How to fix your neck pain without spending £££s on treatments that don’t work.
It’s frustrating to have neck pain, but you’re not alone. Neck problems are on the rise for many people in Britain and researchers think it has something to do with our lifestyle changes over time – including using computers all day!
In this post, I’ll share what may be causing your discomfort as well as how we can fix things together –saving you both money AND time-which is important when dealing with any injury or illness (especially chronic ones).
You can rest easy knowing that we are here to help you. We’ll show how some treatments are not helpful. These passive treatments might give you some short term relief, but they can make your recovery take longer while wasting money on unnecessary therapies.
The truth is that more often than not you can “fix” yourself with some simple advice and exercises, just like our patients.
If, however, you have any of the following, seek a medical assessment from either your GP, NHS 24/111 or the Emergency Department as appropriate:
- History of malignancy
- Infective symptoms e.g. fever
- Sudden severe pain after a fall or injury
- Suddenly develop neck stiffness along with difficulty lifting both arms above your head.
- Pain, tingling, numbness or weakness in your arms or legs
- History of inflammatory disease (especially if on immunosuppressants).
- Abnormal sensation or abnormal power in arms or legs.
Patients under the age of 18 or over the age of 55 with a new onset of symptoms should also consider seeing their GP.
If you don’t have any of these red flags then let us help you start fixing your neck pain! We’ll be answering the following questions:
And much more!
What Is Causing My Neck Pain?
Before we get into the nuts and bolts of what’s most likely causing your pain, having a good understanding of pain can be therapeutic in itself, so let’s clarify what we know about why things hurt:
Pain is normal, personal and always real.
Pain is a normal and useful, although unpleasant, response to what your brain judges to be a threatening situation.
Like an alarm warning you of potential danger, this is often useful but sometimes, just like alarms can go off when there is no danger, you can experience pain even when there is no damage.
Pain is not proportional to tissue damage.
People always find this surprising but it’s very important. Pain is not always proportional to damage. Instead it is a measure of perceived threat – like the alarm system analogy above.
Phantom limb pain is a great example of there being a lot of pain but no tissue damage, in fact, no limb at all! The other extreme is examples of soldier’s experiences on the front line where they have serious tissue damage but don’t experience any pain at the time. This is because context matters a lot when it comes to pain. This was first observed during World War II, when Henry Beecher and his colleagues at Harvard Medical School found that soldiers suffering from severe battle wounds often experienced little or no pain (ref).
We are bioplastic.
Your body is not like a car or machine that needs to be fixed. A much more useful analogy is: your body is like an orchestra where each movement is a different instrument. If you’re experiencing pain or discomfort then we need to re-tune the instrument to get it playing effectively within the orchestra again.
Understand the difference between pain and discomfort.
When recovering from an injury, it’s absolutely essential that we stress the body to improve your function and improve your symptoms.
This will feel uncomfortable, but tolerable. A good example is an old lady who has just had her hip replaced. Even though she may want to rest in bed, the Physiotherapist in the NHS will get them on their feet as soon as possible.
This isn’t because the Physio loves to cause pain and discomfort, it’s because everyone, including the patient, wants them back home as soon as possible.
The intuitive thing to do is to rest the painful area because it feels sensitive and uncomfortable, when in fact that will delay recovery. Instead, you need to gradually stress the tissue to help it adapt and get stronger.
We explain how you can utilise this later on but first let’s take a look at the most common types of neck pain.
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What Are The Different Types of Neck Pain?
Most episodes of neck pain are diagnosed as non-specific neck pain, whiplash, cervical spondylosis or acute torticollis.
Non-specific neck pain is neck pain that doesn’t have a clear cause. In some cases, neck pain may be caused by an injury to the neck, such as whiplash from a car accident or from trying to stop your neck from moving with the force of a crash. That neck pain will typically be evaluated as non-specific neck pain if there is no other identifiable cause of neck pain.
Cervical spondylosis is a neck condition that typically affects people in their 40s and 50s. It causes neck pain and stiffness and can lead to neck pain and stiffness in the neck.
Acute torticollis is neck pain that comes on suddenly. The neck muscles can spasm so much in acute torticollis that they pull the neck into a twisted position, called “torticollis.”
The most common type of neck pain is non-specific neck pain which will be the focus of this article. However, the advice and education provided should have a positive effect on any of the conditions above.
If you would like to discuss any other symptoms you may be having, then please book in for a Physiotherapy consultation.
Non-specific neck pain includes the following signs and symptoms:
- Pain around the neck region that may spread to the shoulder or scapula area or towards the base of the skull
- Associated muscle stiffness
- Pain aggravated by particular movements, postures and activities and relieved by others
- Associated headaches
- Restricted range of neck movement
- Tenderness in neck and shoulder muscles.
As we outlined above, non-specific neck pain means that there is no specific tissue damage causing your pain but rather many interplaying factors that are associated with this type of problem.
Your neck may feel tight, stiff and uncomfortable because it is hypersensitive. This could be related to a bad night’s sleep or a large quick force such as whiplash from a road traffic accident.
Again, it’s important to understand that there doesn’t have to be an injury or any tissue damage to cause this type of pain and it is often influenced by common lifestyle factors such as:
- A lack of physical activity (ref)
- Poor sleep quantity and quality
- Stressful life/work events with little relaxation time (ref)
- Depressing mood (ref)
- Limiting beliefs such as fear of moving your neck because it feels very uncomfortable (ref)
- A combination of all the above.
Before we look at the best treatments for non-specific neck pain, let’s debunk a few common neck pain myths…
What Are The Five Common Neck Pain Myths?
It’s easy to see why some people might be persuaded by outdated neck beliefs, which may have become established before our understanding of the problem evolved.
Many of these myths make you feel like someone needs to fix the problem. But in many cases, with better understanding, you can fix it yourself and save time and money.
Myth #1: Your neck hurts because you have “poor” posture.
It is common to think that your neck pain (or any pain) is caused by bad posture. But that’s not true.
It is worrying how many professionals continue to repeat this myth. One example is the “text neck” myth. “Text neck” is the belief that neck pain or neck pain-like symptoms develop from spending many hours looking down at digital devices like smartphones and tablets.
Research has shown time and time again that neck posture (or any posture) is not associated with pain.
People with “terrible posture” most often have no pain, whereas people with “good posture” can experience chronic pain.
To help illustrate our point, here is one of our stroke survivors Robert practising his walking with a rounded upper back posture (known as kyphotic posture) that many would say was not optimal. However, Robert is pain-free and able to perform everyday tasks within the limitations of his stroke.
Imagine you’re asked to stand at attention like a soldier with “perfect” posture for hours on end. You’d feel just as uncomfortable (if not more) than if you sat at your desk for hours on end. Now imagine performing all of your daily tasks with the “perfect posture” that many old school therapits prescribe…
The worst posture is the one you spend a lot of time in. This is because your neck and shoulder muscles become fatigued after a certain time, which can result in neck pain symptoms.
Myth #2: You should stop moving or exercise as much to prevent neck pain.
Many people with neck problems believe they need to rest their “injured” neck so it has time to heal itself. But the exact opposite is true.
The neck is an incredibly important part of the body that needs to be strong and mobile for everyday tasks like driving, eating or even just turning your head side to side. So you need to keep it moving! (ref)
Myth #3: Your neck hurts because it’s out of alignment and needs manipulating or mobilising to put it back.
Some people like to make their joints crack. But these changes are usually temporary and don’t help the pain. Although it might seem like our neck needs to be put back in or take a good crack, neck posture and alignment aren’t very strongly linked with neck pain.
The highest-quality evidence shows that manipulation alone is bad at providing short-term relief and it does not work for long-term pain or function.
The evidence suggests that some people get better after they have their neck “manipulated” or “cracked”. But it doesn’t help people in the long term and often creates a dependency on this expensive short-term treatment for a condition that is often completely treatable.
Myth #4: Your neck hurts because you’re getting old and it’s a sign of arthritis from wear and tear.
Some people think that their pain is a result of getting old, but it’s not true. Neck pain happens to lots of people, no matter what age they are. The idea that this type of pain is caused by your age isn’t helpful because it doesn’t happen to everyone who gets older.
In fact, even those unfortunate enough to have cervical spondylosis can have very little pain, despite having significantly deformed joints (ref).
In 2015, researchers studied a population of young and old people. They found that 37% of 20-year olds had disc degeneration without neck pain. And 96% of 80-year-olds had disc degeneration without neck pain.
So most old people have thin discs. They are not sick, but their discs are thin. People call these “wrinkles on the inside.” This is a natural process. It does not hurt the person’s body to have thin discs and is not a predictor of neck pain.
This is why getting a scan of your neck won’t be very beneficial for most people with neck pain. Unless you have one of the red flags mentioned at the start, the scan will not inform you why your neck hurts or anything else we don’t already know; the greatest treatment for this is advice, education, and exercise.
Myth #5: “I shouldn’t take pain medication because it will mask the pain”.
Some people may be hesitant to take painkillers because they believe that by doing so, they will “mask” the pain and end up causing more harm. Or you could feel compelled to avoid taking medicine for personal reasons. It’s easy to see why you might think this.
Short-term anti-inflammatory medications can help you get back to activity and recover faster if you take them according to your doctor’s instructions. This is because acute neck discomfort is typically the result of increased sensitivity in the neck rather than any damage. It’s vital to keep in mind that pain isn’t always related to harm.
Gradually increasing your neck movement through discomfort with the assistance of anti-inflammatories can help to break the vicious cycle of pain, decreased movement, tightness and sensitivity.
How Can I Fix My Own Neck Pain?
For some short-term pain relief, you may find a Sports Massage very useful.
A massage can boost your immune system and your mood and reduce stress levels. It can also help reduce your fear of movement as a therapist can show you exactly how to perform the exercises outlined in this post.
For a more long-term solution to your neck pain, we can look to the Treatment Pyramid (ref).
The best evidence is listening and education from a good Physiotherapist who can help reduce your fear of movement and help you understand why your neck hurts and what’s most likely to help.
Next in line is general movement therapy because the more you move, the more you improve (ref).
In terms of overuse injuries, walking is a wonderful pain reliever. The amount you walk has a correlation to the health advantages you gain (ref). This is especially true for those who are not presently walking this much on average since it implies that they can increase their activity level without sacrificing safety.
To minimize the risk of illness and disease, and maximise recovery from pain and injury, UK Chief Medical Officer Physical Activity recommendations recommend at least 150 minutes of moderate-intensity activity every week (moderate means you can talk but not sing, or slightly breathless).
150 minutes should include 30 minutes of progressive resistance training on two separate days, which is next in line on our treatment pyramid. You can’t go wrong by building your neck muscles (ref).
Don’t worry if you don’t have time for any physical activity right now, because there’s a dose response and you get the greatest return on your time investment when you first start.
Remember that everything contributes, so even a 5-minute walk each day may provide significant health benefits and relief from neck discomfort.
Moving more will aid in the utilization of bioplasticity. This phrase refers to the notion that your neck’s tissue can adapt and improve after only slight stress, thanks to movement. This may help you increase your physical and emotional resilience to action and activity with practice.
A good comparison is to compare one’s physical capacity to a cup and daily physical activities and mental stresses to the liquid inside.
The larger your cup, the more stress your neck and brain can tolerate and the less likely you are to get hurt or overwhelmed. With a tiny cup, however, it takes only a little bit of spillage for the cup to overflow and cause discomfort.
You cannot simply rest and expect your pain and discomfort to go away. Instead, you need to stress your tissue in a smart way to start improving your function and symptoms as efficiently as possible.
We can achieve this by using the Goldilocks principle of rehabilitation.
If you just rest your neck and wear a neck brace to protect the neck, the muscles will become stiff and weaker which can exacerbate your symptoms. But if you move too much then you can aggravate your symptoms and delay recovery.
Later in this post we’ll show you how you can get the stress just right.
How Much Should I Stress and How Much Should I Rest My Neck?
So now you know that stress, in the right dose, is amazingly good for you and can help you recover from your neck pain.
When you stress your neck you are actually creating little micro-traumas which signal to your brain and your central nervous system that you need to improve your range of movement and stress.
A useful gauge of how much you should stress your neck is performing exercises that feel uncomfortable. You should be able to breathe out as you move into discomfort, this will help you relax and gradually increase your range of movement and symptoms but ease off if it becomes painful and takes your breath away.
With good quality sleep and stress management strategies your body then super compensates.
When performed consistently with the right amount of stress and recovery the size of your physical capacity “cup” increases and your painful symptoms and neck function improve with it. This is bioplasticity in action.
Too much stress, whether mental or physical, however, can increase your neck pain and muscle tension (ref).
How Long Will It Take Me To Recover?
Unfortunately, not everyone with neck pain experiences complete resolution of their symptoms and disability (ref).
It’s difficult to predict how much you’ll recover and how long it’ll take without a thorough Physiotherapy evaluation. We do know, however, that with the right rehabilitation program, you can alleviate your painful symptoms while also returning to normal levels of function.
Always remember that improving your neck pain and neck function is often a bumpy road with ups and frustrating downs.
Your speed of recovery will depend on the quality of the advice and education you receive, your compliance with the advice provided as well as your levels of fear and catastrophization.
To help avoid setting unrealistic expectations it helps to think in milestones as opposed to timelines. While we provide a free rehab programme (see below) it’s more useful to think of your rehab as stages which you work towards in your own time.
Unfortunately, there is no cure-all for neck issues. Massage, a hot bath, heat pad or neck manipulations may help some individuals feel better right away, but they only last a short time before the symptoms return, which can rapidly become expensive. A free way to get immediate short term relief is using self-massage with a tennis ball as shown in the video below or nice relaxing hot bath.
The next chapter outlines a list of our best mobility and strength treatments that, in our experience, work really well, long-term, for people with neck pain.
What Are The Three Best Exercises For Neck Pain?
The exercises below have been chosen based on the most up-to-date scientific research and our own clinical expertise of successfully treating neck pain patients.
The best neck rehab exercises for you are usually the ones that you find challenging and uncomfortable.
There is no “one-size-fits-all” approach when it comes to rehabilitation exercises, so we recommend you start at stage 1 and practice daily.
Repeat the exercise at least twice daily for best results. Start with 5 repetitions and gradually work up to 15 reps as you feel able.
The Visual Analogue Scale (VAS) below is a tool used by Physiotherapists to help measure the intensity of your pain. The important thing about this scale is that it relates to your interpretation of your pain and can be a useful gauge of your progress.
Stage 1: 1-2 weeks or once you can complete 15 repetitions with only mild discomfort (5/10 VAS) that settles relatively quickly.
Stage 2: 2-4 weeks or once you can complete 15 repetitions with only mild discomfort (5/10 VAS).
*Start with 5 seconds and gradually work your way up to 60 seconds instead of repetitions.
Stage 3: 4-6 weeks or once you can complete 15 repetitions with only mild discomfort (5/10 VAS).
*Start with 5 seconds and gradually work your way up to 60 seconds instead of repetitions.
Frequently Asked Questions
What are the best ways to get more active?
ANYTHING! It all counts, the key is that you enjoy the process. You can find our free resources here and some of our clients find useful are the Couch to 5k.
What does it mean if I hear clicking and grating noises?
The clicking and grinding noise you hear when moving your head is called crepitus. It can be caused by air bubbles popping, tissues rubbing against each other in the joint or bones clanking together due to movement over them – but it doesn’t matter if they’re loud because this isn’t serious!
Should I be worried if I have numbness or tingling?
A nerve can be pinched when the muscles, bones or tissues surrounding it apply too much pressure. As a result you may feel numbness and tingling that will go away once the problem resolves itself but if symptoms are severe; talk with your doctor about drugs to target them such as gabapentin or pregabalin.
What are muscle spasms?
Think of muscle spasms as a small form of prolonged cramp. Very uncomfortable but without any actual tissue damage- this mini-cramp can last between hours and weeks if not treated efficiently.
The best treatments are outlined in this post!
Should I wear a collar?
It is intuitive to think that because you have pain in your neck, the first thing a doctor will tell you to do is rest and protect it while its heal. However even if someone has had an injury like this before they can still be relatively harmful for some people when their symptoms are not severe enough or at all.
Wearing something around the area only makes matters worse by not stressing out muscle tissues sufficiently- so collar should really just stay off unless there’s been major trauma done which could make things much more complicated than needed!
Will an injection help?
In a tiny number of situations, particularly if you have persistent neck or arm discomfort, a long-acting local anaesthetic or a steroid injection may help. The needle is usually placed in the tiny facet joints of your neck during this procedure. These injections are typically given in an x-ray department, allowing the expert to place the needle accurately.
Will I need surgery?
Minor surgery is rarely required. If a nerve or spinal cord is being squeezed and producing arm weakness or excruciating pain that does not subside, it might be helpful. Before discussing the benefits and drawbacks of surgery with you, the doctor will request a scan to look at the nerves and bones.
How will I know I’m improving?
The two best outcome measures for physiotherapy are function and pain. You can track your function by tracking your progress as you work through the exercises outlined above. You can also use our app, which includes access to our Physiotherapist if you want to make sure you’re progressing as efficiently as possible.