Neck pain, a common and complex issue, is often best treated with a combination of manual therapy, myofascial release, and targeted exercises. This integrated approach not only relieves discomfort and improves mobility but frequently leads to a complete resolution of the problem.
Techniques such as manipulation/mobiization and myofascial release address both structural and soft tissue causes, while acupressure within fascial expansions enhances the healing process. Complementing these methods, functional exercise programs strengthens and stabilizes the neck, promoting recovery and preventing future pain, ultimately leading to long-term neck health.
Our Success Rate is Over 90%
Our 90% success rate in treating neck pain underscores the effectiveness of our multimodal, interdisciplinary approach, focusing on pain relief and improved function.
Article Index:
Causes of Neck Pain
Neck pain is a widespread issue with a variety of underlying causes, each requiring a different approach for effective treatment. Understanding these causes is the first step toward finding relief:
Muscle Strain and Tension: Poor posture, long hours at the desk, awkward sleeping positions, or sudden movements can strain neck muscles and tendons, leading to discomfort. It's often those everyday habits that we overlook, like hunching over our phones or slouching at our desks, that set the stage for persistent neck pain.
Injury: Accidents and sports injuries can force the neck beyond its natural range, causing anything from mild strains to severe muscle and ligament damage. Even a minor accident can have lasting effects if not properly treated.
Degenerative Diseases: Conditions such as osteoarthritis, spinal stenosis, and cervical spondylosis lead to the deterioration of cartilage and wear and tear on the spine, contributing to chronic neck pain. As the body ages, these degenerative changes become more common, highlighting the importance of proactive care.
Nerve Compression: Herniated discs or bone spurs in the cervical spine can press on nearby nerves, resulting in significant pain and discomfort. This type of pain can radiate to other parts of the body, making it even more challenging to manage.
Diseases: Although less common, diseases like rheumatoid arthritis, meningitis, certain cancers (such as thyroid or laryngeal), spinal infections, and vascular disorders can present as neck pain. These conditions often require specialized treatment approaches.
Referred Pain: Sometimes, neck pain originates from other areas like the jaw, shoulder, heart, or lungs. For example, TMJ disorders, angina, or pulmonary issues can manifest as pain in the neck, making diagnosis a bit more complex.
Psychological Stress: Stress isn't just a mental burden—it can increase muscle tension, leading to pain or discomfort in the neck. The mind-body connection plays a significant role in how we experience and manage pain.
Symptoms of Neck Pain
Neck pain can manifest in various ways, each indicating different underlying issues. Here’s a quick guide to help identify the cause:
Sharp Pain: This stabbing sensation is often localized and may point to muscle strain, a sprain, a herniated disc, or nerve damage.
General Soreness or Aching: A more diffuse discomfort, usually stemming from muscle fatigue, strain, poor posture, stress, or prolonged sitting in an awkward position.
Pain Worsening with Movement: When pain intensifies with specific movements, it often suggests muscle or ligament strain, joint problems, or issues with spinal discs.
Radiating Pain: Pain that spreads to the shoulders, arms, or fingers often indicates nerve compression or irritation, commonly seen in cervical radiculopathy.
Tingling, Numbness, or Weakness: These sensations, especially when radiating down the arm into the hand, typically result from nerve compression, herniated discs, or spinal stenosis.
Headaches: Especially those at the back of the head, these are frequently due to muscle tension, joint issues, or cervical osteoarthritis.
Stiffness or Limited Range of Motion: Difficulty moving the head and neck usually indicates muscle tightness, joint problems, or structural issues in the neck.
Balance Issues or Dizziness: Though less common, these symptoms can be related to cervical vertebrae or nerve involvement affecting vestibular function.
Understanding these symptoms is key to pinpointing the specific cause of neck pain and is essential for accurate diagnosis and effective treatment.
Physical Examination
A comprehensive physical examination is crucial for accurately diagnosing and treating neck pain. This thorough assessment, similar to those conducted after an automobile accident, is essential to prevent underlying issues from worsening and complicating recovery.
The examination includes orthopedic, neurological, and vascular evaluations, giving a complete picture of the patient’s condition and helping to identify the root causes of neck pain. To aid in this process, we provide video demonstrations, such as our "Cervical Examination" video, which covers inspection, palpation, range of motion assessments, and targeted orthopedic tests. These tools are invaluable for understanding the mechanical and structural factors contributing to neck pain.
Cervical Examination
This video provides a detailed walkthrough of the examination process, including inspection and observation, palpation techniques, assessment of active and passive ranges of motion, and an orthopedic examination focusing on the cervical region.
Cranial Nerve Examination
The Cranial Nerve examination is one of the ways that we assess sensory and motor dysfunction. We commonly perform this examination on all new patients.
Upper Limb Neuro Exam
The upper limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.
Vascular Assessment
Examination A peripheral vascular examination is crucial in identifying indications of vascular-related disorders. Recognizing and treating Peripheral Vascular Disease (PVD) can help prevent cardiovascular and cerebrovascular health complications. This video highlights routine procedures we incorporate into our everyday clinical practice.
Concussion Assessment
When neck pain is accompanied by symptoms suggestive of a concussion, especially after accidents or sports injuries, a Concussion Assessment is crucial. Concussions, which can cause headaches, dizziness, and cognitive issues, may be masked by neck pain, leading to overlooked symptoms that can hinder recovery. Including a concussion assessment ensures a comprehensive understanding of the patient’s injuries and supports a more effective treatment plan, addressing both neck and head trauma for optimal care.
VOMS
VOMS, or Vestibular Ocular Motor Screening, is a method specifically formulated to identify indicators of a concussion, whether from sports, impact tests, or general concussions. It investigates the coordination of balance, vision, and movement systems. VOMS examines five distinct domains of vestibular (balance) and ocular (vision) motor impairment.
HINTS Exam
The HINTS Exam is a diagnostic tool to distinguish benign peripheral disorders from central nervous system conditions, such as strokes. HINTS is an acronym for Head Impulse-Nystagmus-Test of Skew. The 'Head Impulse' component involves testing the function of the vestibulo-ocular reflex. A normal result on this test (HIT) strongly suggests that the cause of Acute Vestibular Syndrome is within the central nervous system.
Dix HallPike Maneuver - Vertigo
BPPV (Benign Paroxysmal Positional Vertigo) is among the leading causes of vertigo, characterized by a sudden feeling of spinning or the internal sensation of the head spinning. While BPPV vertigo can cause significant discomfort, it seldom poses a serious threat unless it heightens the risk of falls. This video will walk you through the Dix Hallpike maneuver, a fundamental step in diagnosing vertigo (BPPV).
Imaging in Neck Pain
Imaging plays a crucial role in diagnosing and managing neck pain due to the complexity of cervical structures. The choice of imaging depends on the suspected issue. X-rays are often the first step for assessing bones and alignment, especially in cases of trauma or suspected degeneration. MRI is preferred for a detailed view of soft tissues, including discs, nerves, and the spinal cord, making it ideal for identifying herniated discs, nerve impingement, or spinal stenosis. Sometimes, nerve conduction studies or EMG may be used to evaluate nerve function.
When to Use Imaging
Imaging isn’t always necessary in the early stages of neck pain, especially if the pain is likely musculoskeletal and without serious red flags. Clinical guidelines suggest imaging only when there are severe neurological deficits, a history of trauma, or when pain doesn’t respond to initial treatments. This approach helps avoid unnecessary exposure to radiation and reduces medical costs.
Impact on Treatment
Imaging results are key to tailoring treatment. For example, identifying a herniated disc might lead to targeted manual therapy, while findings of osteoarthritis or spinal stenosis can guide specific rehabilitation strategies. However, it’s essential to interpret imaging results alongside clinical assessment, as not all abnormalities seen in imaging are the source of pain. Imaging should be used judiciously to create the most effective treatment plan.
Identifying Red Flags in Neck Pain
Identifying red flags in neck pain is crucial, as they may indicate serious underlying conditions that require immediate medical attention. Key red flags to watch for include:
Neurological Deficits: Severe or worsening weakness, coordination problems, or significant numbness in the arms or hands may signal nerve damage or spinal cord compression.
Severe, Unrelenting Pain: Intense pain that doesn't improve with rest or medication could suggest a serious condition.
Pain at Night or Rest: Neck pain that worsens at night or during rest may indicate serious issues such as tumors or infections.
History of Cancer: New neck pain in someone with a history of cancer raises concerns about possible metastasis to the cervical spine.
Fever or Chills: Accompanied by neck pain, these symptoms might indicate infections like meningitis or a spinal abscess.
Sudden-Onset Pain After Trauma: Immediate neck pain following an injury (such as a car accident or fall) could signify fractures or severe soft tissue damage.
Unexplained Weight Loss: Combined with neck pain, this could suggest systemic illnesses like cancer or infection.
Bowel or Bladder Dysfunction: Changes in bowel or bladder control may indicate spinal cord compression, requiring urgent intervention.
Severe Headache or Visual Changes: When combined with neck pain, these symptoms could signal vascular events such as a vertebral artery dissection.
Age Considerations: New neck pain in individuals over 50 or in children should be thoroughly evaluated due to a higher risk of serious conditions.
Quickly recognizing and addressing these red flags through appropriate referral and treatment can significantly improve patient outcomes.
Differential Diagnosis
Creating a differential diagnosis (DDx) for neck pain is essential due to the wide array of potential causes. The initial diagnosis is a starting point, refined through clinical evaluation, diagnostic tests, and the patient’s response to treatment. Below are some key conditions to consider:
Musculoskeletal Causes: Muscle strain, cervical spondylosis, herniated cervical disc, cervical radiculopathy, osteoarthritis, myofascial pain syndrome, and fibromyalgia.
Traumatic Injuries: Whiplash, cervical spine fracture, and soft tissue injuries.
Inflammatory and Rheumatologic Conditions: Rheumatoid arthritis, ankylosing spondylitis, and polymyalgia rheumatica.
Infections: Meningitis, vertebral osteomyelitis, discitis, and spinal epidural abscess.
Vascular Conditions: Vertebral artery dissection and carotid artery dissection.
Neoplastic Causes: Primary cervical spine tumors and metastatic cancer.
Referred Pain: Consider cardiac conditions like angina, pulmonary issues such as pleurisy, gastrointestinal issues like GERD, TMJ disorders, cervical disc problems, and nerve entrapment syndromes like thoracic outlet syndrome.
Neurological Conditions: Cervical myelopathy, multiple sclerosis, and peripheral neuropathy.
Psychogenic Causes: Somatization disorder, depression, and anxiety.
Other Considerations: Thoracic outlet syndrome and congenital abnormalities.
A comprehensive approach to differential diagnosis ensures an accurate and effective treatment plan. Continual reassessment and adjustment based on clinical insights and patient progress are crucial.
Treatment of Neck Pain
An effective treatment for neck pain often involves a dual approach, targeting both soft tissue and joint injuries. A multidisciplinary strategy is particularly beneficial, especially in the early stages when pain is more intense. This approach may include conservative care from musculoskeletal professionals, such as manual therapy and exercises, alongside medical management from physicians who can prescribe medications to control acute pain and inflammation.
Targeting Soft Tissue Injuries
4 Point Neck Pain Protocol
This video demonstrates the importance of addressing neck pain as a unique dysfunction specific to each individual case. Neck pain's complexity requires a tailored strategy, whether the pain stems from local structures or is part of a broader kinetic chain. By recognizing the distinct nature of each instance, effective and customized treatment approaches can be developed.
Fascial Expansion: MSR Neck Pain Protocol
Utilizing fascial expansions in neck pain management presents an effective strategy that merges contemporary insights in fascia, kinetic chain relationships, and core acupuncture or traditional Chinese medicine principles. In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat neck pain.
Addressing Cervical Spine Restrictions
Effectively treating neck pain requires addressing both soft-tissue and joint restrictions within the cervical spine. Ignoring these osseous constraints can hinder full recovery. Certified practitioners often use neck adjustments or mobilization techniques to relieve these restrictions and restore proper function.
Neck Adjustment vs. Neck Mobilization
The choice between neck adjustments and mobilization should be tailored to the patient’s specific needs. For those who may be uncomfortable with neck manipulation, mobilization offers a safe and effective alternative. Practitioners guide patients in choosing the most appropriate approach based on individual circumstances.
While neck manipulation can effectively manage joint restrictions, it may not be suitable for everyone. This technique is typically avoided in patients over 70, those with severe osteoarthritis or osteoporosis, and individuals with autoimmune conditions like Rheumatoid Arthritis.
The final decision should be based on the practitioner’s professional recommendations and the patient’s comfort and preferences. Below are videos demonstrating cervical adjustments and mobilization techniques to help you better understand these approaches.
Cervical Adjustments
Chiropractic adjustments are highly effective for various types of neck injuries. Research shows that neck or back pain patients benefit significantly from chiropractic care, experiencing faster pain relief and quicker recovery than those not undergoing such treatments.
Cervical Mobilization Procedures
Many patients are unaware of their options for addressing neck joint restrictions. Whether you prefer neck adjustments or mobilization techniques, the choice is yours. In the video below, Dr. Abelson demonstrates various cervical joint mobilization procedures.
Treatment Frequency for Neck Pain
Acute Phase:
Goal: Reduce pain and inflammation, prevent further injury.
Frequency: 2-3 times per week for close monitoring and adjustment.
Option: 15-minute sessions twice a week or one 30-minute session weekly.
Subacute Phase:
Goal: Reinforce gains, introduce intensive rehab exercises.
Frequency: Weekly sessions.
Chronic Phase:
Goal: Maintain mobility, manage pain, improve quality of life.
Frequency: Bi-weekly or monthly sessions, based on individual needs.
Option: 15-minute or 30-minute sessions.
Re-examination:
Acute: Every 2-3 weeks.
Subacute: Every 4-6 weeks.
Chronic: Every 6-8 weeks or as needed.
Regular re-examinations ensure the treatment remains effective and aligned with patient progress.
The Role of Exercise in Neck Pain Rehabilitation
Exercise is essential in neck pain recovery, significantly reducing pain and improving mobility. Research shows that combining exercise with manual therapy leads to the best outcomes. Early exercises should be gentle to avoid aggravating pain and to support tissue healing, balancing movement with recovery time to prevent further injury.
Our exercise programs are customized to each patient's specific needs and injury levels. We also provide guidance on daily activities, heat/cold therapy, and sleep positions to support recovery.
The exercises, featured in our video series, are tailored to the patient’s condition, starting with mobility enhancement, progressing to strength building, and incorporating functional exercises for balance and proprioception. Low-intensity aerobic exercise is included to speed up recovery, creating a personalized, step-by-step approach for effective rehabilitation.
Exercise Demonstrations:
5 Minute Neck Pain Relief
Welcome to our "5 Minute Neck Pain Relief" exercise guide, designed to provide effective, quick relief from neck discomfort. This simple routine, which should be performed 3 to 4 times daily, is tailored to help alleviate pain, increase mobility, and promote overall neck health.
PNF Neck Stretches - Mobility, Strength and Power
Studies indicate that PNF stretching techniques efficiently boost and sustain flexibility, augment muscular strength and force, and elevate athletic performance. If you are injured, please ask your physician if these exercises are appropriate.
Neck Strengthening Exercises
Strengthening your neck is crucial for maintaining a healthy posture, preventing future injuries, and resolving existing ones. Incorporating these exercises into your routine should significantly improve your overall posture.
Why Choose Our Approach for Neck Pain Treatment
Our comprehensive approach to treating neck pain consistently achieves a 90% success rate in reducing pain and improving neck function. Here's why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, our methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring you receive the highest standard of care.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including muscle imbalances, joint restrictions, and nerve compression, which are often present in neck pain cases.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target fascial restrictions, muscle tension, and joint dysfunction, delivering effective and long-lasting relief.
Customized Exercise Programs: We create individualized exercise plans that enhance mobility, strengthen the neck, and restore proper function, supporting your recovery.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercise, and supportive care, providing a well-rounded and sustainable solution.
Choose our proven, patient-centered approach for effective, long-term relief from neck pain. Take the first step toward your recovery with confidence.
References
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Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., ... & Flynn, T. W. (2022). "Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association." Journal of Orthopaedic & Sports Physical Therapy, 48(9), 712-735.
Falla, D., Jull, G., Russell, T., Vicenzino, B., & Hodges, P. (2019). "Effect of neck exercise on sitting posture in patients with chronic neck pain." *Physical Therapy, 89*(4), 338-348.
Gross, A., Miller, J., D'Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., ... & Haines, T. (2020). "Manipulation or mobilisation for neck pain: A Cochrane Review." Manual Therapy, 15(4), 315-333.
Haldeman, S., Carroll, L., Cassidy, J. D., Schubert, J., & Nygren, Å. (2023). "The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders." Spine, 33(4S), S5-S7.
Hoy, D. G., Protani, M., De, R., & Buchbinder, R. (2023). "The epidemiology of neck pain." Best Practice & Research Clinical Rheumatology, 24(6), 783-792.
Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., ... & Richardson, C. (2021). "A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache." Spine, 27(17), 1835-1843.
Kjaer, P., Kongsted, A., Hartvigsen, J., Isenberg-Jørgensen, A., Schiøttz-Christensen, B., Søborg, B., ... & Jensen, T. S. (2022). "National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy." European Spine Journal, 26(9), 2242-2257.
Levangie, P. K., & Norkin, C. C. (2022). "Joint Structure and Function: A Comprehensive Analysis." F.A. Davis Company.
Ludvigsson, M. L., Peterson, G., O'Leary, S., Dedering, Å., & Peolsson, A. (2021). "The effect of neck-specific exercise with or without a behavioral approach compared with prescription of physical activity in chronic whiplash: a randomized clinical trial." Spine, 46(7), 434-442.
Martel, J., Dugas, C., Lafond, D., & Descarreaux, M. (2020). "Effectiveness of early versus delayed exercise therapy in patients with acute and subacute neck pain: a systematic review and meta-analysis." PLOS ONE, 15(4), e0231725.
Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2020). "A nonsurgical approach to the management of patients with cervical radiculopathy: A prospective observational cohort study." Journal of Manipulative and Physiological Therapeutics, 33(4), 253-260.
Neumann, D. A. (2021). "Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation." Elsevier Health Sciences.
Panjabi, M. M. (2023). "The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement." *Journal of Spinal Disorders & Techniques, 5*(4), 383-389.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
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Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
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Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.
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