Physiotherapy For Neck Pain Part 3 – Preventing Neck Pain

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Preventing future neck pain is a complex topic, and there is no magic solution. Similar to low back pain, every person has different strengths and weaknesses, previous injury history and lifestyle factors, so everyone needs a personalised approach to preventing future neck pain. But there are some simple principles to follow to reduce your chance of neck pain in the future.

Below is a summary of research-based principles on how to prevent neck pain. Whilst there is still much research to be done, and a personalised approach tailored to your particular situation is always the gold-standard treatment, there are some definite, reliable and consistent findings to guide both the treatment and prevention of recurrent neck pain. In many ways the principles for preventing neck pain are very similar to those used to prevent back pain, as you will see if you have read our post on preventing low back pain.

Treatment Principle #1: An Individual Approach To Neck Pain Treatment And Prevention Is Essential

This principle is the most important of all. A huge range of factors can cause or neck pain and make it more likely to return in the future, and this means that unless you know which particular factors are the main issues for you, it’s hard to know where to start. This is why what may seem a miracle cure for one person may not have any significant benefit for you, or may even make you feels worse.

Some factors that have been shown in the research to increase your risk of neck pain include;

Lifestyle and Occupational factors – being very sedentary or adopting sustained or repeated awkward postures can increase your risk of neck pain. The most common situation for this is long hours sitting at a desk for work, but it can also include lifestyle factors like sitting hunched over a phone or tablet for long periods, or some jobs that require lots of lifting and carrying.

Posture – having a forward-head posture, also sometimes called a poke-neck posture, has some correlation with neck pain. Whilst posture does not play as larger role in neck and back pain as we previously thought, it has been shown to have some increased risk for neck pain.

Physiological factors – past injury, weakness (especially in the deep neck flexor muscle group), tightness, poor movement or exercise techniques, and having a stiff thoracic spine that moves you into a hunched-type posture

Psychological factors – stress, anxiety and depression have all been shown to increase rates of recurrent or chronic neck pain

Treatment Principle #2: Exercise Is Effective In Reducing Your Risk Of Neck Pain

Exercise is effective in preventing neck pain – this is one of the clearest findings from all of the research on how to prevent neck pain. However, the exact type of exercise that is best is not clear, probably because it is different for different people. This relates to principle #1 above – you need an individual treatment approach. Best the research can be broadly summarised into;

Regular Overall Exercise Is Good – in line with health and activity guidelines for the general population, being moderately active for 30 minutes or more will lower your risk of future neck pain. 

Specific Neck Strength Exercises Are Effective – whilst there is still much research to be done, studies to date show that weakness in some muscles, especially the deep neck flexor muscle group, is associated with recurrent, chronic or persisting neck pain. This is true for neck pain in general as well as specific types of neck pain like whiplash. Weakness in these muscle groups may predispose you to a more forward-head posture, and also reduces your “proprioception”, which relates to being less able to maintain the position of your head 

Thoracic Spine Mobility Exercises – your thoracic spine is the part of your spine that sits below your neck, between your shoulder blades. There has been shown to be a link between a stiff thoracic spine, (which usually contributes to people having a forward-head or poke-neck / round-shouldered posture) and neck pain. This is thought to be because reduced thoracic spine mobility causes the neck to move and take weight differently, so in some people increasing the mobility of their thoracic spine is part of effectively treating neck pain and reducing the chance of it coming back in the future. Physiotherapy using hands-on techniques (called manual therapy) can also help initially to increase thoracic mobility, in conjunction with exercise.

What the above discussion about exercise for neck pain means is that we need to get you on the right exercise program for you. That’s why at Central Performance our neck pain exercise programs are personalised for every client. We often include exercises drawn from different areas including Pilates, functional strengthening, mobility (including stretching, foam rolling, BakBalls, and trigger-point release balls, especially for the thoracic spine and pec muscles), motor-control and proprioception retraining, plus exercises specifically to train you for your normal sporting and lifestyle activities (i.e. the exercises we prescribe for a tennis player would be different to a swimmer or a soccer player).

When starting any new exercise program you need to begin at the right level for you, and then progress at the appropriate rate for you. There is no point is doing really gentle exercises that don’t challenge you just because you are scared or fearful of hurting your neck again. Whilst being concerned about hurting your neck again by doing exercise is very understandable, research strongly shows that getting back to moving and exercising as soon as possible is by far the most effective way to manage neck pain. So, we need to assess your current ability to make sure your exercise is in the Goldilocks training zone, i.e. not too little, not too much, but just right! This gives you the right amount of challenge to drive recovery, but stay safe while we do it.

Starting within your limits so that you are confident to return to exercise, having supervision to ensure you have the right technique, and progressing the exercise appropriately will provide you with the physical strength and also the confidence to return to your normal activity again as fast as possible.

Regaining your full strength and confidence also reduces what is called fear avoidance. This is where you stop doing an activity or exercise because you’re worried you will make your pain worse, and the longer you avoid it the weaker and less confident you become. This leads to a downward spiral of ever-decreasing physical activity. Studies show this psychological factor plays a significant role in recurrent or chronic neck pain, just like it does in low back pain. It eventually ends up significantly reducing the range of leisure, sporting and occupational tasks you feel comfortable doing. Having the right exercise program, guidance, support and supervision can very effectively avoid or resolve this fear avoidance.

Principle #3: Moving Regularly Is More Important Than Posture, Core Strength And Ergonomics

This ties in with both of the principles above. Whilst the forward-head or poke-neck posture has been shown to have some effect on the risk of someone having neck pain, other postures and ergonomics factors (i.e. how your desk, chair, screen, keyboard and mouse are set up) have not been shown to be consistently significant predictors of neck pain.

So does this mean that posture and ergonomics are largely irrelevant? No! Again, it comes down to your individual case. For example whilst having poor ergonomics has not consistently shown to be a major factor in causing neck pain, if you add this to a very sedentary lifestyle or a history of a moderate whiplash injury in the past, then put together these things may increase your risk of neck pain. Similarly, having some thoracic spine stiffness and a mild forward-head posture may not be enough to cause someone to have neck pain, but if they then decide that they want to swim 3 times/week for fitness then their stiff thoracic spine and subsequent changed neck movement during swimming may well give them pain. Once again, this highlights the need for a personalised assessment and treatment approach for managing and preventing neck pain.

The same as when studying low back pain, one thing that has been shown consistently to be important is moving regularly – as they say, motion is lotion! Of course this ties in with principle 2 – overall, exercise is good. And regular movement has many other benefits apart from just potentially reducing that recurrence rates for neck pain. Breaking up sustained sitting plus reducing overall time sitting has many benefits across many areas of health like cardiovascular, metabolic (weight control, diabetes), psychological and even some types of cancer (bowel, ovarian and prostate) are reduced by avoiding sustained sitting. The mechanisms for some of this effect are unclear as yet, but in general having a sit-to-stand desk and moving regularly to break up sustained sitting is a great habit to get in to.

So, How Do I Stop My Neck Pain Coming Back?

The above discussion highlights the complex and varied factors to consider when treating and preventing neck pain. This makes an individual approach essential to your success, because an exercise or treatment that works like a miracle for you may be totally ineffective for someone else, or may even make them worse.

This complexity also makes preventing neck pain a tricky area to research, because establishing strategies that work for everyone is impossible. We need to look at these overall findings and then use them in the context of each client’s individual case. What is a priority for one person (eg thoracic mobility in a regular swimmer) may be basically irrelevant to another, who may need deep neck flexor strengthening and to increase their overall activity levels. As you can see, an individual assessment and treatment plan is essential to effectively treat and prevent neck pain.

At Central Performance our physiotherapists effectively treat clients with neck pain every day. We have all of the skills, knowledge and experience needed to effectively relieve your pain and then prevent or minimise your risk of future problems. We also work closely with our experienced team of exercise physiologists and Pilates instructors so that once your pain is relieved you can begin an exercise program designed specifically to meet your needs.


Call us on +61 2 9280 2322 or email us for more info, or book your physiotherapy assessment online today.