Management of neck pain

Neck pain is a common presentation in osteopathic practice.  Luckily sinister causes of neck pain are rare.  Osteopaths are mindful of what are called “red flags” that may indicate a serious pathology.  Neck pain puts significant socioeconomic stress on society mainly in terms of disability and loss of work days.  Most people will have experienced neck pain in their lifetime and the first episode is not uncommon in childhood or as a teenager.

Neck pain is assessed using case history or the medical interview.  This is followed up with physical examination and osteopathic examination.  Sometimes investigations are needed such as X-ray, CT scan or MRI.  There are many causes of neck pain and management is decided by the symptoms and underlying cause.  Things like stiffness, associated arm pain or “pins and needles” make a difference to the management.

Management:

If the neck pain is thought to be “non-specific neck pain” then the following therapies have been shown to be effective.  Non-specific neck pain means neck pain where there is no serious known cause.  This is the most common type of neck pain.

Manual therapy (mobilization) – research favors manual therapy or SMT (spinal manipulative therapy) if it is safe to perform.

Exercises- general exercise and specific neck exercises for strengthening and stretching of neck muscles.

Analgesia (not opioids)- short term and at the lowest effective dose.

Counselling and education – especially if the neck pain is related to psychosocial stress or the workplace where poor ergonomics may be contributing.

Acupuncture has some evidence of effectiveness in the short term.

Acute Neck Pain

If the neck pain is acute meaning very painful and perhaps due to a traumatic injury, the following is recommended:

Keep up usual activities but NO heavy lifting.

Heat or ice, whatever feels better.  (The research says it doesn’t matter)

Manual therapy like joint manipulation or mobilization to the thoracic spine and depending on the diagnosis, mobilization to the cervical spine if it can be tolerated.

Neck range of motion exercises and upper limb exercises within tolerance and when the neck pain starts to improve.

Chronic Neck Pain

This is neck pain that has persisted for longer than 3 months.  About 3% of the population experience chronic neck pain.

A multi-modal approach is required which means many different treatment strategies.

Manipulation/mobilization to the neck and middle back has supportive research.

Supervised and individually tailored exercises for the neck, shoulders and upper limbs.  General exercise is also beneficial because active muscles produce anti inflammatory compounds.

Promotion of an active lifestyle and healthy diet.

Assessment of the work space if this is relevant.  This could mean changing the set up or using a standing desk for part of the work day.

Stress management can be very useful.  Techniques for mindfulness and meditation as well as counselling are used if stress is a major aggravating factor for the neck pain.