Physiotherapy Treatment for Neck Pain: A Comprehensive Guide

Neck pain is a common condition and according to Bovim et al., the annual period prevalence ranges between 30% and 50%. The neck is a vulnerable part of the body, as it supports the head and is highly mobile. The upper cervical region is the most mobile part of the spinal column and it is estimated that it carries out almost half of the total rotation and flexion of the whole spinal column. Consequently, the neck is prone to injury and can produce significant nociceptive and neuropathic pain. It is not a life-threatening condition, but it can cause significant disability and has a substantial socioeconomic impact. There is an extensive range of etiological factors that can lead to neck pain. It can be divided into traumatic and non-traumatic causes. Trauma can cause fractures/dislocations, soft tissue damage, and whiplash injuries. Non-traumatic neck pain usually arises from poor posture, repetitive work-related activities, and prolonged sedentary positions, i.e. reading or working at a computer. This, in turn, can lead to mechanical neck pain, myofascial pain, and pain from osteoarthritis. There is also a substantial amount of evidence linking psychological distress and chronic musculoskeletal pain. This is important to consider as it will influence the patient’s pain behavior and there is evidence to suggest that a combination of cognitive-behavioral therapy and physiotherapy may be more beneficial in this subgroup of patients.

What is Neck Pain?

Whiplash associated disorders (WAD) refer to a range of symptoms resulting from an acceleration-deceleration mechanism of energy transfer to the neck. The most common and well-known cause of WAD is a motor vehicle accident in which the vehicle is struck from behind. It is estimated that up to 83% of people who have sustained a whiplash injury will have neck pain at some point in the months following the accident due to associated cervical facet joint capsule injury and muscle strains of the neck.

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. Because fibromyalgia is a syndrome involving many symptoms and no known cause, there are several possible explanations for the pain in the neck. In a study by Mease et al., it was found that patients with rheumatoid arthritis and fibromyalgia experience greater pain intensity and some increased sensitivity to stimuli in the neck compared with those with RA alone.

Tension myositis syndrome (TMS) is a psychosomatic disorder involving a constellation of benign physical phenomena that can produce chronic pain. In his book “The Mindbody Prescription,” John Sarno describes TMS in great detail, giving it much attention as the primary cause of chronic pain in Western society. Although TMS has many symptoms, it is most commonly associated with localized pain in and around the muscles in the neck and is due to reduced blood flow to these areas.

Neck pain can be divided into two types: acute, due to an injury, and chronic. The most common forms of chronic neck pain are tension myositis syndrome, fibromyalgia, and whiplash associated disorders. These will be addressed individually.

Causes of Neck Pain

This usually occurs with work-related neck pain and is due to a particular activity being carried out over and over again the exact same way with the body not being given a chance to recover. This leads to fatigue in the structures in the neck, poor muscle coordination, muscle imbalances, and sometimes pain. An example is someone who works as a tiler or painter and decorator, they require sustained neck positions to carry out their work and it is often above shoulder height.

Repetitive Strains

Whether it’s holding your head in one position for too long, bending your neck to look down at something, or keeping your head turned or tilted, it can cause strain to the joints, muscles, tendons, and ligaments in your neck. Examples include painting a ceiling, washing your hair at the basin, reading, and knitting. These activities become risk factors when they are continued for too long without a break.

Prolonged postures

There are some things in life we just can’t avoid – prolonged postures and repetitive strains are the most common reasons why we develop neck pain, these are known as mechanical neck pain.

Understanding the Cause

Neck pain is a very common problem, but it can get complicated very quickly. Most people who suffer from acute or chronic neck pain don’t know the true cause of the pain. It’s worth finding out the cause of your neck pain, as the diagnosis can help you understand how a physiotherapist can help alleviate your symptoms.

The Role of Physiotherapy in Neck Pain Treatment

Neck pain is a very common problem. For some people, it gives few problems and is not a high priority for treatment outside of self-treatment. For others, it can be very disabling. It can also be very worrying as the cause of the pain may be unknown. This can also be a detriment as often it is best to treat the problem earlier rather than later. Obviously, the treatment options for neck pain are numerous, ranging from a wait and see what happens approach to more aggressive treatment involving surgery. Physiotherapists are healthcare professionals who can diagnose and treat health conditions that affect people. We use a holistic approach to health and consider how both lifestyle and general well-being can affect neck pain. With a thorough assessment, physiotherapists can diagnose the cause of the pain, select the most appropriate treatment, and systematically treat the problem. A large focus of physiotherapy in neck pain is reducing pain and stiffness, which we know are huge factors in disability with neck pain. Activity can be very effective in reducing pain and stiffness, and often we use patients’ own hobbies and jobs to simulate their positions that bring on the neck pain. A hands-on approach is often used in treating neck pain. This may involve mobilizing stiff joints, massaging tight muscles, stretching, and finally, the strengthening of weak muscles. A variety of techniques can be used so treatment can be catered to each individual, and many will find relief in a relatively short space of time. Posture and providing education are key components of reducing neck pain, preventing its reoccurrence, and stopping it from becoming a chronic problem, which can be the case for many people. This leads into determining the best long-term management plan for neck pain. This is sometimes simply a maintenance exercise program and regular physiotherapy treatment if required. In more complex cases, it may involve…

Common Physiotherapy Techniques for Neck Pain

A systematic review suggests that there is evidence that manual therapy is effective in improving pain, function, and patient satisfaction for those with chronic neck pain. Debilitating neck pain may mean that first you must undergo some gentle mobilization to increase the range of movement before moving onto manipulation. Massage that we know is very relaxing and makes us feel better, but it might not be suitable for neck pain on a long-term basis. The reason for this is that it will only address the symptoms and not the cause of neck pain. A randomized controlled trial has provided evidence that massage is not beneficial for long-term pain relief, and the participants of the trial actually reported increased pain.

Manual therapy is one of the techniques used by physiotherapists to alleviate neck pain. It is proven to be cost effective and has been proposed to have good outcomes for both chronic and acute neck pain. Manual therapy can achieve this by increasing the movement and decreasing the pain.

The physiotherapy treatment is not only an aid to recover from an attack and can ward off any further damage, but also can prevent neck pain from happening again, and thus it helps to save time and money. Physiotherapy treatment is needed to rectify any problem with the spine, or the supporting muscles or ligaments, and any physiotherapy treatment will reflect the nature of the problem. Physiotherapy treatment techniques are changing at a fast pace to adapt to the changing nature of managing neck pain, but still some traditional techniques are relevant in treating neck pain today.

Manual Therapy

Manual therapy for neck pain utilizes any hands-on technique to mobilize or manipulate the cervical spine and its associated structures. There are many different methods and the physiotherapist will choose the most appropriate for the patients’ symptoms. Mobilization is a passive movement of the neck joints in a specific direction and range. A slow and steady oscillatory movement is often used at the limit of joint range. This is often pain-free and is repeated for several bouts. It is especially useful for neck pain in the elderly and for patients experiencing acute whiplash-related neck pain. Segmental mobilization aims to isolate a single spinal joint using specific oscillatory pressures on the neck in a direction that encourages pain-free movement in that segment. Sometimes a technique called muscle energy technique is used to improve joint function. This involves the patient gently contracting their neck muscles in a specific direction, followed by a controlled counter strain from the physiotherapist aimed at restoring normal joint mechanics. A similar method called proprioceptive neuromuscular facilitation and isometric resistance can be used to improve range of movement and muscle function around the neck, especially in patients with chronic pain and associated muscle deconditioning. High velocity low amplitude thrust manipulation is a technique where the joints are taken to their limit of movement and a quick thrust is performed to improve the joint’s range of movement. This is often associated with a clicking sound as the joint releases gas and is safe and effective when performed by a trained professional. It is especially good for mechanical neck pain with associated referred pain in the upper limb and for patients with recent onset neck pain of traumatic origin.

Therapeutic Exercises

It has been suggested that patients with chronic neck pain have poor proprioceptive acuity in the cervical region. Eccleston and O’Dwyer found that joint position sense at the CROM was significantly less accurate in chronic neck pain subjects when compared to control subjects. An existing source of acute neck pain, whiplash injury, has been shown to have temporary dysfunction in proprioceptive control of the cervical spine. This neck strength and sensorimotor deficit is associated with increased re-injury of the neck and conversion of acute pain to chronic pain. All patients with neck pain should have their neck muscle performance assessed and have specific impairments targeted with individualized exercises.

Patients with chronic neck pain demonstrate decreased isotonic strength and isometric endurance of neck flexors and extensors when compared to pain-free individuals. Individuals with disabling neck pain and weakness have shown improvement in functional ability and strength following exercise programs. Global and specific muscle endurance is significantly reduced in patients with chronic neck pain.

Studies show that therapeutic exercises are an effective intervention that a physiotherapist provides. Clinical experience also suggests that many patients with neck pain have reduced strength, endurance, and flexibility of the cervical and shoulder girdle musculature.

Postural Education and Correction

Measures of forward head posture can be taken using a plumb line dropped from C7. This will be useful to determine whether a patient has made improvements with posture over a period of treatment. Other common postural faults include increased upper cervical extension and excessive protraction or retraction of the head.

Research shows positive links between forward head posture and neck pain. This is a common postural fault where the head is positioned in front of the mid-shoulder line. This posture increases the amount of stress placed on the neck and upper back muscles and is often associated with increased upper body weight.

There are many contributors to poor posture, such as occupation, an imbalanced shoulder load (carrying a bag on one shoulder), and muscle weakness or tightness. Many patients with neck pain have poor posture, so it is important that a physiotherapist has the relevant skills and exercises for poor posture neck pain treatment.

When talking about posture in relation to neck pain, we are looking at the positioning of the head in relation to the shoulders. The average weight of a human head is approximately 5kg. Having the head in the correct position reduces stress on the neck muscles and prevents muscle imbalances, which can contribute to faulty joint movement. Good posture also reduces the chances of muscle tightness and pain. It gives a nice appearance and minimizes aging changes to the spine.

Heat and Cold Therapy

Heat and cold therapies are easily administered with household items. Heat for an hour with a hot water bottle or plenty of mineral ice gels, cold with a bag of peas wrapped in a tea towel or with an ice pack. Heat may be too deteriorating and inflammatory for some conditions so it is best to try both to see what your body is going to respond best to. A comparison study into heat and cold therapies for neck pain found there was no huge difference between patients who had thermotherapy compared to cryotherapy; however, the thermotherapy group had higher pain relief scores compared to the cryotherapy group. A suggestion with any neck pain would be to try heat first; however, if you find this causes a lot more pain, then swap to ice. Heat and cold treatments can be tried over the course of around 2 weeks with around 15 minutes application 3 times a day, then assess their efficacy.

Electrical Stimulation

Electrical stimulation (e-stim) uses an electrical current to cause a single muscle or a group of muscles to contract. Contracting the muscle via electrical stimulation helps strengthen the muscle, allows the patient to achieve a maximal muscle contraction that would be difficult to achieve volitionally, and can often times help the muscle achieve a contraction in less time. Muscle force can be measured by the amount of tension that is created in the muscle and e-stim can help measure it. This is important because it is easy to overestimate how strong a volitional muscle contraction is. If a muscle has become atrophied or weakened, the electrical current can help prevent disuse atrophy while the muscle is being re-educated. E-stim can also act on sensory receptors to help alleviate a muscle spasm and reduce inflammation. This can help reduce muscle atrophy. E-stim is often used to retard or prevent muscle atrophy. Disuse atrophy occurs from trauma or diseases in which a muscle has become so weak that normal exercise is painful. The primary goal is to improve motor unit function and to have a muscle contraction. It has been indicated in the literature that initial muscle strength can be regained 3 to 5 times faster with e-stim than with volitional exercise. Keep in mind this may not be functional strength, but it is a start. Electrical stimulation can be used to achieve many different results and it is important to match the type of current and the e-stim set-up with the desired goal. This may include pain relief and it is important to use the proper electrode placement and current to achieve the end result. Electrical stimulation for pain relief was first used in 1965 by Melzack and Wall who were studying the gate control theory for pain. There is much scientific evidence relating to e-stim and various types of currents for pain relief.

Benefits of Physiotherapy for Neck Pain

Pain relief and management is the first thing you should expect from this therapy. When one has an injury, the first thing a person wants is to get rid of the pain. With the physiotherapeutic exercises undertaken to remove any dysfunction of the neck and soft tissues. As well as the therapist may use mobilization and manual therapy techniques. It is very well documented that the use of mobilization and exercise is very effective for neck pain relief. (Systematic review: Kjær M, Juhl C, Electromechanical devices for the application of spinal manipulation: to assess the benefits and risks for patients’ Journal of manual and manipulative therapy 2006, 14, pg E14 E15.) A study by the Medical Research Council has shown that there are no significant differences in global perceived effect between the electrotherapy and the exercise group, but both groups were shown to have significant benefits for the patients after 4 and 12 months. (Miles A study to assess the efficacy of the application of a physiotherapy programme in the management of diffuse neck pain – a randomized controlled trial. Dissertation for the MSc in Manipulative Physiotherapy and the MSc in Neurosciences and Pain. The University of Nottingham 2010.) This is just a glimpse of how physiotherapy is effective at relieving neck pain.

Pain Relief and Management

The first thing that a physiotherapist will do is to perform a thorough examination to determine the cause of the neck pain. The examination may include identifying the patient’s postural type, determining the range of motion available to the patient, and assessing the muscle strength. These factors will help the physiotherapist to determine which muscles are imbalanced and often causing the pain that the patient is experiencing. Once the cause of the pain has been identified, the physiotherapist will begin treatment. One of the most common ways to relieve pain is with the use of heat. Heat helps to relax tight muscles, and heat packs can be applied to the affected area. Heat is also available in the form of ultrasound, which utilizes sound waves to penetrate deep into the tissue. This has a gentle heating effect that can help to relieve pain and tightness. Another method of pain relief is ice, although it is generally used on acute injuries where inflammation is present. Ice is a natural analgesic and can help to numb pain for up to an hour. TENS is a form of electrical therapy that is also effective for pain relief. It involves the application of electrical current to the skin in order to reduce pain. It is based on the theory that stimulating the nerves can block pain signals from being transmitted to the brain and spinal cord. A different current strength is used to stimulate the sensory (for pain relief) and motor nerves (for a decrease in muscle spasm). A physiotherapist will use a variety of other techniques such as soft tissue massage, joint mobilization, and dry needling in order to relieve pain. The most important thing is that pain relief is only the beginning of the treatment plan. The same physiotherapy techniques are then used to treat the cause of the pain and to prevent the pain from returning.

Improved Range of Motion

A recent review from Cross et al in New Zealand was based on the best current evidence. They suggest a multimodal physiotherapy package including range of motion/strengthening exercises may be beneficial for chronic neck pain disorders even though this evidence at best is moderate. Traction techniques were not supported by the evidence at any level due to non-homogenous data and low to very low-quality data. This is consistent with an earlier review by Gross in 2010.

Alberta et al showed that there is grade A evidence for the benefits of active mobilization exercises for relieving pain and improving function in the treatment of neck pain. This high-quality analysis encompassed a smaller number of primary studies; many of which are not included in the later high-level evidence reviews. It states mobilization is likely to be more beneficial for patients with chronic symptoms, rather than acute neck pain and should address the region or segment and specific underlying pathology of the patient. The reviewers rate simple mobilization or non-thrust as more beneficial than complex thrust manipulation techniques. 2 more recent trials were not included in this review but support these findings so have been mentioned alongside their relevant grades of evidence.

Motor control may be decreased in those with chronic whiplash associated disorders (WAD). Reduced deep neck flexor activity on performance of the craniocervical flexibility test and decreased cervical joint position sense have been demonstrated in these patients. It has therefore been suggested that differing exercise protocols be subgrouped according to the extent of patient’s activity tolerance and presenting musculoskeletal impairments. Get info from Audit and M&G.

Strengthening of Neck Muscles

Your neck has a number of small muscles with the primary role of supporting your head, which weighs about 5 kg. In order to do this effectively, these muscles need to be trained to have good endurance. Poor endurance in these muscles can be a factor in the development of neck pain, and can be a barrier to recovery. Strengthening is also important for people who get neck pain when they do specific tasks, such as lifting, because they often have markedly reduced strength in their neck muscles. It is important to learn how to isolate and train the deep neck flexor muscles, and to make sure that other muscles such as the upper trapezius or muscles at the back of the neck do not become overactive in the process. A physiotherapist can teach you how to do this and provide exercises at the correct level for you. Static and isometric exercises are useful to start with, and progressing onto dynamic strengthening exercises for both neck flexors and neck extensor muscles. This may involve using an exercise ball, and resistance exercises which can be done against an exercise band. As a general rule, high load exercises, such as strengthening the upper trapezius in people with neck pain, should not be done as these may exacerbate symptoms.

Prevention of Future Neck Pain

There are two main ways in which physiotherapy can aid in preventing future neck pain. The first is by achieving normal strength and endurance of neck muscles. This will allow the person to undertake activities with reduced risk of neck strain. The second is by increasing the functional and postural capacity of the neck. Physiotherapists can assess whether your neck has sufficient strength and endurance to perform specific tasks, or if it has the capacity to meet the postural demands of certain environments. By improving these factors and increasing the overall capacity of the neck, the risk of pain and disorder will be reduced.

The best kind of treatment for any kind of disorder is to stop it from happening in the first place. By working with physiotherapists in dealing with your neck pain, you can greatly decrease the chance of your pain returning. Patients who took part in exercise therapy reported a 60% reduction in recurring pain two years after the program had finished. This shows how taking the time to deal with your neck pain can have a lasting effect, well after the treatments have ceased.

Physiotherapy Treatment for Neck Pain in Singapore

Physiotherapy treatment goes through several stages, and one should always start with simple less invasive treatments. Rest and activity modification to avoid aggravating the painful area, ice therapy in the initial stages to reduce pain and inflammation, and ergonomic advice to improve posture may be simple but effective in reducing pain. A qualified physiotherapist can give professional advice on posture. This is important as poor posture is often a contributing factor to neck pain. Postural correction would reduce the stress on the neck muscles and prevent recurrence of the pain. High stress levels will also lead to increased muscle tension and pain in the neck and shoulders. Techniques such as relaxation and massage therapy, and stress-free periods of rest can alleviate the pain. A recent Cochrane review has shown that manual therapy with mobilization and exercises provide high-quality evidence for sub-acute and chronic neck pain. This is something which the physiotherapy profession can provide.

Physiotherapy is recognized as one of the more effective treatments for neck pain. Beyond simply pain relief, it is also helpful in the prevention of recurring pain as well as improving function. A group of trained professionals work towards maximizing your potential and promoting a high quality of life.

Neck pain is a common problem in all parts of the world, and Singapore is no exception. A sedentary lifestyle, poor posture or sleeping position, and even static loading at work can often lead to neck pain. Neck pain is also frequently accompanied by pain radiating down the arm, headaches, or arm weakness due to nerve irritation. Hence, it is important to have an effective and convenient treatment for neck pain in Singapore.

Overview of Physiotherapy Services in Singapore

Physiotherapy in Singapore is a well-established and widely utilized mode of treatment for individuals with neck pain. In Singapore, physiotherapy can be accessed through the restructured hospitals, community hospitals, polyclinics, private physiotherapy practices, and home therapy services. Patients will need to obtain a referral from a medical doctor to receive physiotherapy treatment in the restructured hospitals, community hospitals, and polyclinics. Physiotherapy in the private sector can be accessed with or without a referral from a medical doctor. Treatment may take place in the physiotherapist’s clinic, a GP clinic, nursing home, or the patient’s home. Physiotherapy treatment for neck pain can vary greatly and is dependent on the nature and cause of the neck pain, co-existing medical conditions, the age and functional status of the patient, and the goals of the patient. Treatment may involve a variety of physiotherapy techniques and modalities and is aimed at pain reduction, improving neck movement and function, strength, balance and coordination, and patient education. The duration and frequency of physiotherapy can also vary, ranging from a one-time consultation to multiple times in a week, and over a period of weeks to months. Step-down care and home therapy services are often a consideration for patients who have had a long inpatient hospital stay and have multiple healthcare needs. These patients may have significant neck pain and disability and severe functional limitations. Physiotherapy provided by home therapy services can be especially beneficial as it allows this group of patients to receive therapy in their own home and increases the safety and ease of access to health services.

Top Physiotherapy Clinics in Singapore

Physio Works Physio Works is one of the leading providers in physiotherapy and sports massage in Singapore. Located in the central area, it was established in 1999 and since then, has provided effective hands-on treatment and rehabilitation. Physio Works takes pride in maintaining professional excellence by keeping up to date with current evidence-based practice, ensuring that all clients receive the most effective treatment. All Physio Works therapists have extensive experience and post-graduate qualifications in manipulative therapy (completing Masters or equivalent), and are trained to carry out each individualized treatment in a caring and effective manner. Treatment provided here includes back and neck pain, sports injuries, women’s health and continence management, acupuncture, and many more varied conditions. Step-by-step guidance is given to prevent recurrences whenever possible. There are currently 3 clinics located in the central area, east, and west. Feel free to contact their friendly staff if you have any questions for a preferred clinic.

Listing only a few may not be representative, however the few mentioned below are among the top established clinics and have been around for a while.

Cost and Insurance Coverage for Physiotherapy in Singapore

Singapore’s public sector outpatient physiotherapy is considerably cheaper than therapy in private clinics. The former costs between $48.00 – $56.00 for initial assessment and $40.00 – $48.00 for follow-up treatments, while the latter costs range from $80.00 – $160.00 for initial assessment and $70.00 – $120.00 for follow-up treatments. Cost for therapy will thus factor into the decision-making process on the type of setting for physiotherapy. Rehabilitation treatment is not reimbursable under Medishield and Medisave currently, this includes treatment at private clinics. However, in March 2005, IRAS issued a new EDB Productivity and Innovation Credit scheme offering automatic 150% deduction on $400,000.00. This translates to savings of up to $60,000.00 annually, including some form of tax relief on IRAS bills for physiotherapy clinic owners. Unfortunately, for clients who would benefit best from the expertise of senior physiotherapists and/or have physical disabilities that make travelling to seek treatment difficult, there may be a discrepancy in the amount of subsidies they are actually able to utilize. Due to the high demand for polyclinic physiotherapy services, there is a cap on the number of sessions each patient can receive and a waiting list which may be months long. This can be impractical for patients who require regular follow-up or continual therapy.

Patient Testimonials and Success Stories

Helen, 40, teacher. Persistent neck pain, pain between the shoulders, and frequent headaches made competitive badminton and tennis nearly impossible. At that time, my life was plagued with the pain in my shoulders that caused me to be unable to sit and even concentrate on my studies. I had to pull out of various badminton tournaments and an A-level paper due to the intense pain and numbness in my arm. I felt as though all I could do was to rest and avoid activities that worsened my condition. It was discouraging and frustrating to believe that I would have to live with this pain for the rest of my life. After 2 weeks of home physiotherapy, Helen was referred to physiotherapy outpatient where treatment was started to relieve the nerve root compression in her neck. After her badminton accident where she injured her mid-back, Lyn, 19, national badminton player experienced right upper limb pain and right-sided headaches. The pain persisted for a few days until, after a routine doubles match, Lyn collapsed due to intense pain between her shoulder blades with associated right arm numbness. She was afraid, fearing that the symptoms she felt were similar to a past injury her coach had which required surgical intervention. Despite physiotherapy’s known benefits, Cassandra, elderly, smoker with diabetes led a very inactive lifestyle. She was very slow in seeking treatment when she felt aching pain in both her shoulders with symptoms of numbness and “pins and needles” in her feet. This caused her to wake up feeling tired and restless.