How Physiotherapists Treat Neck Pain

by Jonathan Blood-Smyth

Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be

The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.

Many illnesses and conditions can be associated with cervical problems so the physios review the past medical history, general health, loss of weight, normal control of the bowel and bladder, normal appetite, drugs use and quality of sleep. The physio will then ask the patient to disrobe and examine the posture of the thoracic spine, cervical spine, arms and shoulders. Poor posture is very common, with a rounded trunk, rounded shoulders and a poking chin being the most common combination.

Next the physiotherapist will check the movements of the neck, going through neck rotation, neck flexion, neck extension, neck side flexion and retraction. The restriction in range of motion and the level and type of pain elicited on certain movements gives valuable information about the nature of the problem and the likely successful therapy. Further testing involves the reflexes, muscle power and sensibility in the arms to check that the nerves going to the arms are conducting normally.

Manual palpation of the neck is an advanced skill shared by manual therapists and gives information about the more defined location of the neck lesion. The physio will lie the person on their front and press down gently on each spinal level from the high neck down to the upper thoracic levels. By palpating the central bony processes and the small joints at the sides the physio hopes to bring on the patient's symptoms by pressing on a specific structure, pointing to the guilty structure.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough to allow recovery to start, either by physio treatment or autotraction from a home traction kit.

Jonathan Blood-Smyth is a Superintendent practitioner at a busy county teaching hospital. He writes about physiotherapy advice widely in journals and on the web. He is also editor-in-chief of a website which helps patients in the UK find local practitioners throughout Scotland, England, Wales and Northern Ireland