Unlocking Relief: A Guide to Physical Therapy for Different Types of Neck Pain

By Eric Leach, DPT, PT, CSCS

Neck pain is a prevalent issue often encountered in outpatient physical therapy, presenting in various forms and intensities. If you’re grappling with neck discomfort, this blog aims to illuminate different approaches to evaluating the cervical spine and suggest common exercises tailored to different types of neck pain.

During a comprehensive assessment for neck pain, therapists typically categorize the pain presentation into four main categories:

  1. Neck Pain with Mobility Deficits
  2. Neck Pain with Radiating Pain
  3. Neck Pain with Movement Coordination Impairments
  4. Neck Pain with Headache

Let’s delve into each category and explore suitable exercises for addressing them.

Neck Pain with Mobility Deficits:

This category encompasses restricted range of motion due to joint or muscle length restrictions. Conditions like torticollis and facet joint disorders fall under this classification. Here are exercises beneficial for addressing mobility deficits:

Cervical Snags:

  • Wrap a towel around your neck and shoulders, crossing your hands to grab each end. Pull gently to stabilize the towel, then rotate your neck using the top hand for a mild stretch. Perform 2 sets of 10 repetitions on each side.

Lateral Deviation:

  • With one hand behind your back, gently pull your head to the side, maintaining shoulder stability. Hold for 30 seconds on each side, avoiding pushing into pain.
  • Neck Pain with Radiating Pain:

This type involves pain extending from the neck down the arm, often indicating nerve compression. Exercises to alleviate this include:

Cervical Flexion Strengthening:

  • Position yourself on all fours, keeping your neck parallel to the floor, then lift your head back, bringing your chin towards your chest. Hold for 3 sets of 10 repetitions with 3-second holds.

Median Nerve Mobilization:

  • Extend your arm to the side with the affected pain, then side bend your neck away, creating a stretch down the arm. Hold for 15 repetitions with 3-second holds.
  • Neck Pain with Movement Coordination Impairments:

This category encompasses various causes, including trauma-induced injuries and postural abnormalities. Exercises to address these impairments include:

Cervical Mobilization:

  • Therapists may apply gentle force to specific neck segments to alleviate pain.

Chin Tuck and Hold:

  • Engage cervical flexors by tucking your chin, lifting your head off the ground. Hold for a prescribed duration based on your strength.

Bird Dog Row:

  • Assume the bird dog position, maintaining neck position while lifting a weight in one hand to engage the periscapular region.
  • Neck Pain with Headaches:

Cervicogenic headaches commonly stem from mobility restrictions in the upper neck. Exercises to improve mobility include:

Lateral Neck Stretch:

  • Using a chair for support, gently pull your head to the side with one hand, feeling a stretch in the shoulder and neck. Hold for a comfortable duration.

T-Spine Extension on Foam Roller:

  • Lie on your back with a foam roller forming a T with your spine, then extend your back over the roller to improve mobility.

Neck pain affects a significant portion of the population, but physical therapy offers effective management strategies. While these categories cover common neck pain presentations, other variations exist, and seeking guidance from a skilled physical therapist can be invaluable. If neck pain persists, consider exploring physical therapy as a viable solution!

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