Neck pain

Written by Daan Lansdorp, physiotherapist and owner of FysioGrow.

Does your neck hurt when you turn your head, after a long day behind a screen or when you get up in the morning? Does it hold you back at work, in sport or in doing the things you love most? Imagine moving freely again without constantly thinking about your neck.

I’d like to explain where neck pain can come from and what you can do about it. Read on to find out more!

Symptoms of neck pain

Neck pain can show up in different ways. You’ll read more about that below. Besides the pain itself, you may have these symptoms:

• Stiffness in the neck, especially in the morning or after sitting for a long time
• Trouble turning your head or looking up
• Pain radiating to your shoulder, arm or hand
• Tingling or numbness in an arm or finger
• Headache that pulls up from the neck to the back of your head or your temples
• Loss of strength in an arm or a clumsy hand
• Dizziness or a light-headed feeling
• Tension or a tight feeling around the shoulders

Causes of neck pain

Neck pain can have different causes. Think of a sudden wrong movement, long hours of screen work, a poor sleeping position, a whiplash in the past, or wear of the neck vertebrae. All of these causes send a pain signal to the central nervous system.

When the nervous system thinks it sees a problem or damage in the body, it will try to keep the problem from getting worse. It does this by sending a pain signal. So this pain signal actually has a very good reason!

Instead of ‘numbing’ the signal with a painkiller, we can also look for the cause of the problem. Because if you deal with that, there’s a good chance the pain goes away for good. Without having to depend on pain medication.

The most common structural causes of neck pain:

• Cervical disc herniation. A bulging disc in the neck that presses on a nerve, often with pain radiating to the arm or hand.
• Whiplash injury. After a rear-end collision or a fall, the neck can stay oversensitive and painful for a long time, even when scans show no damage.
• Text neck and screen posture. Looking down at your phone or laptop for long periods puts constant load on the neck vertebrae and the muscles between the shoulder blades.
• Trigger points in the neck and shoulder muscles. Local knots in muscles such as the trapezius or levator scapulae can send pain to the back of the head, the eye or the arm.
• Cervicogenic headache. Headache that starts in the upper neck vertebrae and feels like a pulling pain from the neck towards the front.
• Facet joint problems in the neck. The small joints between the neck vertebrae can get irritated, often after a wrong movement or holding the same posture for a long time.
• Weak deep neck muscles and postural muscles. When the stabilising muscles around the neck don’t do their job, the surface muscles take the load and get overloaded.
• Cervical osteoarthritis. Wear of the neck vertebrae or discs. Common over 50 and it doesn’t always cause pain.

There are more possible causes, and we find these out during the assessment. For more general pain that you feel elsewhere in the body, you can read more there.

Sometimes the pain stays, even though the body seems to have healed the acute cause. There can be different reasons for this. The body may have developed compensation strategies so you can keep moving. In the longer term, that compensating can actually overload other parts of the body, often the shoulder or upper back. After a neck episode, muscles can also keep tensing up to protect you. This protective tensing can cause stiffness and pain by itself, even when the original cause is long gone. Because we find this out during the assessment, we can treat it well.

When neck pain becomes chronic

Neck pain that lasts longer than three months often behaves differently from acute neck pain. In that case the nervous system can keep sending the pain signal itself, even when the original problem healed long ago. This is called central sensitisation: the pain system has become more sensitive and reacts more strongly to stimuli that normally wouldn’t hurt.

The neck is an area where stress and emotions almost always show up physically. With long-term stress, bottled-up tension, perfectionism or people-pleasing, the muscles around the neck and shoulders often stay tense all the time. This isn’t a case of “it’s all in your head”. It’s a physiological process where an overactive nervous system really produces pain through muscle tension, reduced blood flow and hormonal signals. This principle is known as the biopsychosocial model and is supported by the KNGF.

The Mind-Body Syndrome theory, first worked out by Dr John Sarno, describes this mechanism in detail. Chronic neck pain and tension headaches are classic examples. Research shows that many people with severe chronic neck pain have hardly any structural abnormalities on MRI. And the other way round, many people with clear “abnormalities” such as mild wear or bulging discs in the neck have no pain at all (as described in a systematic review by Brinjikji et al., 2015). So the pain can’t always be explained by what the scan shows.

For people who fit this profile, we are developing a specific 6-week coaching programme: De Pijncode. This programme doesn’t work on the body, it works on the relationship between emotions and pain, and on calming the overactive nervous system. During an assessment at FysioGrow we look at the mechanical picture, and also at whether this profile plays a part in your pain. If it does, we’ll talk together about which route suits you best.

Treatment of neck pain

Once we’ve found out what’s causing your pain, we draw up a treatment plan. Sometimes that’s a physiotherapy course, sometimes a coaching route, and sometimes a combination of both.

With a physiotherapy course, we first try to get all the muscle tissue, connective tissue and joints working properly again on their own. Sometimes there is still too much tension in the neck and shoulder muscles, and that needs treating first. We do this on the treatment table. Once the tissue has been treated, you can produce more strength straight away and your head moves more freely.

After that we teach the body to make all the tissues work together well again. Every part has to do its job at the right moment. For example: every time you bend forward to look at your phone, the weight of your head should be taken by the deep neck muscles and a good position of your upper back. If those deep muscles don’t switch on well and your upper back stays rounded, the upper neck takes the whole load. One look at your phone is harmless, but over a hundred times a day it becomes constant overload. You feel the pain high in the neck, while the cause sits lower in the chain.

Because the exercise programme teaches the body to share strength and posture fairly across the whole upper back and neck again, we tackle the cause of the pain!

The number of treatments depends on the problem. With overload and posture problems you can often see results quickly. With whiplash or a cervical disc herniation recovery takes longer, because the natural healing process needs more time. And with a chronic picture where stress and the nervous system play a big role, a coaching course like De Pijncode can actually get results faster than continuing to train the body.

Do you want to get rid of your pain? Have a proper assessment of where your pain comes from? Move better, longer and more freely again? Book an appointment now and come and see us at FysioGrow in Rijswijk, near The Hague! If you’d like more information first, click the WhatsApp icon. I’m happy to answer your questions.

Frequently asked questions about neck pain

When should I see a physiotherapist for neck pain?

When neck pain doesn’t ease after a week, when it keeps coming back, or when you have pain radiating to your arm or hand, tingling or loss of strength. It’s also wise to book an appointment if your neck pain comes with regular headaches or if your work is suffering. With sudden severe neck pain after an injury, or neck pain with fever and feeling generally unwell, go straight to your GP.

How long does acute neck pain usually last?

For by far most people, acute neck pain clearly improves within six weeks. What helps in that period is to keep moving, change positions and not avoid the pain. If the pain gets worse after a week, or lasts longer than six weeks, physiotherapy is a good idea to prevent compensation patterns.

What is the difference between acute and chronic neck pain?

Acute neck pain comes on suddenly after a specific trigger such as a wrong movement, sleeping position or overload, and usually gets better by itself. Chronic neck pain lasts longer than three months and is often kept going by a combination of factors: a more sensitive nervous system, compensation patterns, stress and postural load. So the approach is different.

Does physiotherapy help with whiplash?

Yes. With whiplash, besides any tissue injury, an oversensitive nervous system also plays a big role. Physiotherapy helps you gradually build up movement again, let go of protective tensing and regain trust in your neck. With long-term pain, a coaching route like De Pijncode can be a useful addition.

Does my phone cause neck pain?

Not the phone itself, but the posture you use it in. Looking down at a screen for long periods puts constant load on the neck vertebrae and the muscles between the shoulder blades. A small load hundreds of times a day becomes a big overload over time. Changing posture, keeping the screen at eye level and training the deep neck muscles all help.

What can I do myself about neck pain?

Keep moving and avoid holding your neck completely still. Change positions, set up your screen well and do short shoulder and neck exercises regularly during work. A heat patch or a warm bath can ease muscle tension. When stress is an underlying factor, relaxation exercises and good sleep help recovery.

Neck pain and back pain often occur together. Sitting for long periods or a poor posture loads several segments of the spine at the same time.

When neck pain lasts a long time without a clear cause, the nervous system often plays a bigger role than people think. On our page about tailbone pain we explain this background in detail.