How neck pain usually presents
- Stiffness and restricted rotation: often noticed when reversing the car
- Pain at the base of the skull, sometimes becoming a headache
- Pain across the top of the shoulder or between the shoulder blades
- Pain, pins and needles or weakness referring into an arm or hand
- Waking with a neck that will not turn one way at all
What is often going on
The neck is built for mobility. It carries a head weighing around five kilograms on top of seven small, highly mobile segments, and it does that while you spend most of the day looking down.
Move that head forward of your shoulders and the load on the structures holding it up rises considerably. Hold that position for eight hours a day, five days a week, for years, and the joints adapt to it: because joints adapt to how they are loaded. That is the mechanism behind most gradual-onset neck pain, covered in more detail below.
Sudden-onset neck pain is a different story: acute facet joint irritation, a strain, or the aftermath of trauma such as whiplash.
Tech neck and desk-related neck pain
The neck that aches by Thursday afternoon and settles over the weekend. It is one of the most common things we see, and it is almost never about a single bad movement.
Tip your head forward to look at a screen and the muscles at the back of the neck and upper back have to work against a lever. The further forward it goes, the harder they work: continuously, for as long as you hold the position. None of that is a problem for a few minutes. It becomes a problem at eight hours a day, five days a week, for years.
What people notice:
- Aching at the base of the neck and across the top of the shoulders, worse late in the day and late in the week
- A band of tightness between the shoulder blades
- Headaches starting at the base of the skull, often on the more demanding days
- Occasionally pins and needles into an arm or hand
- Jaw tightness, which travels with this more often than people expect
Why stretching alone has not settled it
Most people arrive having already tried stretching the muscles that feel tight. It helps for an hour or two.
It does not last because those muscles are not tight for their own sake: they are tight because they are doing a job that something else has stopped doing. Typically the deep neck stabilisers have shut down and the mid back has stopped rotating, so the superficial muscles hold the head up all day instead. Stretch them and they simply resume, because the work still needs doing. What changes it is restoring movement where it has been lost and rebuilding the capacity of the structures that should be sharing the load.
We also ask in some detail about your desk setup, because that is where the load is coming from. Screen height first: it is the highest-yield change most people can make.
The realistic version
Symptoms usually settle within a few weeks. Changing a pattern you hold for eight hours a day takes longer, and you have to do the exercises. We will give you as few as will do the job, because long programs get abandoned.
When pain travels into the arm
Pain, numbness or weakness extending past the shoulder suggests nerve involvement: commonly irritation of a cervical nerve root from a disc or from narrowing where the nerve exits. This changes the examination and the plan. It is not automatically bad news, and most cases settle with conservative care, but it does need proper neurological testing rather than assumption. See also numbness and tingling.
Seek urgent medical assessment for
Progressive weakness in an arm or leg, difficulty with walking or coordination, sudden severe headache, visual change, difficulty swallowing or speaking, or neck pain following significant trauma.
How we assess it
A first visit runs about 30 minutes: history, then a physical examination of segmental movement through the cervical and thoracic spine, the shoulder girdle, and your habitual head posture, plus neurological and orthopaedic testing where the symptoms call for it.
The thoracic spine gets examined every time. When the mid back stops rotating, the neck makes up the difference, and treating the neck alone in that situation buys temporary relief at best.
What care might involve
- Adjustment where movement has been lost: manual, or low-force using an instrument or drop-piece table if that suits you better
- Soft tissue work to the guarding musculature
- Cold laser therapy where the region is irritable
- Rehabilitation for the deep neck stabilisers and the postural chain, including cervical traction where indicated
You will be told what is about to happen before it happens, and if you would rather a particular technique was not used, there is almost always another way.