In the first post of this series on neck pain we looked at categorising neck pain in to 3 types:
1. Non-Specific Mechanical Neck Pain
2. Radicular, “Pinched / Trapped Nerve” or “Cervical Nerve Root” Pain
3. Possible Serious Pathology
One of the important points we emphasised in the previous post was that whilst the majority of neck pains don’t involve serious damage and will improve within a few weeks, there is a high recurrence rate (approximately 50%). This means that if you have one episode of neck pain you are very likely to have another one. Reducing your risk of more pain episodes is one of the major goals of physio treatment for neck pain.
In this post we will cover how physiotherapists can relieve your current neck pain, including advice on what you should do at home and work to make your recovery as fast as possible. In Part 3 of this series we’ll review the evidence around what you can do to reduce your risk of your neck pain coming back.
Physio For Non-Specific Mechanical Neck Pain
Treatment for non-specific mechanical neck pain begins with relieving your pain and restoring your full range of movement as fast as we can. This gets you back to your normal daily activities, sleeping well and managing ok at work.
Treatment in this phase uses hands-on (manual) treatments including joint mobilisation or manipulation, muscle releases / massage, trigger point releases and other soft-tissue techniques. We match this with a structured exercise program so that you can continue to improve between your treatment sessions. This can include stretches and specific joint mobility techniques, with the goal being to help you relieve your pain and increase your movement as quickly as possible.
As well as prescribing your home exercises, your physio will also guide you through do’s and don’ts for activity at home and work. Research clearly proves that staying active within your comfort levels, avoiding neck collars or bedrest, and returning to your normal work and daily activities as quickly as possible is by far the best way to help your neck pain resolve. When needed, we will discuss using basic medications like Panadol, Neurofen or Voltaren to help your pain settle down.
As your pain improves your physio will progress your exercise program to fully rebuild your strength, restore your full pain-free movement, and guide you towards a return to all of your normal sport, exercise and leisure activities.
Exercise to increase functional strength and movement control is the main focus of later-stage management, and completing a supervised strength program with an accredited exercise physiologist is the gold-standard treatment for this. This is especially important if you have recurrent or persisting pain, as maximising your strength is a key factor in reducing your risk of ongoing pain episodes. Exercise physiology programs are also great if you are working towards a higher-level exercise or sporting goal, or are lacking confidence in returning to your normal gym or exercise activities. Some people prefer Clinical Pilates as a way to continue to build strength, stability and flexibility following an episode of neck pain.
Physio For Radicular Pain – Also Called A Pinched Nerve Or Cervical Nerve Root Pain
If you have a pinched nerve in your neck, the first treatment focus is to relieve the pressure on the nerve. The amount of pressure on the nerve is monitored by the amount of pain that is referred down your arm, as well as the intensity of other neurological symptoms such as numbness, pins-and-needles or weakness. As the pressure comes off the nerve these symptoms will “centralise“, meaning that they don’t spread as far down your arm. Their intensity and frequency will also reduce, and when you no longer have symptoms referred down your arm then we know that the pressure has been taken off the nerve. This is the main measure of improvement that we are looking for in this early stage.
Hands-on (“manual“) treatment is used to specifically open the canal where the nerve exits the spine, as well as to release muscles that tighten up in the area in a protective bracing response. Specific exercises are also used help open this canal and lengthen out tight muscles. The aim is to relieve the pain and neurological symptoms that are referred in to your arm as fast as possible. Sometimes medication such as Voltaren, Panadol or Neurofen can also be helpful.
Once we relieve the pressure on your nerve, the physiotherapy treatment for radicular/pinched nerve pain is largely the same as for non-specific mechanical neck pain. We use a combination of hands-on treatments plus structured exercise programming to restore your full pain-free range of motion, and then reactivate and strengthen your muscles. Staying active within comfort, plus returning to normal work and leisure activities as soon as possible, has been conclusively proven to be the correct way to go.
As with non-specific neck pain, completing a supervised strength program with a physio or accredited exercise physiologist will get you fully back to your normal sport, exercise, work and daily activities. Pilates can also be very helpful, if you prefer this style of exercise. Any background movement problems that may have contributed to your pain should be corrected now to reduce your chance of future problems.
Treatment For Possible Serious Neck Pathology
Neck pain due to serious neck pathology is very rare – present in less than 1% of neck pain cases. It includes things like spinal fractures (broken bones), tumors, and some types of infections and inflammatory conditions. You will usually have other associated symptoms, rather than just neck pain. Your physiotherapist will use well-researched and validated screening tools to rule out possible serious pathology, and if they are concerned they will explain why they are concerned and refer you back to your GP for further investigation.
Neck Pain Treatment Summary
Each case of neck pain is unique, so treatment must be tailored to each individual. However, there are some very well-researched and proven guidelines to help you manage your pain at home, as well as how a physiotherapist can help you beat your neck pain.
1. Stay active within comfort, don’t use a cervical collar, avoid bedrest and return to your normal daily activity as soon as you feel comfortable.
2. Most neck pain episodes will improve in the short-medium term, and physiotherapy treatment using both hands-on techniques and structured exercise will relieve your pain faster. Once this is done you need to focus on how to prevent future pain episodes.
3. Neck pain, if not managed well, has a very high recurrence rate – approximately 50%. So a big focus of treatment is to reduce your risk of future problems by fully restoring your neck’s strength and optimal movement patterns, plus modify lifestyle factors that can irritate your neck like desk ergonomics or gym technique. Exercise, rather than hands-on treatment, is the main treatment technique required in this phase. An exercise physiologist can really help with strengthening your neck, or many clients find that Clinical Pilates is also very effective.
So far in our neck pain series of posts we have covered the 3 different types of neck pain, given you guidelines of what you can do to help your recovery, and reviewed how physiotherapy treatment will help relieve your pain. In our third post we’ll review the evidence around how to reduce your risk of future pain episodes.
As always, if you have any questions about neck pain treatment please feel free to contact one of our friendly physio’s to see how they can help!