How neck pain usually presents
- Stiffness and restricted rotation: often noticed when reversing the car
- Pain at the base of the skull, sometimes becoming a headache
- Pain across the top of the shoulder or between the shoulder blades
- Pain, pins and needles or weakness referring into an arm or hand
- Waking with a neck that will not turn one way at all
What is often going on
The neck is built for mobility. It carries a head weighing around five kilograms on top of seven small, highly mobile segments, and it does that while you spend most of the day looking down.
Move that head forward of your shoulders and the load on the structures holding it up rises considerably. Hold that position for eight hours a day, five days a week, for years, and the joints adapt to it: because joints adapt to how they are loaded. That is the mechanism behind most gradual-onset neck pain, and it is covered further on our tech neck page.
Sudden-onset neck pain is a different story: acute facet joint irritation, a strain, or the aftermath of trauma such as whiplash.
When pain travels into the arm
Pain, numbness or weakness extending past the shoulder suggests nerve involvement: commonly irritation of a cervical nerve root from a disc or from narrowing where the nerve exits. This changes the examination and the plan. It is not automatically bad news, and most cases settle with conservative care, but it does need proper neurological testing rather than assumption. See also numbness and tingling.
Seek urgent medical assessment for
Progressive weakness in an arm or leg, difficulty with walking or coordination, sudden severe headache, visual change, difficulty swallowing or speaking, or neck pain following significant trauma.
How we assess it
A first visit runs about 30 minutes: history, then a physical examination of segmental movement through the cervical and thoracic spine, the shoulder girdle, and your habitual head posture, plus neurological and orthopaedic testing where the symptoms call for it.
The thoracic spine gets examined every time. When the mid back stops rotating, the neck makes up the difference, and treating the neck alone in that situation buys temporary relief at best.
What care might involve
- Adjustment where movement has been lost: manual, or low-force using an instrument or drop-piece table if that suits you better
- Soft tissue work to the guarding musculature
- Cold laser therapy where the region is irritable
- Rehabilitation for the deep neck stabilisers and the postural chain, including cervical traction where indicated
You will be told what is about to happen before it happens, and if you would rather a particular technique was not used, there is almost always another way.