Kelowna Manual Therapy Centre Blog

Neck Pain - A combination of exercise and manual therapy to both the neck and upper back results in speedy recovery 

Manual Physical Therapists have long recognized the importance of treating the thoracic spine in conjunction with treatment to the neck.  “Mechanical neck pain” is the name used when joint and muscle problems result in neck pain. Mechanical neck pain is pain that it typically centred around the neck, shoulders and upper back. Current evidence supports that a combination of manual therapy and exercise is effective for patients with mechanical neck pain. Three categories of manual therapy treatments for the neck and upper back are used to lessen neck pain:

Joint Mobilization can be a rhythmic oscillation or a sustained pressure applied to the joints of the body. This will help to decrease pain as well as restore normal mobility and function.

Joint Manipulation involves a skilled, quick, passive movement applied by a manual therapist to a specific joint. This will help decrease pain as well as restore normal mobility and function.

Soft Tissue Mobilization (including massage, trigger point therapy, etc.) is applied to the muscles, tendons and ligaments. This will help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissue.

Specific therapeutic exercises are also used to maintain and restore range of motion.  The exercises prescribed will be specific to your neck condition.

A Manual Physical Therapist will complete a thorough history taking and physical examination to determine which manual therapy techniques will best help you.  Treatment will also include education in specific therapeutic exercise.  Advice is also provided on ways to reduce the physical stress and strain you are placing on your neck.

Headaches that originate from the neck are termed 'Cervicogenic Headaches'.  The International Headache Society accepts cervicogenic headaches as a distinct form of headache.

For the purpose of this blog they will be called them neck headaches. Neck headaches are common and affect almost half the population at one point in their lifetime. There is much overlap in the symptomatic complaints between neck, tension-type and migraine headaches. It has been reported that almost 2/3 of headache suffers have neck pain with the headache.  So, while there are some similarities in symptoms between the types of headache, assessment by a manual physiotherapist will help determine if the headaches originate from the neck.

Typical complaints of an individual with a neck headache are:

• The headache is primarily one sided or one side dominant.
• The headache will typically not shift from one side to another during the course of the headache.
• The headache can be associated with neck, shoulder or arm pain on the same side.
• The pain typically starts in the neck and spreads to the head.
• The headache is often worsened with prolonged neck postures or repetitive neck motion.
• Other symptoms that can be associated with a neck headache are nausea, visual disturbances such as blurriness and/or light sensitivity, and dizziness.

To help determine if the headache is in fact related to the neck, a manual physiotherapist will evaluate the mobility of the neck and upper back. Joint stiffness of the upper three neck joints, which is evaluated by hands-on palpation, is highly correlated with neck headaches. The neck muscles will also be evaluated for their performance and strength. These assessment findings have been found to be reliable in differentiating between the different forms of headache.

Treatment would consist of joint mobilization and/or manipulation as well as special soft tissue techniques to help restore normal mobility. Specific neck exercises to help restore normal muscle recruitment and control are taught initially. These exercises would then progress to neck strengthening. Muscle imbalances around the shoulder blades are corrected with specific stretching and strengthening exercises. Other exercises for general mobility and specific self-mobilization are taught to help patients self-manage the headache. Other more traditional physiotherapeutic modalities can also be employed to aid with decreasing the symptoms.  Education on posture and the other factors that contribute to the headache must also be addressed.

In summary, neck headaches can be effectively managed through manual physiotherapy and a home-based exercise program.

Wry neck presents itself as an acutely painful neck either caused by a sudden unexpected motion or discovered upon waking.  In either case the pain is so debilitating that medical help is usually sought.

The acutely painful neck presents itself in one of two ways either a lack of mobility turning towards the painful side.  The other typical presentation is that the person suffering wry neck has to hold the head bend and turned away from the side of injury.

The most effective treatment is manual therapy consisting of a quick manipulation if pain allows (or joint mobilization).

After the manual therapy treatment is followed up by heat and electrical stimulation for 15 minutes. After the 15 minutes a series of exercised to regain range of motion is undertaken. This wry neck treatment program was first written about by New Zealand physiotherapist Brian Mulligan. http://www.bmulligan.com/about/concept.html

In the vast majority of cases after this physiotherapy session the mobility is considerably improved.  The patient is then instructed to continue this program again that evening and again next morning.  If sleep is disturbed a towel rolled up around the neck can be used at night.

The good news is that around 90% of patients will feel better with early treatment in 1-2 days.