Across our physiotherapy clinics in Hong Kong Central and Wong Chuk Hang, we see a wide range of clients for neck pain treatment and relief, and believe that the effects of neck pain on a person’s health and wellbeing is often underappreciated. If you’ve ever woken up with a stiff and sore neck, including if it’s accompanied by a headache or pain that radiates to the shoulder or even the arm, it may be time to see a physiotherapist to assess whether you have a neck injury, why it has occurred, and how you can prevent it from recurring in the future.
Being named the second most common musculoskeletal disorder worldwide, the neck is one of the most flexible regions of the spine that supports the weight of our head regardless of the position we crane our neck and body in. Despite the physical weight of our head being on average between 4.5-5.5kgs, the strain on our neck from supporting the head is much higher. Craning your neck at a 60-degree angle can place up to a 27kg neck strain on the neck, approximately six times the original weight of the head. This degree of flexion is not uncommon when we’re staring down at a screen or smartphone.
What Causes Neck Pain?
Having neck pain lets us know that there has been an injury or another issue with the bony vertebrae, joints, intervertebral discs, tendons, ligaments, muscles or nerves around the neck. While anyone can develop neck pain, we do tend to see it more in certain occupations including office and computer workers, manual labourers, healthcare workers, occupational drivers, and the like., While our body is capable of compensating and managing a heavy load for a certain period of time, there is a limit to this where pain and tightness start to develop.
Often, we see neck pain that is related to excessive loading caused by poor posture, as well as activities involving prolonged or repetitive neck flexion. As such, the phrase ‘text neck’ or ‘tech neck’ has been coined over the past decade, and is now becoming a significant concern among children and adolescents. This type of neck pain has been shown to affect more than 50% of teenagers and university students, and up to 63% of office workers now struggle with neck pain each year. The clinical features of text neck are widespread and may include headaches, back and shoulder pain, eye strain, other musculoskeletal pains, irritability, stress, and anxiety.
Sports and traumatic injuries
Neck pain following sports injuries is also a regular occurrence, particularly in fast-paced running sports like rugby and football. Over the course of the game, collisions or tackles cause acceleration or deceleration of the head on the neck, producing significant forces that can lead to injuries like whiplash. Whiplash is also commonly seen after a car incident due to both the impact and the way the seatbelt restrains the body while the neck is often thrust forwards.
Other injuries sustained in the accident like fractures, dislocations, nerve and disc injuries can also affect the neck and give rise to pain. The impacts of traumatic neck injuries and whiplash can be long-standing, and also contribute to shoulder stiffness, arm pain and headaches for up to 20 years after the event.
Degenerative diseases like arthritis or cervical degenerative disc disease (CDDD) can also lead to neck pain:
- Neck osteoarthritis (otherwise known as cervical spondylosis), is caused by the wear and tear that happens to the soft tissue and bones at the top of the spine as people age. Up to 85% of people over the age of 60 show signs of arthritic changes in their necks. Neck osteoarthritis is diagnosed when the degree of degeneration is more severe and is causing problematic symptoms such as pain and restriction of movement. Uncovering mild changes to the neck on imaging in older adults is not uncommon, with many being asymptomatic.
- Rheumatoid arthritis is another degenerative disease that causes neck pain, as well as swelling and stiffness. Rheumatoid arthritis happens when a person’s immune system becomes overactive and targets healthy joint tissues, causing them to become inflamed, swollen and painful, and the symptoms often become more troublesome over time.
- Cervical degenerative disc disease (CDDD) describes a condition where the gel-like discs that provide cushioning between the vertebrae in our spine (called our cervical discs) become worn out and degenerate over time. In the early stages, the neck may become painful and less flexible. As the condition progresses, the spaces between the vertebrae can narrow, and the discs may bulge and subsequently irritate the nerves between the vertebrae. Certain sports like soccer, rugby and horse-riding can accelerate the progression of CDDD if it is already present. This is because of the pressure they can place on the spine and neck.
Interestingly, work-related factors including low job satisfaction, poor perceived work support and high work stress levels, alongside psychological factors including self-perceived depression and poor psychological health have also been shown to indicate an increased risk of developing neck pain. Sometimes, changing our breathing pattern during times when we are busy, stressed or tired can create imbalances in the musculoskeletal system and contribute to the development of neck pain. This is because when you’re not using your diaphragm efficiently, your body may try to recruit certain muscles to help expand the rib cage, with effects going up to the neck.
Neck Pain Symptoms
For some people, their neck pain may be mild, and for others, it can be severe and create difficulty with everyday activities. It may last for a few days, weeks, or in some cases, months or more. Neck pain can cause a range of symptoms, including:
- Sharp pain: The pain in the neck may be localised to one area and feel like a sharp or stabbing pain
- Pain during movement: Moving, twisting, or extending your neck, either up and down or from side to side, can often make neck pain worse
- Neck stiffness: Swelling in your neck and upper spine can cause stiffness and make it difficult to move your head, limiting your range of motion
- Radiating pain or numbness: If your neck pain involves a pinched or compressed nerve, you may notice burning or sharp pain, numbness, tingling, or weakness that radiates to your head, torso, shoulders and either or your arms or hands.
- Headaches: Pain that originates in your neck and travels to your head can also result in a cervicogenic headache that involves the nerves located near the first and second vertebrae in your spine. This is more common with neck pain caused by rheumatoid arthritis.
- In some cases, due to the involvement of the spine, neck pain may also be accompanied by dizziness, poor balance, and migraines.
Physiotherapist Treatment For Neck Pain
Research has found that treatment from an experienced physiotherapist is an effective way to manage neck pain, particularly when treatment includes:
- Helping you understand the what’s, how’s and why’s of your neck pain: Studies have found that a number of everyday factors are strongly linked to neck pain, such as how long you work at a computer, having poor posture, and working with a monitor. Physiotherapists are very familiar with the factors that contribute to neck pain, and so provide timely and accurate advice about what causes neck pain, how to prevent it, and keep it at bay. This may include analysing and adjusting your physical work environment, how you use your computer and devices, how to keep your neck aligned and supported while you sleep so you wake up with less pain and stiffness, how to position your desk and chair for the best ergonomics, and more.
- Manual therapy: Physiotherapists use a range of manual therapy techniques to help reduce neck pain and address any underlying musculoskeletal concerns, including mobilisation and hands-on remedial massage. Research has found that just five sessions of manual therapy are effective in significantly improving neck pain and mobility, and further evidence indicates that three sessions of weekly physiotherapy that includes manual therapy and therapeutic exercises can reduce neck pain and improve range of movement for people that have pain with nerve-related neck pain. Manual physiotherapy is a proven way to lower pain levels and disability scores for neck pain, including cases where the pain radiates, such as into the arm.
- Exercises: Treatment with a physiotherapist often involves specific exercises tailored to your physical needs, to stretch and strengthen your musculoskeletal system, correct posture, and improve your joint health and range of motion. Research has found that many people who struggle with neck pain tend to hold their head in a forward position, contributing to further pain. Postural exercises such as chin tucks, trapezius stretches and thoracic extensions can help to correct and reverse a craned-neck posture. Just 12 weeks of strength training exercises have shown improvements in neck pain and function for those with chronic neck pain, and several studies have demonstrated that neck pain can be reduced by strength training exercises that target specific muscle structures
- Physical activity: When working with a physiotherapist, you’ll receive guidance and advice on how to keep physically active and exercise effectively to reduce and prevent neck pain. Inactivity tends to make joint pain worse, including neck pain resulting from arthritis, so physiotherapists may recommend light exercises such as yoga, tai chi or Pilates to reduce stiffness and improve strength and flexibility, or low-impact aerobic exercises such as swimming or walking.
- Home care: Your physio may also recommend ways to help manage your neck pain at home without irritating or worsening your symptoms. Potential solutions include hot or cold compresses which can be helpful to reduce inflammation, swelling, stiffness, and pain when used appropriately.
Preventing Neck Pain Tips
To help prevent neck pain, don’t forget to:
- Balance your computer workstation: keep your desk and chair at a height where the first line on your screen sits at eye level. Sit against your backrest and keep your knees below your hips with your feet flat on the floor. If you’re having trouble achieving a good foot posture, use a footrest.
- Take regular breaks from your desk and computer: for every 15-30 minutes, stand up and take a break for at least one minute. In this time we recommend some gentle mobility and stretching exercises:
(credit to the Hong Kong Centre of Health Protection)
Here is the looking up and down neck flexion exercise as demonstrated by our physiotherapists:
- Avoid cradling your mobile phone between your neck and shoulder: switch to earphones, a headset or speaker function instead.
- When using your phone, bring it up to your eye level as this minimises the pressure on your neck.
- Sleep in a good position: use a pillow that supports your neck’s natural curve, avoid using too many pillows, and avoid sleeping on your stomach.
- Regularly switch shoulder or arm sides when carrying a heavy bag or child for a prolonged period.
- Keep your head against the headrest when driving: you can adjust your headrest, seat height and the angle of the backrest to help prevent overstretching of the neck and upper limbs forwards.’