Neck Pain: Causes, Symptoms, Diagnosis & Physiotherapy Management

Neck Pain: Causes, Symptoms, Diagnosis & Physiotherapy Management

Neck pain (cervical pain) is one of the most common musculoskeletal complaints, affecting millions of people worldwide. Sedentary lifestyle, long screen time, poor posture, and muscle strain are among the leading contributors.
Neck pain may be mild and temporary — or severe enough to affect daily activities, sleep, and work productivity.

What Is Neck Pain?

Neck pain refers to discomfort, stiffness, or soreness in the cervical region — from the base of the skull to the upper shoulders.
It may be:

• Mechanical (muscle or joint-related)

• Neuropathic (nerve-related)

• Referred pain from shoulder, upper back, or jaw

Neck pain is also called cervicalgia.

Common Causes of Neck Pain

Neck pain develops from many conditions. The most frequent include:

1. Muscle Strain

• Overuse

• Long sitting

• Poor posture (“text neck”)

• Sudden jerky movements

2. Poor Ergonomics

• Laptop use

• Mobile phone use

• Forward head posture

• Unsuitable chair/workstation

3. Cervical Spondylosis

Degenerative changes in cervical vertebrae and discs due to aging.

4. Cervical Disc Herniation

Disc protrusion can compress spinal nerves → causing radiating pain.

5. Whiplash Injury

Sudden acceleration–deceleration force (e.g., car accidents).

6. Facet Joint Dysfunction

Inflammation or locking of cervical facet joints.

7. Osteoarthritis

Wear-and-tear changes leading to stiffness.

8. Stress & Muscle Tension

Psychological stress increases muscle tightness.

9. Sleeping Problems

Wrong pillow height or sleep posture.

10. Medical Conditions

• Meningitis (rare but serious)

• Tumors (rare)

• Infections

Symptoms of Neck Pain

Common symptoms include:

• Pain in neck at rest or with movement

• Stiffness

• Muscle tightness/spasm

• Decreased range of motion

• Headache (cervicogenic headache)

• Pain radiating to shoulder or arm

• Tingling, numbness, or weakness (if nerve compression)

• Difficulty maintaining posture

Red Flag Symptoms (Need Immediate Medical Care)

• Sudden severe pain after trauma

• Fever with neck stiffness

• Radiating pain with progressive weakness

• Loss of bowel/bladder control

• Unexplained weight loss

• Night pain worsening

Diagnosis of Neck Pain

1. Clinical Examination

• Posture assessment

• Range of motion (ROM)

• Palpation

• Muscle strength testing

• Neurological assessment

2. Imaging

• X-rays → alignment, spondylosis

• MRI → disc herniation, nerve compression

• CT scan → trauma or bony detail

3. Physiotherapy Special Tests

Common tests used for assessment include:

• Spurling Test (cervical radiculopathy)

• Cervical Distraction Test

• Upper Limb Tension Test (ULTT)

• Cervical Flexion-Rotation Test (C1–C2 dysfunction)

• Shoulder Abduction Relief Test

Physiotherapy Management of Neck Pain

Physiotherapy is the first-line treatment for most neck pain cases. It restores mobility, reduces pain, and improves posture.

Below is phase-wise management:

🔹 Phase 1: Acute Stage (0–2 Weeks)

Goals

• Reduce pain

• Decrease muscle spasm

• Protect the neck

• Gentle mobility

Treatment

1. Cryotherapy

Ice pack 10–15 minutes to reduce inflammation.

2. Pain-Free AROM

Gentle neck rotation, flexion, extension.

3. Soft Tissue Release

Light massage, trigger point release.

4. Isometric Neck Exercises

• Neck flexion

• Extension

• Side bending

• Rotation

5. Postural Correction

• Chin tuck

• Avoid forward head posture

6. Ergonomic Advice

• Correct chair height

• Laptop at eye level

• Limiting mobile phone usage

🔹 Phase 2: Subacute Stage (2–6 Weeks)

Goals

• Restore full ROM

• Improve muscle strength

• Correct posture

• Improve endurance

Treatment

1. Manual Therapy

• Cervical mobilization (Grades I–III)

• Thoracic spine mobilization

2. Stretching

• Upper trapezius

• Levator scapulae

• Pectoralis major/minor

3. Strengthening Exercises

• Scapular retraction

• Resistance band exercises

• Deep cervical flexor strengthening (chin tucks + pressure biofeedback)

4. Proprioceptive Training

• Laser pointer tracking

• Balance and coordination tasks

🔹 Phase 3: Chronic Stage (6 Weeks and Beyond)

Goals

• Full return to function

• Improve endurance

• Prevent recurrence

• Enhance workplace/physical capability

Treatment

1. Advanced Strengthening

• Therabands

• Dumbbells

• Scapulothoracic strengthening

2. Aerobic Exercise

• Walking

• Cycling

• Swimming

3. Ergonomic Retraining

• Long-term workstation setup

• Frequent breaks during computer work

4. Lifestyle Modification

• Stress reduction techniques

• Sleep posture correction

Home Exercises for Neck Pain

1. Chin Tucks

Improves cervical alignment.

2. Shoulder Blade Squeezes

Strengthens postural muscles.

3. Neck Stretches

• Side stretch

• Forward flexion

• Upper trapezius stretch

4. Resistance Band Strengthening

For cervical and scapular muscles.

When to Consider Other Treatments?

If symptoms do not improve with physiotherapy, the doctor may consider:

• NSAIDs

• Muscle relaxants

• Epidural steroid injections

• Radiofrequency ablation

• Surgery (rare cases of severe nerve compression)

Prevention of Neck Pain

• Maintain good posture

• Keep screen at eye level

• Take breaks every 20–30 minutes

• Strengthen neck and shoulder muscles

• Use a proper pillow

• Avoid sleeping on stomach

• Stay physically active

Conclusion

Neck pain is a widespread problem that significantly affects quality of life. Early diagnosis, proper physiotherapy, ergonomic correction, and lifestyle changes are key to recovery.
With a structured, phase-wise rehabilitation plan, most patients regain full mobility, strength, and function — and prevent future recurrences.