolate just the deep neck muscles and relaxing the already tight outer muscles. It will take practice!
If you feel any increased discomfort during or after doing these exercises please cease immediately and seek further advice.
Other neck advice
Persistent back & neck pain advice
Persistent or chronic back & neck pain is reality for many people. They stop doing activities they used to enjoy, struggle to work and to maintain relationships.
Chronic pain is complex and needs a multi-pronged approach.
The Hills Integrated Pain Team in Mount Barker, Adelaide Hills, helps people with persistent back, neck, leg or shoulder pain.
Our Spinal Physiotherapist’s work in conjunction with Pain Psychologist’s to road map you through to self-managing your problem.
Call 1300 189 289 to enquire or check out our Hills Integrated Pain Team page here for more information.
Is your night time routine the reason for your neck pain?
Are you waking up with pain in the neck, stiffness in the morning, stabbing pains in the arms or back or headaches?
Waking up with these symptoms can leave you feeling irritable and tired throughout the day.
Is your night time routine what is causing your pain?
We discuss the do’s and don’ts of your night time routine and contributing factors to neck pain such as pillow selection, sleeping positions and using your gadgets in bed prior to sleep.
Sleeping with the wrong pillow has been significantly linked to poor sleep and neck pain. Having the right pillow to avoid pain is a necessity for sleeping well and getting a good night’s rest.
A suitable pillow is one that offers neck support and will position your neck in neutral alignment during sleep. Studies have (Ren et al. 2016 & Gordon et al. 2010) shown that pillow height elevation significantly increased average and peak pressures of the cranial and cervical regions and increased curvature of the cervical spine reflecting quality of sleep.
Various structures in the neck (muscle, ligaments and joints) maybe stressed and irritated when sleeping with poor mechanics and can be worsened with pre-existing neck pain.
When it comes to pillow selection, there is no one size fits all rule
The decision is based on several factors which include the right pillow height, curvature and firmness for the person’s size, sleeping position, personal preference and comfort. Too firm a pillow won’t allow the neck to relax during sleep, where as too flat a pillow will put a strain on the neck.
Depending on your recovery stage from a neck injury, different pillows maybe better at a certain time of recovery.
Personal comfort and pain management are the best guides.
Sleeping position is a significant consideration when choosing the correct pillow:
- When sleeping on back:
- A low pillow is recommended for this position. Extra support with a small rolled towel in a pillow case under the neck can help maintain neutral neck alignment.
- Some pillows allow this with a roll-shaped area for the neck and a deeper, lower area for the head.
- Some people find it more comfortable to tuck the pillow under the shoulders in this position, so the head if further up and the neck not flexed (bent forwards).
- This position may put the neck in a more extended position, and maybe more comfortable for people with muscle pain.
- When sleeping on side:
- Ensure your pillow is not too high to allow good alignment between your neck, head and shoulder. The best pillow will fill in space between the mattress and head/neck.
- Contour pillows are a good choice if your neck is thinner than your head. Resting one arm on a pillow and adding a pillow between the knees provides more support for the spine.
- When sleeping on stomach:
- This position isn’t recommended as it promotes the head and back to arch and often requires sustained head rotation which can stress the structures in the neck (i.e. compression of the joints).
- It is often difficult to change sleep patterns, but trying to fall asleep in another position is recommended. If not able, a flat pillow or no pillow at all is the best option with the hips and abdominals supported with a pillow to maintain natural spinal curves.
Night Time Routine
A poor night routine which may include reading in poor positions, checking emails or playing on your phone before bed maybe contributing to your neck pain.
Because of your head being tilted in this position, the support is no longer coming from your shoulder and your neck muscles will need to compensate to support the weight of your head which over 8 hours of sleep can cause a great deal of stress to those muscles and joints.
Tips to avoid neck pain from phone usage include:
- raising the phone or mobile to eye level
- minimise phone time at night
- and taking frequent breaks
An experienced myPhysioSA Physiotherapist can help your neck by assessing and diagnosing your condition and providing you a plan to manage your pain.
We also provide lots of practical and sensible advice about posture and effective night routines to avoid placing excessive strain to your neck.
A big part of our treatment is to provide hands on treatment to address potential imbalances in your neck muscles and exercises to promote good posture and strength.
Surprise & impress your partner or friends with an upper back massage.
Our ‘How to massage video’ by Remedial Massage Therapist Michael will teach you how to properly massage the muscles between the shoulder blades, at the top of the shoulder and up into the neck muscles.
Micheal explains the best techniques to use, how you should be doing them and what you should be feeling for.
In under 10 minutes you will be in the know, and confident to give the best proper massage ever!
How should you be sitting in front of your computer to avoid neck and back pain, and headaches?
Cameron, from myPhysioSA Mount Barker, talks you through how to best sit and simply explains how to set up your chair and workstation for the best ergonomics.
If your sitting posture and workstation set up isn’t good, then you have a high risk of developing neck pain, back pain and/or headaches, especially if you are spending hours per day sitting in front of your computer.
Ergonomics involves finding your ideal position relative to your chair, desk, keyboard/mouse and computer monitor. Cameron explains how to do this.
I have seen a specialist or surgeon and they have recommended surgery, what should I do now?
When to seek a second opinion
You should always feel confident in any specialist that you see and their recommendations and explanations should make sense. This is also important when seeing a spinal specialist or surgeon. They should explain to you about your symptoms, why you have them, any scans you have had and any findings on their examination.
If you do not feel comfortable with the specialist you see or you are still unsure, then you can always seek a second opinion by asking for a second referral to another specialist from your GP.
Pre-operative education and conditioning
Outcomes following spinal surgery often can be maximised by your preparation before surgery.
Being as physically fit and strong as possible prior to your surgery will give you a distinct advantage when commencing your post-operative rehabilitation and you will get up and going quicker from day one. Of course exercising when you have neck pain can be difficult.
Your Physiotherapist or an Exercise Physiologist are experts at finding safe and appropriate ways to exercise in spite of your neck injury. Learn more about exercise physiology at: https://myphysiosa.com.au/exercise-physiology/
Your Physiotherapist will guide you through your rehabilitation after your surgery, but a pre-operative Physiotherapy appointment to explain your rehabilitation protocol can help to prepare you both physically and psychologically for the surgery ahead.
We would recommend that you attempt to stop smoking as this can delay healing following surgery. Also try and increase your general fitness and strength prior to any spinal operation.
You may also be asked to stop or reduce some medications you are taking to prevent any excessive bleeding during surgery.
Learning about pain and pain management has also been shown to be very useful before undergoing any operation, including spinal surgery.
There are a number of good resources on the internet and talk to your myPhysioSA spinal Physiotherapist about these when you attend the pre-operative appointment.
Following most spinal operations you will see your physiotherapist every day you are in hospital. In most cases you will sit on the edge of bed and start to do a small walk day one following your operation.
This has been shown at assist in minimising complications and also improving long term recovery outcomes.
You will also be instructed on some basic home exercises to complete each day over the first 2-3 weeks.
These exercises will depend on your operation and the recommendations of your surgeon.
Following discharge from hospital we recommend that you are regularly reviewed by your spinal physiotherapist. This allows them to monitor you and progress your rehabilitation program and exercises regularly.
Return to work and activity
Setting goals is also important for patients and will determine the goals of your rehabilitation.
Some people want to return to work, sport or just something that they really like doing again, like walking, dancing or gardening.
Goals are individual and will depend on the patient. Most patients who have a desk job will be able to return to work around the 4-6 week mark post lower back surgery but may require to do shorter days to start off with depending on discomfort.
Following neck surgery this is likely to be 2-4 weeks later as sitting for long periods may be uncomfortable.
Returning to hard, physical work will be longer due to the nature of the work.
Also after having lumbar fusion patients will likely take a little longer to return to work.
Returning to sport following surgery is possible but usually takes 9-18 months depending on the sport, recovery and rehabilitation.
What can you do to give yourself the best chance of not developing neck pain?
There are many factors that have been shown to increase our chances of developing neck pain. Some we have no control over (such as genetics), but others we can influence to reduce our chances of experiencing neck pain.
Maintain good general health:
- Maintain a healthy body weight
- Quit smoking
- Participate in regular physical exercise. Check out the Australian Governments recommendations for exercise here:
- Sleep time = recovery time. Without adequate time and quality of sleep our body is not able to repair and recuperate from the stresses and strains of the day. Whilst different for everybody, 7-9 hours is appropriate for most people.
- Check 10 top tips for healthy sleep here:
- There is little evidence to support the commonly held belief that certain postures and positions are the cause of neck pain.
- Your best posture is your next posture!
- Healthy posture involves moving through all sorts of different positions. The key is to move regularly.
- Watch Matt, a spinal physiotherapist at myPhysioSA discuss the influence of posture on spinal pain:
- Of course, moving regularly can sometimes be difficult to manage, particularly if we are busy at work, or have an assignment deadline to meet. Check out these tips for reducing sedentary postures at work and home:
- When circumstances dictate the we need to sit at the computer for a long period, there are certain ergonomic principles that we can apply that help to reduce the amount of stress and strain that we put on our neck.
- Watch Cameron, A spinal physiotherapist at myPhysioSA explain the best ergonomic set up for your desk:
Keep stress in check
- Most of us can relate to the feeling of a clenching jaw and rising shoulders when we are under stress. This common response to stress can result in increased workload, fatigue and pain in the muscles of our neck and shoulders.
- Learn some exercise strategies to reduce tension in your neck muscles here:
- Stress has also been demonstrated to change the way that we experience pain by ‘amplifying’ pain messages.
- De-stressing means different things to different people, but check out these top tips for reducing your stress levels:
Stay strong and flexible
- Our neck needs to be able to perform all sorts of demanding tasks.
- Regular stretching and strengthening exercise can help to ensure that our neck remains ‘fit for purpose’ and avoid injuries.
- Check out these videos of handy exercises that you can try at home: