Neck pain: answering commonly asked questions

Danny Dinh

Physiotherapist

March 13, 2022

A follow-up on my previous neck pain article

This article is a follow-up to my previous neck pain article, which described the assessment and treatment of a patient who experienced neck pain when she worked from home, as well as a few tips and explanations regarding load management and posture. 

Instead of focusing on a case study, this one will serve to answer the most commonly asked questions about neck pain.

How long does it take to get rid of neck pain?

This depends on what “type” of neck pain you have. Most neck pains can resolve fast, and are part of a rapidly reversible mechanical group, also known as a cervical derangement (as discussed in my previous two articles on back and neck pain [hyperlinks]. After establishing a directional preference, which is a movement that specifically targets the patient’s pain, their condition can resolve within days.

Some neck pains are more stubborn and need manual therapy, stretching, and strengthening in all directions to get better instead. These neck pains typically get better after a few weeks but need 2-3 months to approach resolution.

The third and last subgroup of neck pain is what we call non-mechanical. These do not improve with stretches and exercises at all and need to get worked up.

Is there a stretch I should do for my neck pain?

Everybody’s neck pain is unique to them and needs a tailor-made plan of exercises and stretches, but let’s try one exercise that has helped many of my patients.

1. First, to know if the exercise is actually good for you, let’s establish a few baselines. Baselines are positions and movements that reliably reproduce your usual neck pain. Some common baselines include neck rotations and flexion (as depicted in the picture). You can also use unique movements and positions that you know irritate your neck as well. If you have neck pain at rest, you can also use that as a baseline.
2. Now, let’s try an exercise: cervical retraction and extension. a) Start by fully retracting your neck by pressing on your chin. Make sure that, like the model in the picture, you are not bringing your head down or up during the movement, but only backward. b) Now, extend your neck while in a retracted position by stretching upward as high as possible. c) If the movement is tolerable, continue until you’ve done 15 repetitions. If needed, you can take a few seconds in between reps.
3. Let’s recheck our baselines: perform all the movements you did in step #1.
4. How to interpret your results:

If your baselines significantly improve, your likelihood of having a rapidly reversible condition is higher. You can continue doing this exercise ten times every two hours and see if you can improve even more. If your baselines only minimally improved, try doing another set of 15 reps of the exercise but this time try to lean even further back, then recheck baselines once more. For an example case study on a rapidly reversible condition, check out my case study on back pain as well as my philosophy article.

If your baselines did not change or only minimally improved, try doing one last set of 15 reps of the exercise but this time try to lean even further back, then recheck baselines once more.

If your baselines worsened, don’t continue this exercise at home. Your likelihood of having a rapidly reversible condition remains high, but this is not the right direction to continue. 

What causes neck pain?

In insidious pain, which is pain that gradually started without being triggered by any trauma, the cause is multifactorial. It can be a combination of many things: food, nutrition, sustained postures, hormonal, etc. Trying to find out the exact cause of it can be difficult. With my patients, I always go through their history and current pain patterns to identify any potential pain triggers in their environment.

To learn more about the link between neck pain, posture, and load management, please refer to this article [hyperlink].

Do I have a nerve problem? 

If you feel any of these following symptoms, it is likely that there is a nerve involved in your condition:

• Pain going down the arm or the upper back

• Burning, tingling, freezing, and electricity

• A loss of sensation (usually felt in the fingers)

• Muscle weakness (a common sign is that you drop things randomly)

• Throbbing and sharp pain

The prognosis for nerve-related neck pain is still very good, however! Together, we can identify what exercises you can do to decompress the nerve and resolve your problems.

Could my neck pain be caused by my pillow?

It is possible but unlikely. 

The pillow we sleep with at night is often blamed for our neck pain, but it is not always the case. While it is difficult to judge whether your pillow is the root cause of your neck pain since many other factors are present, here are some signs that it could be aggravating it:

• You regularly wake up at night with neck pain.
• Your neck feels stiff or painful in the morning.
• You actually feel better when you sleep with a different pillow.

What type of pillow should I use if I have neck pain?

Unfortunately, there is no universal perfect pillow for neck pain, despite many different companies with different kinds of pillows claiming to be it.

Pillow can be: large or small, hard or soft, and made of different materials such as memory foam, latex, down, feather, etc.

Before shelling out good money for a pillow (and some of these can be quite pricey!), make sure it will actually make a difference. If your pillow is soft (as most sleeping pillows are), try sleeping for two to three nights with a hard pillow (you can either use a sofa pillow or borrow someone’s) and see if you feel a change in your neck pain. If after a few nights there is still no difference, then it is very unlikely that purchasing a new pillow would help with your pain.

Sometimes, it’s not about the pillow and more about how you use it. This picture from the Reembody Method showcases one of my favorite ways of using my pillow and is also something that I have my patients try out when they have neck pain. We place a pillow or towel under the shoulder blades in order to support our upper back. You can actually forgo the towel and still sleep in this position: most pillows are large enough to cover both your neck and upper back, you just have to make sure to slip yours underneath your shoulders.

What this position does is support both your head and upper back, which ensures that your neck stays neutral. This is opposed to a more typical pillow position, which supports only the head and leaves your neck at a protruded angle.

Of course, this position is not a universal cure for neck pain (if only it was so easy!), but it may help relieve your pain at night or in the morning, is free and worth trying out if you’re considering purchasing a new pillow.

How should I organize my desk?

This question was discussed in my previous neck pain article [hyperlink], here was the answer:

1. Your default position, ie: the position you will be staying in the most, should be comfortable for you. The image on the right is the most popular “ergonomic” default position for most people. However, use it more as a starting point and a suggestion for your desk posture! If sitting like the guy in the image makes you feel tense or uncomfortable, make some adjustments! For example, raise or lower your armrests so that your shoulders feel relaxed while you’re using your keyboard, and modify the height of your monitor (or laptop screen) so that your neck feels comfortable during long work sessions.

2. Move move move! You don’t need to do anything drastic that would disrupt your workflow and prevent you from meeting your work deadlines. This is easier said than done, so here are some suggestions to help you be more active while working from home or in an office.

a.  Let’s steal a trick from the optometrists’ playbook: the 20-20-20 rule, which states that every 20 minutes, you should look at something 20 feet away for 20 seconds. Let’s add another 20: every 20 minutes, move or change positions for 20 seconds. Some examples of exercises to do in those 20 seconds: standing up and stretching your neck, looking at the ceiling and stretching your arms, or simply getting up from the chair and sitting back down a couple of times.

b.  If possible, invest in an electronic standing desk. This makes changing positions even easier. At a press of a button, you could switch from sitting to working in a standing position. Alternate between sitting and standing as you see fit.

c. Other practical workplace accessories to keep you active include an exercise ball chair to replace your current office chair, a desk treadmill (if you have a standing desk), and a desk cycle. 

Moving forward

If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.

If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at dannydinh.physio@gmail.com or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.

Further reading

Here are some suggestions of articles I have written recently, organized by topics.

An in-depth explanation of my physiotherapy philosophy: Part 1, Part 2

Neck pain: a case study, answering common questions from patients

Low back pain & sciatica: case study 1, case study 2

Knee pain: case study 1

Shoulder pain: case study 1

An explanation of referred pain

Why choose telerehabilitation

7 reasons why I love my profession

Images courtesy of: Reembody, Corner Stone Physio, Musculoskeletal Key, Pinterest (Kristy Izbicki)