Neck Pain

These three account for most of what we see, and they're managed differently.

Wry neck (torticollis). The neck muscles spasm, one side becomes painful, and you can't straighten your head ². It happens at any age but is most common in teenagers and young adults, usually after something small: sleeping awkwardly, a sudden flick of the head, carrying an unbalanced load like a suitcase, or a viral infection ^1,2. Treated early it responds well, often within days ¹, and usually clears within about 7 to 10 days ². Rarely (particularly over 40, and very rarely in infants) it has an underlying medical cause, not a mechanical one ¹. Torticollis in a baby is a different problem again, covered in Torticollis in Babies.

A simple muscle strain. Pain and stiffness stay in the neck and shoulder. It's sore to move but it does move, it eases with heat and gentle activity, and nothing is happening in your arm.

A pinched nerve (radicular pain). The giveaway isn't the neck, it's the arm. Pins and needles, numbness, or an arm that feels cold points away from a simple strain ⁴, and weakness or numbness in an arm or leg needs prompt assessment, not a wait-and-see week ³.

Neck pain that started in a car accident is a different pathway again: see Whiplash.

Most neck pain is diagnosed without a scan ³. A doctor asks about your symptoms and your pain, then examines you ³. Blood tests, an X-ray, or a CT or MRI scan are for tracking down a specific cause when one is suspected ³.

The arm is what changes things. Shooting pains down your arm, or numbness or a loss of power in your arm or hand, are a reason to see your doctor, because you may need further investigations such as medical imaging ¹.

The first appointment is about working out which of those you have. Clinical practice guidelines sort neck pain into four categories: mobility deficits, movement coordination impairments (where whiplash sits), headaches, and radiating pain ¹⁰. And the category changes the plan. So we test how your neck moves, not just where it's sore.

From there:

On what physiotherapy can offer: treatment may help you recover more quickly and may give short-term relief ³, and the Better Health Channel (approved in consultation with the Australian Physiotherapy Association) says neck pain can generally be successfully treated by physiotherapists ¹. We'd rather quote both than promise more than either says.

We plan neck pain treatment along The Well Motion Recovery Path™. What moves you up a phase is what your neck can do, not how many days have passed.

• Reset: the first days. Heat, and keeping the neck moving as far as pain allows ^1,2. For a wry neck, passive joint mobilisation as well ¹. No collar ³. Expect the stiffness to outlast the sharp pain. We move you on once you can turn far enough for ordinary tasks without the pain building.
• Rebuild: most of the work. Range of movement first, then strength through the shoulder blades and arms ¹⁰, with Manual Therapy alongside when stiffness is the main problem ^5,10. Expect range to come back before stamina does. We move you on when your neck handles what your day asks of it without flaring that night.
• Return: full days at the desk or on site, driving, sleep, sport if you play it. We check how the neck copes with your longest working position. You leave with an exercise program and a habit of breaking up long sits, both tested in prevention trials ^11,12.

How long it usually takes. A wry neck usually settles within about 7 to 10 days ². Most other neck pain improves within a few weeks ^3,4. It often comes back, though: a review of general population studies found between half and three quarters of people with neck pain reported it again 1 to 5 years later ¹⁴.

Prevention has been tested for neck pain, and moving comes out ahead of furniture:

• Exercise has the best backing. Across five trials and 1,722 adults, exercise programs probably lowered the chance of a new episode of neck pain over the next 12 months ¹¹. Most of those people were office workers, and how big the benefit is day to day is still unclear ¹¹.
• Break up long sits. In a six-month trial of 193 office workers at high risk of neck pain, 17% of those prompted to take active breaks, or to shift position in their chair, developed new neck pain. In the comparison group it was 44% ¹².
• Don't expect a new desk to do it alone. An earlier review of three trials found ergonomic programs didn't reduce the risk of a new episode, though the evidence was low quality ¹³. Set your desk up sensibly, then get up and move anyway.
• Take stress seriously. Stress and anxiety can trigger neck pain ³.