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Physiotherapy Management for Neck Pain

The most common causes of neck pain are injury and postural problems. Neck pain is also caused by arthritis and degenerative disc disease. Most common cause of arthritis in neck is osteoarthritis. Neck pain is caused by diseases involving facet joint, disc, spinal nerve, cervical radiculopathy1 and vertebral column. Treatment of neck pain follows complete examination and diagnosis. Choice of Physical Therapy treatment depends on cause of pain. Thus, it is important to know the cause of neck pain prior to initiation of physical therapy. It is very important to do neck exercises not only when you are in pain, but also to prevent any injuries and keep your neck muscles strong. Physical therapy for neck is provided by physical therapist and chiropractor.2

Physiotherapy Management for Neck Pain

1. Physiotherapy Techniques To Treat Neck Pain3

A. Manipulative Therapy for Neck Pain:

  • Effective Treatment-
    • Manual manipulative therapy is quite an effective method to treat both acute as well as chronic neck pain.
  • Improvements-
    • Manipulative therapy can achieve improvement of neck movements, reduce pain, and prevent further deterioration resulting in acceleration of neck pain.
  • Objective of Therapy-
    • Manipulative therapy for neck pain involves therapeutic exercise, manipulation, and passive joint mobilizations.

B. Neck Strengthening Exercises:

i. Precautions-

  • Exact Technique- This type of exercise must be performed correctly in order to avoid injury.
  • Resistance- Resistance and time of exercise should gradually increase within expected “pain boundaries”.
  • Avoid Pain- Never try to do an exercise to the point of pain.
  • Slow Rhythm- Do following exercises very slowly.
  • Limitations- If your pain worsens, stop the exercise. Evaluate the intensity and duration of pain. If pain disappears then begin exercise after 24 to 48 hours break.
  • Continued Pain- See the treating physician.

ii. Technique-

  • Neck Flexion-
    • Flex the head forward about 2/3rd of the optimum range and prevent further forward movement by using hand.
    • Hand placed over forehead resists further forward movement and flexion of neck.
    • Continue forward head movement for brief period, while continuing resistance with hand.
  • Neck Extension-
    • Extend the head backward about 2/3rd of optimum possible extension.
    • Resist further extension with both hand locked in placed over back of the head or occipital bone.
    • Hold the position while trying to further extend the neck against the resistance established by both hand.
    • Repeat both exercise and increase frequency from 2 to 10 times over 2 weeks period.
  • Lateral Tilt of Head-
    • Tilt the head side way about 2/3rd of optimum possible tilt.
    • Resist further tilt with hand placed over same side of skull above ear.
    • Hold the position while trying to further tilt the neck against the resistance established by hand of same side.
    • Repeat the exercise and increase frequency from 2 to 10 times over 2 weeks period.

iii. Objective and Goal-

  • Increases range of motion in the neck,
  • Builds coordination and strength in the cervical musculature.
  • Prevents further deterioration of disease and pain.

C. Neck Massage:

i. Precautions-

  • Precautions should be taken during massage therapy of Neck.
  • Deep massage therapy is avoided.
  • Massage therapy for neck is safe when performed by experience therapist.

ii. Technique-

  • Massage therapy includes superficial or deep massage.
  • Massage therapy improves blood circulation of muscles, ligaments and bones.
  • Improved blood circulation results in decreased inflammation and reduces pain caused by inflammation.

iii Objective and Goal-

  • Improve blood circulation
  • Improve facet joint movements
  • Improve muscle fatigue and excretion of lactic acid.
  • Improve muscle metabolism

2. Neck Postural Advice:

A. Neck Postural Problems-

  • Position of neck is important while standing, sitting and lying down position.
  • Different muscle assists in maintaining neck posture.
  • Muscles strength and mass is built on habitual postural position.
  • Chronic pain generated in facet joint, ligament, tendon and muscle prevents certain movement and position of neck and head.

B. Correction Posture-

  • Physical therapist following the examination evaluates the cause of abnormal posture of neck and suggests correction.
  • Everyday your neck muscles do many actions and each of the neck muscles performs multiple functions.
  • Therapist will suggest posture, which will use the less painful muscles and tendons.

C. Objective and Goal-

  • It is very important to maintain good neck posture. Your neck muscles can be strained if you have bad neck posture, especially if your neck posture is chronic.
  • Also bad neck posture would cause your neck to be in a compromised position that can cause a tight shoulder muscles, stiff neck, and a trapezius that hurts at the gentlest touch.

Also Read:


  1. Cervical radiculopathy: study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044].
    Langevin P1, Roy JS, Desmeules F.
    BMC Musculoskelet Disord. 2012 Jan 31;13:10.
  2. Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey.
    Carlesso LC1, Macdermid JC, Gross AR, Walton DM, Santaguida PL.
    Chiropr Man Therap. 2014 Mar 24;22(1):11.
  3. Manual therapy and exercise for neck pain: a systematic review.
    Miller J1, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL.
    Man Ther. 2010 Aug;15(4):334-54.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 9, 2022

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