Neck Pain Physio Brisbane | Whiplash & Desk Pain

Neck Pain Rehabilitation

Getting neck pain at the computer? Join the club. It’s frustrating, it’s annoying, you are trying to get your work done, and it keeps popping back up. Or maybe you’ve recently had a car accident and you’ve suffered an episode of whiplash. Neck pain is one of the most common presentations physiotherapists see and there is a vast range of different presentations from those driven by postural changes, to whiplash, nerve impingement/compression, and acute wry necks. For such a small region of the body, there are a lot of potential differential diagnoses that need to be worked through to determine an accurate diagnosis. Approximately 15% of adults will experience an episode of acute neck pain per year so let’s help make sure you aren’t one of them in the future and learn how to best manage your neck pain now, and help reduce your risk of future episodes of neck pain.

Neck pain can disrupt many normal parts of day-to-day life. One of the most common frustrations I hear from clients is simply the pain, tension, and stiffness build-up that they often experience with prolonged periods of sitting. A lot of clients blame this on their posture and it may play a role, but often posture isn’t the be-all and end-all that some clients perceive it to be. There actually isn’t any research linking posture as a causative factor of pain, but it can certainly be part of the picture. Neck pain is clearly highly multifactorial with concerns potentially including muscle tightness or weakness, joint stiffness, postural elements, as well as contributing factors from either the shoulder joint or the thoracic spine.

Physiotherapist assessing a client's neck and shoulder posture

Anatomy of the Neck

Cervical facet joints are synovial joints that exist between adjacent vertebrae's superior and inferior articular processes. The superior articular process of one vertebra articulates with the inferior articular process of the vertebra above it. Facet joints are located between the pedicle and lamina of a vertebra. They provide stability to the spinal column.

The articulating surfaces of the facet joints are covered with hyaline cartilage, which helps to reduce friction and wear and tear on the joints. The joint capsule is a thin layer of tissue that surrounds the joint and helps to keep it in place. The facet joints are also innervated by nerves from the spinal nerves, which provide sensation to the joints and allow them to move.

Cervical facet joints allow for a variety of movements in the neck, including flexion, extension, lateral flexion, and rotation. They also help to stabilize the neck and prevent excessive movement.

Diagram of a spinal segment showing the facet joints and disc joint

The cervical musculature is the group of muscles that controls the movement of the head and neck. We divide it into three groups:

Anterior muscles: These muscles are in the neck's front and flex the neck forward. They include the sternocleidomastoid muscle, the longus colli muscle, and the longus capitis muscle.

Lateral muscles: These muscles are on the sides of the neck and rotate and tilt the head. They include the scalene muscles, the trapezius muscle, and the levator scapulae muscle.

Posterior muscles: These muscles are in the back of the neck and extend the neck backward. They include the splenius capitis muscle, the semispinalis cervicis muscle, and the multifidus muscle.

The cervical nerves, which branch off of the spinal cord, innervate the cervical musculature. The vertebral arteries and the deep cervical arteries also supplied with blood the muscles.

The cervical musculature is essential for allowing us to move our head and neck. It also helps to stabilize the neck and protect the spinal cord.

Diagram of the muscles at the back of the neck

The cervical discs are the cushions that sit between the vertebrae in the neck. They comprise a tough outer layer called the annulus fibrosus and a soft inner layer called the nucleus pulposus. Collagen fibres form circular rings in the annulus fibrosus, while the nucleus pulposus is filled with a jelly-like substance.

The cervical nerve roots are the nerves that branch off the spinal cord and exit the cervical spine. There are eight pairs of cervical nerve roots, one for each cervical vertebra. The nerve roots exit the spinal cord through openings in the vertebrae called intervertebral foramina.

The cervical discs and nerve roots are closely related. The nerve roots pass through the intervertebral foramina, and the discs provide cushioning and support for the nerve roots.

Some additional details about the anatomy of the cervical discs and nerve root structures include:

The cervical discs are between the C2 and C7 vertebrae.
The annulus fibrosus is the tough outer layer of the disc.
The nucleus pulposus is the soft inner layer of the disc.
The cervical nerve roots exit the spinal cord through openings in the vertebrae called intervertebral foramina.
The nerve roots pass through the intervertebral foramina and are near the cervical discs.
The cervical discs and nerve roots are important structures that allow for movement and flexibility in the neck. They also provide cushioning and support for the spinal cord.

Diagram of cervical radiculopathy, showing a trapped nerve in the neck

Neck Pain Subjective Assessment

Necks are tricky, a lot of different structures can be causing symptoms, a thorough subjective examination to rule in and rule out potential structures is necessary. As with any other presentation I always try to allow my clients to tell their story, as often you will answer a lot of the questions I might ask.

What Happened?

The first thing I will always want to know when someone comes in with a complaint of neck pain is whether something caused it, or whether it slowly came on with no precipitating injury or mechanism. I find most times, clients often report that there was no injury per se, the most common injury people report is often whiplash. Most cases I find are of a slow gradual onset, with stiffness and tightness perceived by my clients. If there was a mechanism of injury, such as a motor vehicle accident, or an incident at work, we will delve into the mechanism and what happened. If you have had a motor vehicle accident, simple factors such as whether you saw the other vehicle coming are quite important bits of information.

Any Strange Sensations?

Neck injuries can do funny things, and they can sometimes cause some strange sensations such as feelings of pins and needles, tingling, numbness, or a loss of pressure input. These potential sensations could indicate that there is neural involvement, whether that be increased nerve tension or a potential source of nerve compression at the neck, such as a disc bulge. Other than sensation changes, nerve involvement can also send pain sensations. Often these are described as like "electric shocks" or "like lightning". Try to make a note of as many factors that you have found to contribute to these sensations such as positions or movements that may trigger them.

Posture and Work

I know I said above that posture isn't the be all and end all, but hang with me here. Posture can definitely be a factor, but it can play out in many ways. I like to tease out the different postures that you sit in, the different working environments including chairs, desks, computers, laptops etc. These feed into the postural debate before we even get into what your posture is actually like. Often I can find some people overcorrect their posture and end up working too hard and sometimes need to just relax their bodies a touch. But without the discussion about it, we can't ever end up knowing for sure.

Injury History

A previous history of neck pain is one of the leading predictors of a future episode of neck pain. Any previous episodes of neck pain will be of interest, particularly if you have been having recurrent episodes of similar types of pain. Delving into your previous treatments, what their diagnoses have been, and whether it helped will be extremely beneficial in trying to untangle the story of why it keeps returning.

Neck Pain Objective Assessment

As I've mentioned the neck is complex, there are a lot of structures that may be causing symptoms, but hopefully after our thorough subjective examination we have narrowed it down to a handful of specific diagnoses. An objective examination aims to assess these specific hypotheses through a series of tests to either rule them in or rule them out as a potential diagnosis.

Range of Motion

Assessing the range of motion in the cervical spine is often the first assessment I will perform. This allows me to get a gross overview of the potential causes such as muscular, joint based, or nerve/disc related disorders. As with most of my other tests, I will ask you to best describe the sensations that you feel, whether that be tightness, stiffness, an achy or sharp pain. These descriptions can help assist in the diagnosis of your neck pain.

Joints and Palpation

Palpation is one of the most common assessments physiotherapists will perform when assessing cervical pain. Palpation of the muscles allows us to assess for areas of increased muscle tone that could indicate a muscle that is weak or tight. Palpation of joint structures, such as the facet joints, could reveal an underlying joint stiffness or irritability to touch. On some occasions, referred pain may be felt during this assessment. It’s important to highlight this to me, as it might correlate with a diagnosis.

Neurologicals and Neurodynamics

Neural symptoms such as shooting electric like pains, or altered sensations such as pins and needles, tingling, or feelings of numbness may all indicate nerve involvement. Depending upon the symptoms you are displaying, I may perform either, or both, of a neurological or neurodynamic assessment. A neurological assessment involves three key assessments: a sensation test, strength testing, and an assessment of reflexes. These three tests work together to lead us to identifying a potential diagnosis that may require imaging, such as an MRI, to confirm. Without this assessment, an MRI is simply a picture, we must apply a clinical picture to it to truly determine the findings.

A neurodynamic assessment assesses the extensibility of the nerve pathways within the arm. There are three key neural pathways, the ulna, median, and radial nerve pathways. These three testing positions will aim to provoke your symptoms. If we can reproduce your symptoms, we may bias this test further to determine whether the symptoms appear to be coming higher at the cervical spine, or further down the nerve pathway in the arm.

Other Regions

As with every other body part that physiotherapists treat, we also have to rule out any interplay with any other body parts. Often, with the cervical spine, this is going to be the shoulder joint or the thoracic spine. I undertake a thorough assessment of both areas to look for any areas such as muscle weakness at the shoulder, or increased joint stiffness in the thoracic spine that might lead to increased forces at the cervical spine.

Steps to Success for Recovering from Neck Pain

Hands On Treatment

Treating neck pain requires a precise diagnosis and targeted hands-on treatment coupled with an individualised and specific exercise program. Hands-on treatment around the cervical is performed with a targeted approach of mobilisations of the joints and release of the soft tissues. I perform most of my work with the client in a supine position (laying on your back) as I find this is the best position for my clients to relax and avoid tensing up.

Mobilisations are a technique aimed at reducing pain sensitivity of the joint structures as well as improve joint mobility. They can also help to reduce any neural symptoms by reducing potential nerve irritation at the level of the nerve root. Some physiotherapists may have a recipe approach to cervical mobilisations, in the sense that they will perform their glide in the same direction for each client. Instead, I prefer to look and find what is the stiffest direction for each joint to ensure that we can get the best bang for our buck regarding treatment time.

Massage and soft tissue release are almost a given for clients with neck pain. Often shoulders are tense and some of the neck muscles may go into spasm in acute cases, or in longer-term cases, there may be longer-term muscle tightness present that we need to work through to ensure the best effect from our joint mobilisations.

Cervical traction can be a really nice technique that can have significant effects on a wide range of presentations. Traction is the process of opening up the joint spaces and provide some stretch to some of the cervical musculature. This technique can work great in acute cases such as a wry neck, but also can have significant effects for clients who have neural irritation or compression through the cervical joints.

Physiotherapist treating a client's neck as she lies on a treatment table

Neck Exercises and Adjunct Treatments

Now, for my favourite part, and most of my client’s least favourite part, the exercise program. Exercise is the best long-term treatment for pretty much any musculoskeletal complaint. Often for cases of neck pain, we want to maximise mobility through the cervical and thoracic spine, improve strength through the back and shoulder complex, and improve muscular endurance. Some stretches may be necessary, but often I find most clients need strengthening much more than they need stretching, and it can often fix the tightness issue at the same time.

Meanwhile, adjunct treatments such as dry needling and taping can have significant benefits for clients. Dry needling can be highly beneficial in reducing muscle tone as well as reducing pain sensitivity. Whilst I often use taping as a short-term de-loading technique so that we can reduce pain and irritability and can allow us to speed up your road to rehabilitation.

Your Questions About Neck Pain

What causes neck pain?

Most neck pain comes from the joints, muscles and discs of the neck becoming sensitive, often after long periods in one position, a heavy week at the desk, poor sleep, stress or an awkward movement. Whiplash from a car accident is another common cause. Like back pain, a single damaged structure often cannot be pinpointed, and that is normal. Less commonly, neck pain involves an irritated nerve causing arm symptoms. My assessment looks at how your neck moves and what triggers your pain, and screens for anything that needs a medical review.

Do I need a scan for neck pain?

Usually not. Most neck pain is diagnosed and managed from your history and a physical assessment, and scans often show age-related changes such as disc bulges and wear that are just as common in people without pain. A scan becomes useful after significant trauma, when there is increasing weakness or numbness in the arm, or when symptoms are not improving as expected with treatment. If I think you need imaging, I will write to your GP to organise it.

Why does my neck pain spread into my arm or head?

The structures in your neck share nerve pathways with the shoulder, arm and head, so pain can travel. Pain that spreads into the shoulder blade or upper arm is often referred from the neck joints and muscles. Sharper pain, pins and needles or numbness travelling down the arm suggests an irritated nerve root, sometimes called cervical radiculopathy. Pain spreading up into the head is often a cervicogenic headache, which I cover on my headache physio page. Each needs a slightly different approach.

What exercises help neck pain at home?

Gentle movement is the best place to start: slowly turning your head side to side, tilting your ear towards your shoulder, and looking up and down within a comfortable range. Chin tucks help switch on the deep muscles at the front of the neck, and shoulder blade squeezes and rows strengthen the upper back. Regular movement breaks matter more than doing a long routine once a day. If an exercise causes pain that spreads into your arm, stop it and let me know. I tailor exercises to what your neck responds to.

How should I set up my desk to ease neck pain?

Set the top of your screen at or slightly below eye level and about an arm's length away. If you use a laptop, a stand with a separate keyboard and mouse makes a big difference. Sit with your feet flat and your elbows roughly at desk height, and keep things you use often within easy reach. No setup is perfect for eight hours, though, so the most important change is moving regularly. Aim to stand up, roll your shoulders and look away from the screen every 30 to 45 minutes.

What role does posture play?

Almost every client who I see who’s an office worker who complains of neck pain reports that “my problem is my posture”. But what is good posture, and why does posture seem to cause so many problems in so many people? I’d love to agree with these people but I just can’t, currently, there isn’t any research that has identified a link between certain postures creating pain, whether that be neck pain, shoulder pain, upper or lower back pain, there just isn’t a link yet. So why does the research say one thing but everyone else tells me different?

Here’s what I think the problem is. I agree with the research that certain postures don’t cause pain, but I also agree with my clients, but I think the answer isn’t the posture itself, it’s that we are always in the same posture, or we force ourselves to sit in an unnatural position because “my teacher in grade 4 told me to sit up straight”. As good as your teacher was, they probably didn’t quite grasp the complexities of posture. I believe humans adapt and move. The notion that there is a “correct posture” to sit in is incredibly outdated. We should be able to change postures throughout the day based on comfort and what we are doing. Why should I force myself to sit dead straight and be uncomfortable just to feel like I’m sitting in the correct position? It makes no sense to me. I encourage my clients to think of three questions when they think about their posture:

Do I think I’m sitting in a “good posture”?
If you don’t think you are, change and adapt so that you feel you are sitting in a “good posture”, but then you have to ask yourself about questions 2 and 3 which I think are the keys

Do I feel comfortable?

Do I feel like I have to work hard to maintain this position?

These questions are the keys, if you put yourself in a “good posture” and you don’t feel comfortable and it feels like hard work you are going to want to move away from it as soon as you get engrossed in whatever it is you are working on. Whereas if you were to just relax 10% or let those shoulders drop a bit, or slouch just a touch you’ll be able to make yourself much more comfortable, and it will be a much more sustainable position. Doing this throughout the day I find helps find the natural flow of posture and allows you to change throughout the day based on how you feel.

Physiotherapist assessing a client's shoulder and upper back posture

Physiotherapist assessing a client's neck movement as he looks up

Neck Pain FAQs

Most episodes of acute neck pain, including a wry neck, improve a lot within 1 to 2 weeks and settle within about 6 weeks. Whiplash and longer-standing neck pain can take longer, and I will give you a realistic timeframe after your assessment.

It can play a part, but it is rarely the only cause. Waking up with a stiff neck is more often linked to sleeping position, stress or what your neck has been doing during the day. A pillow that keeps your neck level with the rest of your spine is a good start, but there is no single best pillow for everyone.

Seek urgent medical attention if your neck pain follows a significant accident or fall, or comes with worsening numbness or weakness in your arms, problems with balance or walking, a sudden severe headache, dizziness, double vision, difficulty speaking or swallowing, or a fever.

Yes. Staying active and gradually restoring movement is one of the most important things you can do after whiplash. Hands-on treatment and a targeted exercise program help settle pain and stiffness, and most people improve over a few weeks to a few months.

Each consultation is 45 minutes and costs $110, for both your first appointment and follow-ups. Dry needling, taping and exercise bands are included at no extra cost. If you need a longer course of rehab, my 3, 6 and 12 week rehabilitation programs work out cheaper than paying per session.

Yes. You can claim a rebate from your health fund for every session. PRP Physio is not a preferred provider for any fund, so your rebate may be slightly smaller than at a preferred provider. Your fund can confirm the exact amount using item code 500 for your first consultation and 505 for follow-ups.

Yes, if your neck pain was caused by your work, such as an injury or a strain from your workstation or tasks. Your GP starts the claim and gives you a WorkCover certificate, which acts as your referral. Once your claim is accepted, I bill WorkCover directly, so there are no out-of-pocket costs for you. WorkCover covers your first five sessions, and I speak with your case manager if you need more.

Yes. Neck pain and whiplash are the most common injuries after a car accident. If you have been injured in a motor vehicle accident, the cost of your physio is usually covered by the third party insurer of the vehicle at fault. See your GP as soon as you can after the accident so your injuries are documented and your GP can refer you for physio. Most insurers cover your first consultation, and I then send the insurer a treatment plan outlining my findings, your goals and how many sessions I recommend. I bill the insurer directly, so there are no out-of-pocket costs for approved claims.

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Neck Pain Physiotherapy Brisbane