Neck Pain

Neck Pain and Cervicalgia

Cervicalgia, or neck pain, is a very common condition that affects a significant proportion of the adult population. It encompasses all pain felt in the cervical region, from the base of the skull to the upper back. Neck pain can be acute (torticollis, whiplash) or chronic, and it frequently accompanies headaches, shoulder tension or upper limb symptoms. Osteopathy provides a manual approach to assess and treat the mechanical factors contributing to cervical discomfort.

Common Symptoms

Neck pain can present with a variety of symptoms depending on its origin:

• Localised pain in the neck — A dull ache or sharp pain in the cervical region, often aggravated by head movements, prolonged postures or stress.
• Reduced range of motion — Difficulty turning the head, looking up or tilting the neck to one side. This is particularly characteristic of acute torticollis.
• Headaches — Cervicogenic headaches originate from cervical dysfunction and are frequently felt at the base of the skull, around the temples or behind the eyes.
• Shoulder and upper back tension — Muscular tension in the trapezius, levator scapulae and rhomboid muscles often accompanies cervical pain.
• Radiating pain into the arm — When neck pain is accompanied by pain, tingling or numbness travelling into the shoulder, arm or hand, this may indicate cervical nerve root involvement (cervicobrachial neuralgia).
• Dizziness or visual disturbance — In some cases, cervical dysfunction can contribute to feelings of dizziness, visual blurring or a sensation of imbalance.

Contributing Factors

Cervicalgia is often multifactorial. The following elements may contribute to or maintain cervical pain:

• Prolonged screen use — Extended computer or smartphone use in a forward-head posture places sustained strain on the cervical spine and surrounding muscles.
• Poor ergonomics — An unsuitable workstation setup (screen height, desk position, chair support) is a common contributor to chronic neck tension.
• Stress and psycho-emotional tension — Emotional stress frequently manifests as increased muscular tension in the cervical and upper thoracic region.
• Previous cervical trauma — A history of whiplash, fall or direct impact to the neck can leave residual restrictions that predispose to recurrent cervical pain.
• Jaw dysfunction (TMJ) — Dysfunction of the temporomandibular joint is closely linked to cervical mechanics. Bruxism, jaw clenching and dental malocclusion can contribute to cervical tension.
• Sleep position — An unsupportive pillow or habitual sleep posture can maintain cervical strain overnight.

Osteopathic Assessment

The assessment begins with a detailed clinical interview to understand the onset, duration and characteristics of the neck pain, as well as the patient's medical history, occupation and daily habits. This is followed by a thorough physical examination including cervical range-of-motion testing, neurological screening, palpation of the cervical and thoracic spine, and assessment of the shoulders, jaw and upper limbs.

The aim is to establish a clear osteopathic diagnosis: identifying the areas of restricted mobility, muscular tension and mechanical imbalance that contribute to the pain. If clinical findings suggest a condition requiring further medical investigation, the patient is referred appropriately.

Treatment Approach

Osteopathic treatment of neck pain is adapted to the individual patient and may include:

• Gentle cervical mobilisations — Restoring mobility to the cervical vertebrae through precise, controlled movements.
• Myofascial release — Addressing tension in the cervical muscles, upper trapezius, sub-occipital muscles and scalenes.
• Thoracic and rib cage work — Cervical pain often involves compensations from the thoracic spine and ribcage. Restoring mobility in these areas can significantly reduce cervical strain.
• Cranial techniques — For patients presenting with headaches or dizziness associated with cervical dysfunction, cranial techniques may be beneficial.
• TMJ assessment and treatment — When jaw dysfunction is identified as a contributing factor, treatment includes the temporomandibular joint and associated muscles.

At the end of the session, the osteopath provides personalised advice on ergonomics, posture, stretching exercises and stress management strategies to help prevent recurrence.

Number of Sessions

For acute cervical pain (torticollis, recent onset), 1 to 2 sessions usually bring significant relief. For chronic or recurrent cervicalgia, 2 to 4 sessions may be necessary to address all contributing factors and achieve lasting improvement. Regular maintenance appointments may be recommended for patients with occupational or postural risk factors.

References

• Gross A, Langevin P, Burnie SJ et al. (2015). Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, 9:CD004249. PMID 26397370
• Dunning JR, Cleland JA, Waldrop MA et al. (2012). Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy, 42(1):5-18. PMID 21979312