Neck pain is a very common complaint and those suffering from it can often end up with symptoms lasting a lot longer than it takes for damaged tissue (bone, ligament, muscle etc) to physically repair and heal. The patient’s anxiety or fear about their neck pain is just as important as the sport they play or the physical requirements of their job.

There are many ways that a neck can get injured and it all has to do with forces exerted upon the neck and the ability of the supporting structure to be able to withstand these forces. 

The speed, direction, and size of these forces along with the length of time that the neck is exposed to them will determine the extent of the injury.

For the purpose of this review, let’s focus on mechanical or non-specific neck pain. In other words, the type of neck pain that presents itself possibly without a specific incident. The pain that often presents itself after doing something new like painting the house or after long days at the office. Symptoms usually include a loss of movement and pain with different postures/movements.  Once we are confident that there is no significant structural damage, no significant neural symptoms, or any need for emergency medical management, then we would typically classify this pain as mechanical or non-specific neck pain.

The best way to prevent your neck from getting injured is the same as with any other part of the body; we strengthen it. Most of us are great at training from the shoulders down but we should be applying the same training principles to the structures of the neck. The most important muscles are the deep lying active stabilisers of the neck, known as the deep neck flexors (Figure 1). If you can improve the ability to use these and subsequently strengthen them, then you should usually see an improvement in your symptoms. The combination of these muscles working appropriately along with the muscles that drive movements at the neck (see Figure 2) is how the neck should move and stay stable.

Physiotherapists will also use manual therapy techniques such as massage, trigger point therapy, joint mobilisations to guide treatment and ease the intensity of painful symptoms but ultimately the road to improvement involves the patients actively strengthening the DNF and prime movers of the neck. Self-treatment techniques such as self-massage and heat therapy can also be very  beneficial for patients to manage and improve their symptoms at home.

Once pain has been reduced to acceptable levels for the individual, then the focus should turn to improving strength and movement deficits that led to the development of the neck pain.

As with all strengthening programmes, it is important to allow time for the body to adapt to the new stress before judging the effectiveness of it. It can take up to 12 weeks before seeing a significant improvement in muscle performance. Consistency of effort with the rehabilitation programme and a little bit of patient will be required.