Neck Pain

Much like low back pain, neck pain is a major cause of impairment, with 70% of people suffering from neck pain through their lives. It is second only to low back pain as the most frequent cause of long term absenteeism. Akin to low back pain, imaging (MRI) and pain are not predictive factors of dysfunction. From this we can ascertain that there is something else driving the pain.


Risk Factors

Factors such as a sedentary lifestyle, occupation, trauma, fear avoidance, stress, anxiety, and depression have been outlined in the literature to play a major role in neck pain.


Evidence Approach

Current best evidence takes a multimodal approach to managing neck pain, with exercise, manual therapy and patient education being key components. Strengthening postural muscles combined with neuromuscular re-education and endurance training, are important elements of an exercise programme.



Mobilisation, traction and manipulation have been found to reduce pain when combined with an exercise programme. The purpose of these hands on therapies is to help the client move properly which will act as an inhibitor to pain. As the cervical postural muscles begin to take over, (due to exercise programme) pain inhibition is further utilised and the client no longer needs hands on therapy.

There is strong evidence in the literature to suggest patient education has a positive relationship to a good prognosis. Emphasising and reinforcing current evidence that pain doesn’t mean damage and motion is good for your neck are important messages. Early return to non-provocative activities is central to recovery.



Childs JD, Cleland JA, Elliott JM, Teyhen D, Wainner R, Whitman J, Sopky B, Godges J, Flynn ;T. (2008). Neck Pain: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 38(9) A1-A34

Gross A, Haines T, Goldsmith C, Santaguida L, McLaughlin L, Peloso P, Burnie S, Hoving J, COG. (2009). Knowledge to Action: A Challenge for Neck Pain Treatment. Journal of Orthopaedic & Sports Physical Therapy 39(5), 351-363

Van Oosterwijck J, Nijs J, Meeus M, Paul L.. (2012). Evidence for central sensitization in chronic whiplash: A systematic literature review. European Joiurnal of Pain, 17: 299-312

Michaleff Z, Maher C, Lin CW, Rebbeck T, Jull G, Latimer J, Connelly L, Sterling M. (2014).; Comprehensive Physiotherapy exercise Programme or Advice for Chronic Whiplash (PROMIS): A Pragmatic Randomised Controlled Trial. The Lancet, 1-9.

Scholten-Peeters G, Bekkering G, Verhagen A, Van Der Windt D, Lanser K, Hendrix E, Oostendrop R.(2002). Clinical Practice Guidelines for the Physiotherapy of Patients with Whiplash –Associated Disorders. Spine 27(4): 412-422.

Stone A, Vicenzino B, Lim E, Sterling M. (2013). Measures of central hyperexcitability in chronic whiplash associated disorder: A systematic review and meta-analysis. Manual Therapy, 18: 111-117 Zusman M. (2013). Belief Reinforcement: One Reason why Costs for Low Back Pain have not Decreased. Journal of Multidisciplinary Healthcare, 6: 197-204.