Physiotherapy For Neck Pain

Physiotherapy For Neck Pain

Neck pain is a common musculoskeletal ailment that plagues people with varying ages, physical activity levels, and lifestyles. Often, the cause of such pain is benign and is due to mechanical issues such as body posture, movement patterns, lifestyle, and injury.


However, there are also more sinister health conditions that can present as neck pain as well. It is thus essential to have neck pain or stiffness assessed by a licensed healthcare professional such as a physiotherapist or physical therapist to identify the root cause of your pain and to rule out any serious health conditions.


Physiotherapy is an integral part of managing bodily pain, injuries, illnesses, and chronic diseases. Physical rehabilitation is especially essential in managing musculoskeletal and orthopaedic conditions such as neck pain.


As with other health conditions, prevention is better than cure. Regular physiotherapy sessions can help people understand their bodies better and move better. This in turn minimises the risk of injury and discomfort. However, if an injury is already present, physiotherapy a key aspect of pain management and a facilitator for the return to normal life.


At Balance Core, our Integrated Balance Approach is unique in its systematic analysis of the human body as a whole to identify each patient’s individual problems and needs to tailor an effective treatment program to suit the person. It is our goal to work with our clients and patients to achieve help them in their journeys towards good health and high quality of life.

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Common Neck Pain Diagnoses

  • Herniated Disc
  • Degenerated Disc Disease
  • Whiplash associated disorders (e.g. due to a car accident)
  • Wry neck
  • Cervical Spondylosis
  • Cervical Myelopathy
  • Spinal Cord Injuries
  • Muscular Strain
  • Cervicogenic Headaches
  • Tension Headaches

Common Symptoms of Neck Pain

Local Neck Discomfort

Discomfort in the neck region alone constantly present or associated only with movements.

Referred Pain

Referred pain is felt in a region away from its source. For example, a pinched nerve in the cervical spine (neck) region can present as a pain between the shoulder blades which is away from the source (the neck).

Radiating Pain

Radiating pain, on the other hand, begins in the neck and travels alone a path. It is often due to irritation to the nerves in the neck region, resulting in radiating or shooting pain and/or numbness along the chest, upper back, arms, or hands depending on the nerve that is involved.

Overload and strain

Poor movement in the surrounding joints such as in those in the thoracic spine, the shoulder blades, the shoulders, the ribs, and the lower back can also result in overload in the cervical spine resulting in neck strain and discomfort.

Poor or altered coordination

In severe cases such as cervical myelopathy where the spinal cord is compressed, a person may experience numbness in his/her hands and feet and will have reduced coordination resulting in an altered walking pattern and difficulty managing fine motor tasks such as buttoning shirts. The person may also find him or herself tripping easily or having difficulties with negotiating stairs, steps, and curbs.


In some cases, associated headaches arising from joint stiffness or tightness in the neck muscles can also occur. These are often referred to as cervicogenic headaches or tension headaches. People with such headaches typically complain of a tightness or pain in the head, forehead, behind or around the eyes, and in the jaw. The symptoms are usually made worse with head, upper back, or shoulder movements.

Neck pain accompanied with chest tightness and shoulder discomfort

Less commonly, neck pain can also be a referred pain originating elsewhere. An example would be the heart. Heart conditions can result in neck pain or stiffness together with chest and/or shoulder discomfort. It is thus critical to seek professional help instead of attempting to self-diagnose a bodily discomfort.

Common Ways People Describe Musculoskeletal Neck Pain

Musculoskeletal neck pain is caused by the physical and mechanical factors involving the musculo- (muscle) and skeletal (skeleton) system. It usually presents with the following symptoms:

  1. Tightness and achy sesnsations in the neck
  2. Pulling pain in the neck
  3. Headaches
  4. Eye pain
  5. General discomfort in the neck, upper back, chest and shoulder regions
  6. Nausea and vomiting
  7. Pain on movement
  8. Poor Posture
common causes of neck pain

Common Causes of Neck Pain

The cause of musculoskeletal discomforts is usually multi-factorial. Below are some possible causes:

  1. Poor posture
  2. Poor exercise technique
  3. Lack of training or preparation for sport and exercise
  4. Tight muscles
  5. Stiffness in joints
  6. Myofascial tightness
  7. Nerve irritation or compression
  8. Tissue Injury (e.g. due to trauma or repetitive strain)
  9. Sedentary lifestyle

How is it Diagnosed?

A physiotherapist is an expert in musculoskeletal disorders and can diagnose and identify the source and cause of neck pain to design a specific treatment program to reduce pain and stiffness, and to help patients retune to their normal lifestyle.

Diagnosis is often made using a range of assessment tools. These tools include:




A physiotherapist will observe a person’s typical static postures (i.e. in sitting, standing and lying down) as well as the person’s usual movement patterns in their daily life (e.g. walking and working) and in their sport (i.e. sporting techniques). These observational findings provides vital information for the physiotherapist to identify risk factors for neck pain, the likely cause for injury or overload, and to guide subsequent assessments and tests.


Manual Palpation


Physically palpating (i.e. feeling) a person’s area of pain and the regions around it would provide a physiotherapist with valuable information about the texture, tightness, rigidity, temperature, and alignment of the neck structures. This in turn informs the physiotherapist of the possible reason for the neck pain, the likelihood of inflammation, and whether it is localised (i.e. stemming from the neck) or potentially referred from a different organ such as the heart.


Range of Motion Testing


Neck movement will be assessed when diagnosing the cause of discomfort. This is a test of how much or how far a person can look from side to side, up and down, and tilting the head towards each shoulder. Often, the neighbouring joints are also assessed to identify if the neck discomfort is arising solely from the neck or is related to other areas in the body.


Joint Mobility Testing


Joint mobilisation is a skill that physiotherapists are trained in in their undergraduate degree programs. This technique is used to assess a joint’s movement and to test for joint stiffness and/or stability.


Strength Testing


To assess the integrity and function of muscles in the region, a physiotherapist will also assess a person’s strength in the head and neck, as well as in the arms and legs. Testing of strength in the arms and legs cues the physiotherapist in on the neurological status of the person as well as to identify any movement pattern issues that is contributing to the neck pain.


Neurological Testing


Due to the narrow passages in which nerves travel within and around the spinal column, a physiotherapist will always assess the nerve system in a person with neck pain. These tests can include a series of coordination tests, strength tests, sensation tests, and an assessment of the person’s reflexes.


Gait Analysis


Many people with neck pain are surprised that their balance and walking need to be assessed when they are experiencing neck pain. Again, in view of the passage of vital nerves through the spinal column, such assessments are crucial to rule in and/or rule out other sinister issues that may require further medical or surgical interventions. An example of this is cervical myelopathy that can result in changes in a person’s coordination and balance.


Red Flag Testing


Red flags are symptoms and alert signs that indicate serious underlying pathology and conditions. A licensed and professional physiotherapist is trained to identify them through common subjective complaints as well as through special tests. These assessments allow urgent and/or sinister conditions to be identified and treated early.


Medical Imaging


If a physiotherapist suspects possible structural injuries or deviations, he or she will refer a patient for further medical imaging and a review with an orthopaedic surgeon. Medical imaging is not necessary in the diagnosis of neck pain, but in cases where red flags are suspected, imaging such as Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) scan, and X-rays can help to confirm diagnoses and guide potential surgical management(s).

Treatment Options

Neck pain can be treated with medical interventions such as the use of analgesics (i.e. pain medication), with surgical interventions, or with conservative management like physiotherapy or physical therapy. Physiotherapy typically includes hands-on techniques, exercises, and education.
balance core neck pain treatment

Conservative (Non-Surgical) Management Options

Conservative management that does not involve surgery is often the first line of treatment to reduce neck pain. Physiotherapists are trained in manual therapy, exercise prescription, and are well-versed in teaching clients and patients how to maintain good posture, reduce pain, and prevent further injury.


While general exercises are essential for good health, specific and targeted therapeutic exercises prescribed by physiotherapists are designed to manage specific issues that cause pain. An example would be when musculoskeletal discomfort is caused by an imbalance in the tension of structures — and hence postural alignment — through a joint or body part, targeted exercises aimed at reduces tightness in shortened muscles and strengthening weak or under-utilised muscles can help to improve posture and symptoms.


Generally, if the condition is not due to sinister orthopaedic problems such as a serious herniated disc, fracture, or dislocation, conservative management is sufficient for managing musculoskeletal issues.


However, should the patient require surgery, a period of pre-habilitation (i.e. physiotherapy before surgery) would often be recommended to improve the patient’s baseline strength, mobility, and fitness prior to having the operation. This would ensure a more successful outcome wherein the patient is able to return to activities of daily living sooner after the operation. Thereafter, the patient will continue to follow-up with post-operative physiotherapy to facilitate healing and to minimise the risk of re-injury and discomfort.


Of course, in serious cases such as after a traumatic injury or severe spinal instability, urgent surgery would be required to stabilise the patient’s condition. In such cases, post-operative physiotherapy after the surgery will be essential to help the regain his or her strength, mobility, and function when there is no longer an immediate threat to his or her life.


Thankfully, such circumstances are rare and most instances of neck pain are musculoskeletal inn nature and can be managed conservatively with physiotherapy.

Physiotherapy Management of Acute Neck Pain

In the acute phase of neck pain where there is a new or recent injury to the structures in the neck, treatment is often aimed at pain relief and gradual improvement in mobility. This is achieved through gentle massage therapy, gentle joint mobilisations, the use of ice packs or heat packs, simple exercises to maintain range and movement, as well as adjunct therapy such as ultrasound therapy to facilitate healing.


During this time, the role of the physiotherapist is to facilitate tissue healing and assisting the patient to protect the injured areas whilst maintaining activity and mobility in the unaffected regions. Typically, the acute inflammatory stage of injury lasts a week or two. Hence, it is common to continue to experience some discomfort in the initial phases of rehabilitation.


If pain is severe, pain medication can be prescribed by a medical doctor to help reduce symptoms to allow the patient to rest better and to participate in rehabilitation actively.

Physiotherapy Management of Subacute and Chronic Neck Pain

After a few sessions of physiotherapy, the symptoms of acute pain and inflammation should subside as the patient enters into the sub-acute and chronic stages. During these stages, the pain is more manageable and less irritable. Thus, the focus of physiotherapy will shift towards treatments that can provide long-term improvements and to facilitate a patient’s ability to self-manage.


Physiotherapy management in these stages would typically include the use of active exercises such as mobility and strengthening exercises, education on how to improve posture, and facilitating the building of an active lifestyle. Hands-on techniques such as myofascial trigger point release, joint mobilisations and joint manipulations would also be used where appropriate to aid in recovery.


Exercises prescribed by physiotherapists are often specially and uniquely tailored to suit each patient’s specific needs. While general exercise can help to decrease pain and improve health, specific mobility and strengthening exercises targeted at the neck muscles as well as those in the shoulder are essential to reduce the recurrence of pain. Thus, physiotherapists often recommend engaging in a combination of both types of exercises.


A systematic review and holistic understanding of a patient’s habits, movement patterns, posture(s) and requirements for his or her daily activities, sports, and/or hobbies is key to designing a suitable exercise program to suit his or her needs.

Longer-Term Prognosis and Management of Neck Pain

Unfortunately, it is important to note that neck pain can recur, and the risk of developing chronic neck pain or neck discomfort that subsides and subsequently returns is high. This is highlighted in the clinical practice guidelines published by the American Physical Therapy Association. The president of the International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT). Kenneth Olsen, also documented in his book Manual Physical Therapy of the Spine that between 50% to 80% of people with neck pain experience it again one to five years later.


Therefore, having a tailored exercise program and being equipped with knowledge to manage one’s own symptoms is key to long-term success in managing neck pain.

What do we do at Balance Core?

At Balance Core, we strive for excellence in providing an accurate diagnosis and managing neck pain with effective treatment(s). We believe in ensuring a systematic review of a person’s posture, body alignment, movement patterns and habits to identify the root cause of problems and pain.


Our physiotherapists are highly trained in manual palpation and observation to identify the sources of discomfort. This allows us to help our clients and patients to minimise their symptoms in a few sessions and to empower them to continue managing their conditions with a targeted treatment program with exercises and habit changes.


We use a combination of manual therapy (i.e. hands-on techniques), adjunct modalities such as dry needling, taping, ultrasound therapy and TECAR therapy, as well as exercises to help our clients and patients to achieve their goals.

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    Frequently Asked Questions

    Do I need an appointment?
    Yes, our treatment is generally on one to one basis, and you will need to contact us to schedule an appointment
    Do I need a referral letter from a doctor?
    In Singapore, physiotherapy sessions are regulated by the Allied Health Professions Council, and under the current regulation, this is not a mandatory requirement to obtain a referral from a doctor before seeing a physiotherapist. When the attending physiotherapist deems that the patient needs medical attention, we will refer the client to a relevant doctor for further care
    Do I need to take an X-ray or MRI scan before seeing a physiotherapist?

    Your physiotherapist will perform a thorough assessment to evaluate the problem and identify the problem’s root cause. A detailed explanation will be given so that you can fully understand your issues and the outline of subsequent physiotherapy treatment plans.

    Thereafter, a treatment involving muscle release, specific muscle activation or joint mobilization, etc. will be rendered to provide symptomatic pain relief and address underlying root problems.

    What attire should I wear for my appointment?

    Comfortable clothing – preferably T shirt and shorts. We do provide clothings for you to change into if needed