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What a pain in the neck!

Neck pain is the second most common musculoskeletal disorder in the United States and 30-50% of Americans will experience neck pain in their lifetime (Gorrell 2016, Horn 2016). Despite so many people suffering from neck pain many of them never seek help because they attribute their pain to getting older (Dikkers 2016)! This simply isn’t true. Pain can be a warning sign or indicator from your brain that something is not right. So rather than avoiding it, take care of your neck pain so that you can enjoy your life and your sport.

Causes of neck pain

Poor posture, weakness and muscle tightness can contribute to all categories of neck pain. With a majority of people sitting at a desk all day, working at a computer or on their phone it is no wonder neck pain is on the rise.

  1. Mechanical neck pain (MNP): presents as generalized neck and/or shoulder pain. Symptoms can be provoked by neck movement, neck postures, or palpation of the cervical muscles (Celenay 2016). The pain can also be caused by muscle trigger points, poor posture, overuse, improper warm-up or impaired mechanics.

  2. Muscle spasms or muscle strains: often present as pain in the neck, shoulders or between the shoulder blades. Muscle spasms may cause headaches and loss of motion. Spasms or strains can be caused by poor posture, overuse, improper warm-up or impaired mechanics.

  3. Disc herniation: may present as pain in the neck, between the shoulder blades, arms or hands. Weakness, numbness or tingling often accompanies neck pain. It is not uncommon for people to feel no pain in the neck and still have symptoms in the arms or hands.  Just because you have a herniation does not mean you will need surgery, it completely depends on the severity. A majority of disc injuries can be addressed with physical therapy or chiropractic care. Disc injuries may be caused by a fall, motor vehicle accident, poor posture, improper lifting, overuse or poor mechanics.

  4. Spinal Stenosis: frequently presents with radiating pain, numbness and weakness. Often occurs with or years after a disc herniation. Stenosis is essentially narrowing of the canal in which the nerves come out of. It can be central or one sided.

  5. Facet arthropathy: will typically present with loss of motion pain in the neck and possibly pain into the shoulders. Muscle spasms may ensue because of compensation patterns that form from the degeneration of the facets. Poor posture, mechanics and overuse may play a role in its development.

  6. Malignancy: is rarely a cause of neck pain however it should not be overlooked when ruling in/out the cause of neck pain. It can present with localized pain in cervical spine, or radiating pain into the shoulders and into the arms. Pain from malignancy is most often worse at night, possibly accompanied with loss of appetite, disturbed sleeping, increased fatigue or night sweats. If any of these symptoms occur in conjunction with your neck pain follow up immediately with a physician.

Endurance athletes and neck pain:

Athletes are not immune to the common causes of neck pain that occur in everyday life, however with each individual sports comes other considerations for why one’s neck may be hurting. If you are a multisport athlete your neck pain may be aggravated from the compression caused in running, but is likely a result of the swimming or cycling component of your training.  At Precision we see primarily endurance athletes but many of them are golfers as well; therefore, we will touch upon a handful of sport specific considerations below. 

Common causes of neck pain in cyclists (Carcia 2013):​

  • Helmet is too heavy or too far forward on head

  • Spending too much time with hands in drops

  • Riding on uneven surfaces which increases vibrations

  • Increased thoracic kyphosis (hump in upper spine from hours of riding)

  • Forward head posture (sticking chin out) causing prolonged upper cervical extension

Common causes for neck pain in swimmers:

  • Faulty stroke mechanics

  • Over compensating while breathing

  • Poor body and head alignment

  • Poor kicking mechanics

Common causes for neck pain in golfers:

  • Over-rotating your body or neck during swing

  • No warm-up

  • Limited shoulder, hip and pelvic ROM

  • Weakness in core/hips or scapular stabilizers

  • Poor postural alignment before/during and after swing

Here are some good tips from Hospital of Special surgery in NYC for how to modify your golf game with specifics based on individual neck injuries.

What can you do about it?

Do any of the possible causes above resonate with you? Don’t wait until your neck pain had gotten unbearable. Horn et al found that early intervention for neck pain by physical therapist resulted in better patient outcomes, improved disability and pain and less money was spent overall. Despite the possibility of high costs initially it was found that patients utilize less resources and improved much more quickly which ultimately leads to their cost savings. 

What do physical therapists do for neck pain? 

Manual Therapy has been found to be more affective in reducing neck pain than seeing a general practitioner or physical therapist that doesn’t provide manual therapy (Dikkers 2015).  Manual therapy is a hands on technique to improve how a person's joints, muscles, ligaments, nerves and tendons function. Manual therapy includes joint mobilizations, manipulations, trigger point dry needling and soft tissue work. If your therapists doesn't spend part of their session "hands on" you may not be getting the best care. 

Assess your movement If you are a cyclist be sure to have your bike fit properly, if you are a swimmer or a golfer take lessons. Have someone that understands the biomechanics of your sport video tape you performing your sports and give you feedback, drills and complementary exercises to improve your form. If your physical therapist is unable to assess your sport specific movement they will be able to direct you to those that can. At Precision we assess various movement patterns regularly and we often collaborate with our local coaches and bike fit professionals to better serve our clients. 

Direct you specific strengthening exercises that can help improve posture, support the weight of your head and improve your movement patterns. Strengthening your core, shoulder girdle and neck muscles are all important. In a 2013 literature review by Bertozzi et al. therapeutic exercise/ strengthening was helpful in reducing neck pain. Physical therapists are movement specialists. A majority of our training focuses on understanding movement and how to teach proper movement. A good therapist will spend time explaining the exercises they give you, review them with you and make sure you perform them correctly.  

Your posture standing, sitting at your desk, reading, talking or texting on your phone can all impact how your neck feels. Have you ever noticed someone’s chin sticking out while they are sitting trying to reading something on their computer screen? If not take a look around at your colleagues and I am sure you will notice. Your therapist can help you find your optimal posture in sitting, standing and driving. Click here for a blog I wrote in April to help improve your posture. However, you made need a full ergonomic assessment done for you office. Many larger companies have in-house ergonomic specialists that can come assess your office situation.

Physical therapy can be incredibly helpful in improving pain and function following a neck injury. In conjunction with manual therapy improving your mechanics, posture and strength are imperative to living a less painful future. 


1. Gorrell, Lindsay M. et al.Manual and Instrument Applied Cervical Manipulation for Mechanical Neck Pain: A Randomized Controlled Trial Journal of Manipulative & Physiological Therapeutics, Volume 39 , Issue 5, 319 - 329

2. Horn et al. A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis. BMC Health Services Research (2016) 16:253 DOI 10.1186/s12913-016-1504-5

3. Dikkers MF, Westerman MJ, Rubinstein SM, van Tulder MW, Anema JR (2016) Why Neck Pain Patients Are Not Referred to Manual Therapy: A Qualitative Study among Dutch Primary Care Stakeholders. PLoS ONE 11(6): e0157465. doi:10.1371/journal.pone.0157465

4. Celenay, Seyda Toprak et al. Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: A prospective, randomised controlled trialManual Therapy , Volume 21 , 144 - 150


6. Carcia CR, Scibek SS, Seagrove C. (2013). Evaluation and management of common cycling injuries.  In  C Hughes (Eds.), Orthopeadic Management of the Runner, Cyclist, and Swimmer. APTA  Home study course.


8. Bertozzi, L., Gardenghi, I., Turoni, F., Villafañe, J. H., Capra, F., Guccione, A. A., & Pillastrini, P. (2013). Effect of Therapeutic Exercise on Pain and Disability in the Management of Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis of Randomized Trials. Physical Therapy, (), . Accessed July 31, 2016.


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