Getting on Top of Neck Pain

Neck pain is most commonly associated with the whiplash injury many people involved in a car crash experience, but there are a variety of other causes. The key to addressing neck pain is a thorough assessment, which results in a diagnosis you can have faith in. This means that an appropriate plan can be put in place to manage and rehabilitate the neck, which decreases the likelihood of permanent disability and a recurrence of the issue.
Picture of Jimmy Goulis

Jimmy Goulis

How common is neck pain?

Between 50-70 per cent of us are likely to live with an episode of neck pain, at some point over our lifetime.

In fact, if you are currently experiencing neck pain, you have something in common with around 15 per cent of your fellow Australians.

The good news is in most instances it is not serious.

 While neck pain can be an issue at any age, it generally follows an upward trend as we get older, with the peak incidence occurring among those in the 45 to 55 year age group.

Although the incidence of neck pain among men and women follows the same upward trajectory, it is more common among the female population. Some international studies suggest this difference can be two-fold. Office workers in particular are susceptible to neck pain with the incidence increasing to nearly 50%.

 There are a number of reasons why someone might develop pain in their neck. The risk factors include:

  • Low levels of physical activity.
  • Being overweight.
  • Poor posture.
  • High levels of psychological stress.
  •  High durations spent working on computer.
  • Jobs that involve repetitive movements of the neck and shoulders.
  • Being female.

Anatomy of the neck

The neck, also known as the cervical spine, is a complex structure. Functionally, the neck provides stability and support for the head. It is also responsible for head movement. Understanding the anatomy and structure of the neck, the role the different components play, and their relationship to each other is key to understanding different neck pain types and causes. It is also important in determining how to manage and treat pain in this area of the spinal cord.

Bones in the neck

There are seven bones (C1 to C7) known as vertebrae in the cervical spine.

  • C1 and C2: The first two vertebrae are atypical and referred to as the atlas (C1) and axis (C2). Together, they make up the craniovertebral junction (CVJ), which is where head connects to the spinal column. The atlas and axis support the head and are key to its range of movement.
  • C3 to C7: Although they are smaller, the remainder of the vertebrae in the cervical spine (C3 to C7) are typical vertebrae and have the same shape as other vertebrae in the spine.

Discs in the neck

A disc sits between each of the vertebrae. They are made cartilage, which gives them flexibility. Each disc looks like a round rubbery pad and performs the function of a shock absorber, cushioning the vertebrae and limiting wear and tear when the cervical spine moves.

Facet joints in the neck

To stabilise the cervical spine and enable the neck to move back and forward and side to side, each vertebrae has two sets of facet joints that connect with the vertebrae above and below.

Muscles and ligaments in the neck

A complex network of muscles and ligaments add stability and movement to the neck and head.

Neck muscles are divided into superficial and deep groups. The superficial muscles, which you can feel under the skin, are primarily responsible for head and neck movement, while the deep muscles, which connect to the vertebrae, are key in providing support and stability to the head and neck.

The neck muscles are also categorised according to their location. The anterior neck muscles (those at the front of the neck) play a key role in swallowing, breathing, speech, and head movement.

The lateral neck muscles (those on both sides of the neck) are responsible for rotation and moving the head from side to side.

Posterior neck muscles (those at the back of the neck) stretch from the shoulder to just below the ears, assisting with movement.

Nerves in the neck

The spinal cord begins at the base of the brain and contains the sensory and motor nerve fibres.

  • Nerves responsible for movement: Motor nerves are responsible for movement.
  • Nerves responsible for sensation: Sensory nerves communicate sensations, such as pain, temperature, and touch between the brain and body.


If the nerves that travel through this area of the body to the torso and limbs sustain serious trauma, this can cause a devastating effect, including total paralysis, in some instances.

Each of the seven cervical nerves exits the spinal column at the corresponding vertebrae, and is responsible for a distinct area of the body:

  • C1, C2, and C3 are responsible for movement of the head and neck, as well as sensation on the sides of the face and scalp.
  • C4 provides sensation to parts of the upper arms, the neck, and shoulders. It also enables shoulder movement and diaphragm movement during breathing.
  • C5 contributes to shoulder and bicep movement, along with sensation at the shoulder tips.
  • C6 enables wrist and bicep movement, while providing sensation to the medial side of the forearms and hands.
  • C7 communicates sensation along the lateral arms and middle finger. It also allows for movement of the triceps.

General symptoms of neck pain, including stiff neck

When people are experiencing neck pain, including severe neck pain, they may be experiencing a range of symptoms and looking to understand why their neck is hurting.

The symptoms the person is experiencing are key to determining the underlying cause of their neck pain.

Some of the common symptoms relating to neck pain include:

  • Aching or persistent pain in the neck.
  • Neck stiffness, or limited range of motion in the neck.
  • A neck pain headache, or pain that radiates to the shoulders or arms.
  • Tenderness or muscle spasms in the neck.
  • Numbness or tingling in the arms or hands.


A combination of neck and shoulder pain.

Neck pain on the right side as well as neck pain on the left side.

Neck pain causes

As the nerves in this part of the spinal cord supply movement and sensation to almost the entire body, symptoms can be quite complex and aren’t necessarily confined to the neck.

Sometimes symptoms in another part of the body can be indicative of a neck problem and vice versa.

When determining the cause of neck pain, it’s important to understand the different neck pain types.

Musculoskeletal neck pain

Musculoskeletal neck pain causes are typically divided into two categories:

  • Trauma: Neck injuries that are the result of a trauma can range from mild to serious depending on the type of trauma experienced. The treatment of all major trauma should involve an assessment of the head and neck.
  • Insidious: The majority of musculoskeletal neck pain is insidious in nature, and ranges from degenerative changes which occur over a number of years to simply waking up having slept on your neck the wrong way. Often insidious neck pain is the result of the accumulation of micro stresses rather than a specific incident or event.

Medical neck pain

Non-musculoskeletal neck pain is that with a medical origin. There are several areas that should be considered when screening for a medical cause to neck pain, the physiotherapist considers vascular conditions, infection, cancer or space occupying lesion, and inflammatory conditions, as the underlying cause.

Neck pain diagnosis

At Pollinate Health our experienced physiotherapist completes a subjective assessment which elicits a full list of symptoms and performs an objective assessment which involves a thorough examination and tests. Each aspect of this process is designed to determine the cause of the neck pain.

The best way to understand this process is to think of it as a diagnostic sieve. When the physiotherapist first meets with you, either in person or via telehealth, there are a whole heap of possible diagnosis. By asking relevant questions and performing appropriate examinations and tests, the physiotherapist works their way through the different causes, sifting out first the neck pain red flags and medical conditions, before turning their attention to musculoskeletal causes. Starting with the most serious causes and working down to the less serious, possible causes are sifted away. What remains in the sieve at the end of the process represents the most likely diagnosis

Subjective examination for neck pain

The physiotherapist will usually begin by asking about the neck pain you are experiencing. This includes:

  • Site: Where is the pain? Do some areas of the neck experience more or less pain?
  • Onset: Does the pain come on suddenly or gradually? What are you doing when you experience the pain?
  • Characteristics: What is the nature of the pain? Is it dull and achey or sharp and stabbing? Is the pain constant or intermittent?
  • Radiation: Does the pain radiate anywhere, such as the arms and shoulders?
  • Associations: Do you experience any other symptoms associated with the pain, such as tingling, pins and needles, numbness, weakness, decreased movement, stiffness, headaches?
  • Timing: Is there a pattern to the pain? Is it present when you wake-up? Does it get worse as the day goes on? Is the pain the result of a traumatic event, such as a car accident or slip and fall? How long have you had it? Is it acute or chronic?
  • Exacerbations: Does anything make the pain worse (or better)?
  • Severity: On a scale of one to ten, how severe is the pain?

SPECIFIC SUBJECTIVE SCREENING FOR NECK PAIN RED FLAGS
During the subjective examination, the physiotherapist will also ask specific screening questions that relate to each of the red flags to rule them out as a cause. It’s often difficult to understand why the physiotherapist is asking some of these questions and some people might worry they have something serious.

These questions should reassure you that the physiotherapist is taking a proper and thorough history. Many people live with chronic neck pain for years due to an incorrect diagnosis. This process should give you confidence in your diagnosis because the physiotherapist is being thorough and sifting through all the potential causes.

One of the advantages of seeing the physiotherapist at Pollinate Health is our leadership team has

advanced qualifications and works in the hospital system with the medical profession, so c.a not only diagnose medical issues but refer you to the appropriate medical professional for management and treatment.

The red flag conditions relating to neck pain include:

  • Vascular conditions:  The most common vascular conditions are stroke or TIA. To screen for these conditions the physiotherapist will ask about the five D’s and three N’s:
    -Diplopia (double vision)
    -Dizziness
    -Drop attacks
    -Dysarthria (speech disorders)
    -Dysphagia (difficulty swallowing)
    -Ataxia of gait (difficulty walking)
    -Nausea
    -Numbness
    -Nystagmus (rapid eye movements)
  • Infections: Sometimes an infection manifests as pain in neck. The physiotherapist will ask if you have been feeling generally unwell or have experienced fevers, rigors, or night sweats.
  • Trauma: The physiotherapist will ask about recent traumas to rule it out as a cause of neck pain before beginning treatment. If there has been a trauma that could have resulted in a fracture or ligamentous injury, it’s important to exercise caution until there has been a proper evaluation.
  • Cancer or tumour: Some of the symptoms a physiotherapist will ask to rule out a cancer or tumour are loss of appetite, unexplained weight loss, headaches, and family history. They will also ask you about sensation changes and muscle weakness.
  • Inflammatory conditions: When screening for inflammatory conditions, the physiotherapist is considering conditions such as rheumatoid arthritis, inflammatory myopathies, and fibromyalgia. Screening for inflammatory conditions requires obtaining a family history of these conditions. The physiotherapist will also ask about bilateral or cyclical symptoms in other parts of the body.
  • Cardiac causes: Myocardial infarctions (heart attacks) and angina commonly manifest with referred pain in typically the right shoulder and neck. To assess cardiac causes, the physiotherapist will ask about specific symptoms, such as shortness of breath, chest pain, and lightheadedness. They will also ask about the various cardiac risk factors, including smoking, physical activity, and diet.

Objective examination for neck pain

The objective examination for neck pain involves physically assessing the person’s neck stability and movement. Testing for stability is difficult. To test movement, the physiotherapist assesses flexion, extension, lateral flexion, and rotation. This will identify limitations in movement or pain caused by certain movements and provide insight into the underlying cause of the neck hurting.

SPECIFIC OBJECTIVE SCREENING FOR NECK PAIN RED FLAGS

If trauma is a possible cause of the neck pain, the physiotherapist might arrange an x-ray or CT scan when  a bone injury or fracture is suspected. For injuries relating to the soft structures in the neck, they might organize an MRI.

To assess for other red flags there are a range of specific tests that are indicative of specific conditions. The most common include assessing your walk, reflexes, and muscle weakness or sensation changes in your limbs along the distribution of the nerves.

Physiotherapists are also likely to feel for irregularities in the neck that might suggest a tumour or swelling of the lymph nodes, which is common in infections.

Some physiotherapists may arrange nerve conduction studies which assess the nerve along its distribution path to determine where a problem arises.

What if your neck pain is musculoskeletal?

After working through this process, you can be confident when the physiotherapist diagnoses your neck pain as musculoskeletal.

Common musculoskeletal neck pain causes include:

  • Discogenic pain: As the spine degenerates over time, the intervertebral discs deteriorate. This can lead to disc bulges and herniations. When they interfere with the nerve pathways, a dull ache is felt in the neck, which is sometimes accompanied by weakness and sensation changes in the limbs.
  • Facet joint pain: Facet joints connecting the bones of the cervical spine may suffer wear and tear, which can lead to pain and stiffness in the neck.
  • Spinal Stenosis: Sometimes the canal formed by the vertebrae narrows causing pressure on the nerves inside. This often results in neck pain which sometimes radiates to shoulders, arms, and legs. A loss of sensation in the limbs or torso may also be experienced depending on the nerves that have the pressure on them.
  • Degenerative processes: As we age, our spine can degenerate as a result of a conditions like osteoporosis or spondylolisthesis which is the displacement of one of the spinal vertebrae.
  • Muscle strain or muscle tension: Stress can be a cause of muscle tension, while muscle strains can occur when you twist your neck or sleep awkwardly on your neck. Some traumas, such as a whiplash injury can also result in muscle strains.

Where you can find support for your neck pain

If you are experiencing neck pain consider booking an appointment for a comprehensive assessment with the experienced physiotherapist at Pollinate Health. He will complete a thorough assessment and make a diagnosis before discussing how you can best manage and treat the pain.

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