Neck pain
Picture71This is largely due to overstressing  (see example of mechanical stress in picture below) of the various structures in the neck i.e. the discs, joints and nerves. This pain may be a deep aching pain or a burning pain and may be felt in the neck, head, arms or thoracic area. Other symptoms you may experience along with neck pain are numbness, pins and needles and weakness. Less common symptoms are nausea, dizzyness ringing in the ears and visual disturbances.
One of the most common causes of headaches is the overstressing of the upper joints of the neck, just below the skull. This is often the result of whiplash injury or prolonged poor posture.

If the pain is felt in the arms or you are experiencing symptoms of dizzyness, nausea, visual symptoms or ringing in the ears, it is a sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.


Hold your index finger back until you feel the strain and then hold it there for a few minutes. It will soon start feeling sore not only around the joint but the pain will spread further afield. Imagine if you did that to your neck when sitting in a slouched position for a long period of time.




Your spine is composed of 24 bones called vertebra, which are separated in front by a shock absorber called an intervertebral disc and at the back by the facet joints. Through a hole in each vertebra runs the spinal cord, sprouting nerves which lead to other parts of the body. The spine has five sections; the cervical spine or neck, the thoracic spine, the lumbar spine, the sacrum, and the tailbone or coccyx. (see fig 3).



THE VERTEBRAE (see Fig 2.)

The vertebra are building blocks, they house and protect your spinal cord. You can feel them if you run your fingers up the middle of your back. Your vertebrae may be responsible for neck pain when:one is fractured due to the application of strong enough forces.e.g. diving into a shallow pool and hitting the head.

Physical stress over a long period of time causes the shape of your vertebrae to change (poor posture).Also certain diseases weaken them e.g.Osteoporosis.


The disc sits between two vertebrae. It has a jelly like centre which acts as a shock absorber as well as allowing movements of the spine.

Injury to a disc can occur with:Picture3

  • Abnormal forces being applied to the disc causing it to tear or rupture e.g. bending forward and twisting.
  • Wear and tear or injury to your disc, causing the supporting ligaments to weaken leaving the jelly like centre to create a bulge in the disc.


If the bulge in the disc is big enough it can put pressure on adjacent sensitive structures causing pain and other symptoms e.g. numbness and pins and needles. Disc pain is commonly felt in the neck alone, down into the shoulder blades, down the arm or as a headache.
The nerves leave the spinal cord though holes between the vertebrae. These nerves can be pinched by a herniated disc, inflamed facet joints or bone spurs.
Injury to a nerve may give rise to a burning pain, pins and needles, numbness or weakness in the head, neck, arms and chest. Coldness or heaviness may also be experienced.


neck 1

The neck is surrounded by muscles which either serve to move the neck, or to support and stabilise the neck. As a result or poor posture, injury or bad habits an imbalance between these muscle groups may occur. One muscle group becomes strong while the other becomes weak.The body then loses its natural balance and the various structures of the spinal column become overstressed.

Pain is often felt across the top of the shoulders and is put down to stress. Usually what happens is that stress, poor posture or poor movement habits of the shoulders or neck cause the muscles across the top of the shoulder to become overused, tight, tender and painful.


The ligaments are strong fibrous bands which hold the vertebrae together, limit their motion as well as protect the disc. These ligaments are most commonly injured :in quick unprotected movements as in whiplash.or slowly due to poor posture (head poked forward).


It is important to have a good understanding of the effect that posture and movement have on your neck. As there are may different types of neck problems it is essential that you understand what will benefit your particular neck problem.
The postures and movements which reduce or bring the pain from the periphery into the middle of your neck are the correct ones for you. If the pain moves down into your shoulder or arm then it it the wrong movement or posture for your neck.

REMEMBER if you have pain  in the arm, numbness, pins and needles, dizzyness, nausea, visual symptoms or ringing in the ears, it is sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.


Neck pain can be caused

  • accidents such as a whiplash injury
  • holding sustained postures where the neck is stressed by being held at the end of the available range of movement. This happens with poor posture ( especally when sitting and driving), working overhead for long periods of time as in painting the ceiling.
  • lifting heavy objects where the muscles that stabilise the neck are not strong enough to do so


Most people if they have to sit for a long time will eventually slouch. They will lose the natural inward curve of their lower back and their head and neck will assume the “poked forward” position. (see Fig. 7) This results in stressing the structures of the neck, which over a long period of time will lead to pain. Initially the pain will only be there when assuming this position for hours on end. But as this position becomes a habit, the pain will become constant and there will pain with neck movements as well

neck 2




It is important to sit in the correct posture whether as a preventative measure or to relieve stress on an already painful neck. In order to maintain correct neck posture it is essential that the posture of the lower back is correct as well. When sitting you must keep the natural inward curve (or lordosis) of your lower back.This will make it easier to hold your head in the correct position neck 3(Fig 8). Your shoulders should be relaxed.
Maintaining good posture in a chair with a back rest is made easier with a lumbar roll. A lumbar roll is an especially designed cushion which provides support for the back when sitting and is available from most physiotherapists. Be careful of chairs with headrests as they tend to push your head forward unless they are exactly right for you.
When sitting leaning forwards over a computer or a desk it is important to lean forward at the hips, keeping the lordosis in your lower back and your head in the correct position.

Fig 7


When lying and resting it is important that you sleep in a good position with your neck fully supported. If you experience neck pain which is worse in the morning then your sleeping position may need correcting.
Pillows supply the support needed for your neck when sleeping. It is important that you can mould them by adjusting the contents of the pillows. Memory foam  pillows. moulded pillows and feather pillows(as long as you aren’t prone to asthma sinutus etc.) are examples of pillows which will give your neck good support while you are sleeping. Dacron pillows can be made more easy to mould to the shape of your neck by opening the pillow up and teasing the dacron into “cotton wool balls”.
Sleeping on your back. One pillow is usually all that is needed. It should be moulded to support the hollow at the back of your neck and the corenrs of the pillow pulled around to support the sides of your neck..
Sleeping on your side. The height of your pillow should fill the gap between your ear and the bed, supporting your neck and keeping your spine in a straight line.Therefore two pillows are usually required. The top pillow should be able to be moulded to support the hollow of your neck between the neck and shoulders so that the head and neck are correctly aligned. It is not neccessary for the bottom pillow to be able to be moulded as it supplies the bulk.
Sleeping on your stomach. This is not ideal
In this position your neck is usually turned fully to one side and kept in this position all night.This can give rise to pain due to mechanical stress. (Remember the example of mechanical stress on the first page!) This places a lot of strain on the structures of the neck and often results in neck pain which is worse in the morning and eases during the day. In this case sleeping on your stomach should be avoided.
N.B. Should you not be able to mould your pillow to support your neck, make a soft roll of foam about 8cm across and the length of your pillow. Place this inside the pillow case (at the lower edge) on top of the pillow. This will support the hollow of your neck when lying on your side or your back.
If you have trouble finding a comfortable position please ask your physiotherapist. Sometimes they might have a pillow for you to take home and try out.

neck 4



Physiotherapy treatment depends on an accurate assessment to determine the cause of the pain. The cause may be one or all of those mentioned above.
• postural education. Retraining of good posture so that it becomes second nature. This may also require improving the movement and strength of the muscles and joints of the neck and back
• Joint mobilisations and manipulation. These are ‘hands on” techniques used to increase the movement of the joints in the neck and back
• Nerve mobilisations- these are ‘hands on” techniques used to improve the movement of the nerves through the structures and tissues of the neck
• Techniques and exercises to reduce intervertebral disc bulges
• An individualised stretching, strengthening and functional exercise plan
• Advice re returning to work or sport
• Education on how to prevent future back pain
• Onward referral for X- Ray if needed
• Onward referral to GP or specialist if needed