Having Neck Pain? A Guide to Physiotherapy Treatment for Relief

Stiff Neck Causes, Symptoms and Treatment

Common Neck Pain Conditions that we treat

Some common conditions causing neck pain are degenerative disc disease, neck strain, osteoarthritis, cervical spondylosis, spinal stenosis, poor posture, and neck injuries such as whiplash, a herniated disc, or a pinched nerve (cervical radiculopathy).

Uncertain of your condition? Visit us for an assessment, and we will help you figure it out.

You are not imagining it! It is what the medical community calls cervicogenic headaches, which means headaches originating from the neck

What are the usual complaints from people who suffer from cervicogenic headaches?

Firstly, most sufferers complain of a deep dull ache starting from the base of the skull to the top of the head, usually over just one side of the head. It may be present on both sides if the neck pain and stiffness are on both sides of the neck. Other complaints include feeling pressure at the back of the eye and discomfort in the jaw.

Secondly, another symptom that confirms the diagnosis is the presence of tenderness when pressure is applied over the area of the cervical spine immediately under the skull. In some cases, when pressure is applied for long enough, sufferers feel some relief from the headache.

What are some of the activities that aggravate this condition?

Typically, activities that require the neck to be in a sustained strained position for a prolonged period of time will aggravate this problem. The neck posture is often faulty, the head is turned or tilted to one side or if the sufferer is adopting the “poke chin” position.

Examples of such activities including reading, using the computer especially the laptop, putting on makeup, looking up for too long or watching movies or theatre when seated on the side of the hall.

Why do these activities aggravate the headache?

When we adopt the “poke chin” posture, we apply compressive stress to the upper part of the cervical spine, namely, C1 and C2 levels (C1/C2 refers to the first two cervical vertebrae in the spine). Similarly, when we turn our head to one side, we compress the C1-2 level on the same side.

This happens as most of the movement of the head occurs at these 2 spinal levels. So if we sustained these postures or repetitively perform them, these 2 levels will start to degenerate and the cartilage wears out over time. This in turn results in stiffness of the upper cervical spine.

What is the relevance between the C1-2 levels and headaches?

The nerves that exit C1-2 and sometimes C3 supply sensation to the back of the skull to the top of the head and in some people, to the jaw area. The nerves that exit from the right side of the neck will supply only the right side of the head, likewise for the left.

When these joints are stiff or mal-aligned, the nerves at the affected levels will be irritated causing pain. So when one has a right-sided upper neck pain or stiffness, the pain is always referred to the right side of the head.

What can we do?

We need to improve the cervical joint alignment and mobility at the C1-2 levels and to remove the compressive forces, which is to adopt good posture. This will reduce the irritation to the nerves.

If the cervical facet joints are slightly rotated due to contractile forces of tight muscles surrounding the neck, the affected joints are already in some amount of compression and may not allow full functional or physiological range. In this situation, physiotherapists can apply the “MUSCLE ENERGY TECHNIQUE” to realign the joint position. This technique uses the muscles to reposition the joint.

Technique Tips

Once the joint is in a neutral position, the actual stiffness (hypomobility) can then be accurately assessed. Stiffness can be treated by various techniques, such as passive mobilization through the MAITLAND technique or with the clients’ active movement with the MULLIGAN SNAG technique. If the joints remain stiff even after a few sessions of mobilization, MANIPULATION can be applied. Once the ideal mobility has been achieved, the client will be expected to maintain it by self-mobilization with a strap.

Once the mobility is improved, the headache will be resolved. The client can remain pain free for a long time provided the original cause of poor posture is solved. Good ergonomics here is paramount.

Whiplash is a type of neck pain that results from an injury following a sudden acceleration-deceleration force or movement of the head backwards, forwards, or sideways. This movement is unrestrained, rapid and abrupt, often due to a car accident. The acceleration-deceleration force causes the head into forward-flexion (head-down position), and the head gets whipped back very quickly into extension (the head in a looking-up position).

Aside from road traffic accidents, these events can also cause whiplash:

  • being struck on the head by a solid or heavy object
  • the head is suddenly jolted backwards due to a slip or fall
  • a sudden blow to the head, such as during sports like rugby or boxing

When these events occur, the forces may injure bony or soft tissues such as the neck muscles, disc, tendons, ligaments, and nerve roots.

Several Grades of Whiplash Severity

There are several grades to the severity of whiplash-associated disorders (WAD).

  • Grade 0: No physical signs of injury. No pain or discomfort.
  • Grade 1: No physical signs of injury. Neck pain, tenderness or stiffness.
  • Grade 2: Neck pain, stiffness or tenderness. Some physical signs of injury such as point of tenderness or trouble turning the head.
  • Grade 3: Pain, tenderness or stiffness and neurological signs of injury, such as changes to the reflexes or weakness experienced in the arms.
  • Grade 4: Pain, fracture or dislocation of the neck.

The above grading is also known as the Quebec Classification Disorder and is used as a guideline by the Singapore courts to assess neck injuries.

What are whiplash symptoms?

Because the soft tissues in the neck become stretched and strained, several symptoms can also occur following whiplash injury. Symptoms after the initial trauma can occur immediately after the injury or even after a few days. Also, do note that whiplash can also occur at relatively low-speed crashes.

People who experience whiplash may develop one or more of the following symptoms, which include:

  • Headache
  • Pain in the shoulders and arms
  • Dizziness
  • Altered sensation, pins and needles, numbness in the arms
  • Weakness
  • Visual and auditory symptoms
  • Difficulty concentrating
  • Difficulty in swallowing

Less common symptoms include dizziness, memory loss, pins and needles in your arms and hands, poor concentration and irritability. The symptoms are usually worse the day after the injury and may continue to worse for the next several days. People experiencing such symptoms should seek proper medical advice as soon as possible within 24 hours.

Related: Whiplash – Part I

Why is your neck so stiff and it hurts to move?

In most mild, (Grade 1 or 2) whiplashes, the muscles attached to the neck joints (cervical spinal vertebrae) are strained and suffer some form of bruising. In anticipation of the shock, the neck muscles will tense up to support the neck and head, before being forcibly stretched by the force of the accident. The force will exceed these muscles’ ability to support and cause a strain.

It is these sprained muscles that hurt when you later move your head as they are very much involved the movement of the head and neck.

Stiffness comes on later as a result of lack of movement to avoid the pain. This lack of movement is a form of pain avoidance

Stiffness is often the result of neck joints losing their mobility from the lack of movement and the muscles that become tight and taut as a result of being held in place for long periods of time.

The stiffness later makes it hard to move without pain in a vicious circle.

Physiotherapy Options

Treatment options for whiplash with physiotherapy include mobilisation, manipulation and exercises. Most whiplash patients will feel better within a few weeks of treatment. The sooner you start your treatment and follow the treatment plan, the shorter your recovery period will be. Putting off treatment will often lead to chronic issues setting in and making it that much harder and longer to recover.

  • Reduce neck pain, headaches and inflammation.
  • Improve the range of motion of your neck joints (see manual therapy and joint mobilisation)
  • Improve your neck posture through neck position awareness (proprioception), fine motor control and balance.
  • Lengthen tight-and-shorten muscles by releasing taut and tense muscles.
  • Strengthen your neck and upper back (thoracic spine) muscles.

Experienced Physio Near You

Located in Singapore, our team of physiotherapists at Core Concepts can aid in your road to recovery by effectively resolving your injury with treatment options tailored to your condition. With actively guided treatment, you can expect to recover with reduced neck pain, improved neck posture and minimise your chances of future neck pain.

Spondylosis (pronounced – spon – di – lo – sis ) is a degenerative condition of the spine vertebral joints. It is also commonly known as Cervical Spondylosis or Lumbar Spondylosis when it occurs in the neck and lower back respectively. Primarily as a result of wear-and-tear of the bones and cartilage, the space between two spinal vertebrae narrows with spondylosis. It is this narrowing of the space that leads of the sensation of pain and numbness. As the space between the vertebrae narrows, it impinges on the nerve root emerging from the spine at the location. Depending on the location of the nerve root, pain may be felt down the arm or legs (See Dermatome Patterns)

Type of Spondylosis

When spondylosis occurs in the neck, it is known as “cervical spondylosis”. At the lower back, it is known as “lumbar spondylosis”.

Bones spurs or osteophytes sometimes occur together with spondylosis. These bone spurs are abnormal growth that occurs usually as a result of the body attempting to stabilise the degenerated joint. Like in the case of an unstable building, we building extra scaffolding to better support the building. Unfortunately, these bone spurs can sometime further aggravate the spondylosis condition by pressing onto a nerve themselves.

Although cervical spondylosis and lumbar spondylosis is a condition arising from wear-and-tear and is often found in older adults, it is not uncommon to find spondylosis in younger adults in their late 20s or 30s. Early wear-and-tear of joints are usually exacerbated by un-even pressures or forces of a joint as a result of poor bio-mechanics (e.g posture), excessive repetitive movement of the joint and excessive loads on the joint.

Spondylosis should not be confused with spondylitis, spondylolysis, or spondylolisthesis which sound and spelt similarly.

Symptoms of Spondylosis

Spondylosis symptoms often develop slowly over time but may start suddenly as a result of the nerve compression. The most common symptoms are:

  • Neck pain (may radiate to the arms or shoulder)
  • Neck stiffness that gets worse over time
  • Loss of sensation or abnormal sensations in the shoulders, arms, or legs
  • Weakness of the arms or legs
  • Headaches, particularly in the back of the head (see Tension Headaches)

More severe but less common spondylosis symptoms are:

  • Loss of balance
  • Loss of control over the bladder or bowels (if the spinal cord is compressed)

Treatment for Spondylosis

While the degeneration cannot be cured or reversed, the symptoms and pain that results from the spondylosis degeneration can be managed and alleviated. At Core Concepts, we may treat spondylosis with one or more of the following technique or approaches

Experiencing back pain? Click here to find out more about physiotherapy for back pain relief and how Core Concepts can help

Studies show that about 1 in every 5 Singaporeans1 suffer from back pain and neck pain, and you have some 80% chance of suffering from back pain and neck pain sometime during your lifetime.

Common Causes

Common causes of back and neck pain include:

  • Straining the muscles or ligaments
  • Pressure on the inter-vertebral discs
  • Nerve compression or entrapment
  • Damage to the vertebra (spine).

Back pain and neck pain may either occur suddenly or over time due to repetitive strain. The same survey found that about 1 in 10 Singaporeans suffer attacks of pain once a month or more frequently. In most cases, nothing abnormal shows up in tests such as X-rays and there is no permanent damage.

Pain is a complex symptom that affects us both physically and mentally. Your response is as individual as you are. (See “Pain Layers“)

Find out how physiotherapy techniques such as manual therapy and core stability training helps to relieve and assist in the prevention of back and neck pain.

Reference:

  1. Feb 2000 survey conducted by Back Society of Singapore

Therefore, it is important to seek medical advice from a physiotherapist to get an accurate diagnosis of your condition. Only after getting an accurate diagnosis, then will you be able to apply the appropriate treatment methods to resolve the pain. Instead of self-diagnosing and risking the chance of an inaccurate diagnosis, it would be better to consult with our physiotherapists.

Looking for neck pain relief?

You are not alone – Neck Pain affects 1 in 3 people around the world. With the increased usage of mobile devices in today’s modern society coupled with sedentary lifestyles, more people are suffering from neck pain than ever before.

If you’ve tried various methods for pain relief but can’t seem to find a lasting solution for your persistent neck pain then Core Concepts’ Physiotherapy Singapore may have your answer. Compared to other types of solutions such as painkillers and home remedies that only offer temporary pain relief, Physiotherapy can provide you with a permanent solution to your neck pain.

Thus, this is because we do not only treat the symptoms but also fix the underlying cause of your pain.

What is Neck Pain Physiotherapy?

Core Concepts Physiotherapist doing an assessment on the client to accurately determine the cause of her neck pain condition.
Core Concepts Physiotherapist doing an assessment on the client to accurately determine the cause of her neck pain condition.

Physiotherapists are experts in human anatomy and are experts in matters relating to muscles, bones, joints, tendons, and ligaments. Neck Pain Physiotherapy aims to relieve pain and treat the condition through methods such as manual therapy, manipulation, and exercises.

Physiotherapy also does not involve any medication or surgery but our physiotherapists can refer you to a specialist and work closely with them if necessary. 

Neck pain causes and complications, find out how to resolve your pain condition with physiotherapy.

Physiotherapy Provides More than Just Immediate Pain Relief

During your first session, your physiotherapist will run a thorough assessment to accurately determine the cause of your pain. Afterwhich, your physiotherapist will help to provide immediate pain relief through manual therapy or massage therapy by releasing tight knots or reducing the compression in your neck. This will ensure that you will walk out of our door in significantly less pain than when you first came to us.

Here at Core Concepts Singapore, we practice a value-based healthcare system – where we aim to maximize your rehabilitation potential. Our goal is to get you feeling better at the soonest with as few sessions as possible. During your first session, your physiotherapist will also find out more about your treatment goals and develop a treatment plan that is suited to your needs.

Instead of only fixing the obvious symptoms, we dive deeper to find out the root cause of your pain and work on resolving that as well to ensure that the pain does not return. Your treatment plan will also include fixing the root cause of your neck pain to ensure that it does not trigger neck pain for you again.

In some cases, we can maximise your rehab potential. Going beyond what you were capable of doing before the incident. For instance, stiffness in your neck could have made it difficult for you to perform simple daily tasks such as turning your head to check on your side mirror while driving. Physiotherapy can help you to perform such tasks better and with no discomfort.

Core Concepts – Neck Pain Relief Specialists

Neck pain is more complicated than you think. Very often, the answer to what’s causing your pain is far deeper than what you expect. The spine is an intricate system that holds 33 bones, joints, ligaments and muscles. Your spine is also responsible for holding your body upright, supporting daily body movements like walking and moving around. It is important to note that your spine is not an isolated part of the body – it can be affected by other parts of the body as well.

The human anatomy is an interlinked system of bones, muscles, joints, ligaments that help you to perform your daily functions. Thus when one part of the body starts hurting, there is a possibility that the pain could be attributed to another part of the body. One simple movement such as raising your arm involves not only the arm but the entire body. For instance, if your shoulder is injured, it could result in neck pain as you will not be able to move your arm normally. This could result in additional pressure on the neck, causing neck strain or pain. Or vice-versa.

Neck Pain – A symptom, not a condition

Pain, like a fever, is a symptom and could be an indication of a multitude of problems. You could take medication to get rid of the fever, but without going to the doctor to get a proper diagnosis, you will be unable to find out the root cause of the fever. Without treating the root cause, the fever will likely return if your body is unable to heal itself. And the body has an amazing to heal and recover from a whole host of problems.

Likewise, pain is a symptom and you can temporarily relieve the pain through pain medication and hot compresses. However, without consulting a physiotherapist, you will not be able to find out the root cause of your pain and resolve it. And if your body cannot adequately heal itself, it often leads to chronic issues and long-term and deeper problems later on. Other times it doesn’t heal right like a broken bone not set properly. Your physiotherapist can help you do that.

The Thinking Physiotherapists

At Core Concepts, we understand the importance of diagnosing the root cause of the problem and treating that to prevent a recurrence. We are firm believers in ‘The Thinking Physiotherapist’ and acknowledge that pain is a symptom and has various layers. Our first step is to determine the root cause by digging deeper into the symptoms. We strip away the symptoms layer by layer to find out what is causing the pain. After determining the root cause, we resolve the multiple layers of pain you feel. Instead of just simply temporarily relieving your pain symptoms, we also aim to fix the underlying cause. From there, we work to ensure that your pain doesn’t return by making your body stronger and more functional.

At Core Concepts Singapore

We understand the importance of diagnosing and treating the root cause to prevent a recurrence. We are firm believers in ‘The Thinking Physiotherapist’ and acknowledge that pain is a symptom and has various layers.

Our first step is determining the root cause of the problem by digging deeper into the symptoms layer by layer. After determining the root cause, we resolve the multiple layers of pain you feel. Instead of just simply temporarily relieve your symptoms, we also aim to fix the underlying cause. After, we ensure that your pain doesn’t return by making sure your body is stronger and more functional.