If you had physical therapy for neck pain 20 years ago, you might have pointed to the pain and had a therapist apply passive modalities such as ultrasound, heat or ice to the affected area. The field of Physical Therapy and the associated research has come a long way to help us understand what treatment techniques are more and less effective in today’s fast paced world. This article will address some treatment techniques that you may or may not be familiar with and that we offer at Pacific Physical Therapy. 

When a patient begins treatment for neck pain, a thorough history including the cause of the symptoms and positions/activities that reproduce symptoms or alleviate symptoms will be completed. The therapist would also most likely assess range of motion, muscle tenderness, joint mobility, neural tension (if complaints of symptoms radiating into the arms are present), muscle strength, posture, and proprioception. [Proprioception is the body’s ability to have internal knowledge of the position of a specific joint or muscle in relation to the rest of the body.] The answers to these tests and questions can direct a physical therapist to the treatment options most appropriate for the patient.  

Neck pain can be caused by a variety of dysfunctions, but generally it falls into two categories: Onset with an injury such as whiplash or onset without an injury, which is generally postural or degenerative. With whiplash type injuries, there is research that shows that “ability to reproduce a target position of the neck” does diminish.1 This is much like the way that balance/proprioception in an ankle may be limited after an ankle sprain. Other research indicates that proprioception can be trained and improved upon.2 Here at Pacific Physical Therapy, we use Motion Guidance for many of our patients to retrain the neck’s sense of positioning. This option is not only beneficial for pain reduction and neuro-muscular re-education, but it can also be fun! Using visual feedback while tracing lines and designs can help your brain sync the movement patterns and improve the sense of where the neck is in relation to the head and body. 

Another research-based treatment options for patients with neck pain is cranio-cervical flexion training – also known as deep neck flexor strengthening. This type of strengthening has been shown to be very effective at reducing neck pain, both in patients with whiplash who have reduced strength in this area and patients with postural dysfunction.4 This means it can be very beneficial for people who fall into both the injury and no injury categories. The way I typically like to describe this treatment method is that it is similar to strengthening the core to reduce low back pain. The deep neck flexors are basically the core for your cervical spine. It can be challenging to contract the correct muscles without a skilled therapist to guide you through the exercises initially, but the exercises can be done at home once the correct form and technique is learned. 

At Pacific Physical Therapy, we strive to ensure that each patient’s care is individualized with treatment options that help them achieve their goals. Part of our job is to use our skills and knowledge to help reduce pain through manual therapy skills such as muscle energy techniques, soft tissue mobilization, joint mobilizations. We may also utilize some of the “old fashioned” modalities if deemed appropriate. The way I see it though, the most important part of our job is to give our patients the knowledge and skills they need to return to living a lifestyle that includes the ability to participate in activities that give them joy.  

Alicia Gilfoy PT, MPT has been treating patients with vestibular conditions for 9 years and has taken additional coursework to ensure a comprehensive diagnosis and treatment plan for her patients.

1. Loudon JK, Ruhl M, Field E: Ability to Reproduce Head Position After Whiplash Injury. Spine. 1997, 22: 865-868.  
2. Izquierdo TG, Pecos-Martin D, Girbés EL: Comparison of Craion-Cervical Flexion Training Versus Cervical Proprioception Training in Patients with Chronic Neck Pain: A Randomized Controlled Clinical Trial. J Rehabil Med. 2016, 48: 48-55. 
3. G Jull, E Kristjansson, P Dall’Alba: Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Manual Therapy. 2004, 9: 89-94. 
4. Edmondston SJ, Wallumrød ME, MacLéid F, Kvamme LS, Joebges S, Brabham GC: Reliability of isometric muscle endurance tests in subjects with postural neck pain. J Manip Physiol Ther. 2008, 31: 348-354.