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neck pain

Neck pains are aches, pain and discomfort that are experienced in the neck (which is the front, back and left / right sides of the neck). It means the entire area that's above the shoulder and below the head.

The neck houses a lot of very important structures, such as the cervical nerves, and unfortunately yes, the nerves can sometimes be affected by injury, slipped discs or other issues that affects nerves, and this can cause pain that radiates (travels) to

  • upper back
  • shoulders
  • arms
  • and sometimes all the way to hands and fingers too

Yes, all from the neck. 

That's why as a hand therapist, whenever I treat patients, I have to do differential diagnosis to check if there are higher-nerve involvement, not just look, assume and treat fingers and hands.

neck pain causes

Neck pains are so common that it affects 30% of the population in Singapore and Asia. That means if you're in an office or classroom of 100 persons, at least 30 of them have neck aches and pains!

Neck pains can be caused by sudden injuries or trauma such as

...and also caused by slow, non-trauma accidents such as

  • arthritis (osteoarthritis, wear and tear)
  • disc degeneration, spondylosis, spondylolisthesis
  • poor ergonomics, posture and habits such as the way one sits, works, walks etc
  • medical issues such as cancer

risk factors and who gets neck pains

Most of the time, neck aches and pains seem to affect moreso adults between 25-50 years of age...but of course, there are people who gets neck issues at young age (we have had neck pain patients who are 5 years old, who fell and sprained their neck) and older ones more than 60 years old.

Some cervical pain studies are showing that women are more likely than men to suffer neck pain.

Risk factors for getting neck pain includes:

  • poor posture
  • overweight / obesity
  • smoking
  • repetitive lifting
  • office and computer work
  • involvement in athletic activity

People with neck pain can have difficulty doing / participating in activities such as

  • reading
  • working
  • walking
  • driving
  • sleeping* (most of them hate difficulty sleeping due to neck pain)
  • playing sports

good news

The good news is that most of neck pain issues and patients do not need invasive injections or surgeries for their necks, and respond well to neck physiotherapy.


Only a very, very small handful of patients will benefit from neck surgery (we will tell you), and it needs to have a variety of reasons such as

  • unstable neck joint
  • extremely painful (more than 6 or 7 out of 10 pain scale)
  • too frequent
  • patient very keen for surgery (and its risks)

Regardless if you choose to have neck surgery or injections, you will 100% benefit from neck physiotherapy sessions to:

  • increase your neck range of motion: flexion, extension, rotation
  • normalize neck posture
  • pain relief and reduction (to eventual zero pain)
  • build neck strength, stamina and stability to support head in activities and life

what Does neck pain even Feel like?

The most common description of neck aches and pains by patients we'd seen since 2005:

  • sharp neck pain
  • sore, "sour" ache in the neck
  • throbbing, pulsating neck pain
  • pins and needles or tingling sensation in the neck
  • dull, ongoing ache
  • stabbing, jabbing, jolting pains
  • stiff, locked, blocked neck pain

For some patients, they / their neck pains may be caused by inflamed or irritated nerves that may radiate and travel to

  • upper / mid back
  • shoulder blades / shoulder
  • arm / elbow
  • hand and fingers

This symptom is called cervical radiculopathy.

Our senior physios will assess and determine if this is something you have, and refer you to a suitable neck orthopedic doctor for the right treatment for your neck pains.

Signs and Symptoms of neck pains and injuries

Signs and symptoms of your neck pain will depend entirely on the structures that are injured or affected, as well as how severe it is and how long it has been.

The common signs of neck pains and issues:

  • neck difficult to bend / flex / extend
  • neck difficult to rotate
  • difficult to look around / behind the shoulder
  • weakness in the shoulders / arms
  • muscle spasms

Some other neck pain symptoms:

  • Neck pain and / or pains and discomfort in the upper back, shoulders, arms, hands
  • Tingling, weakness or numbness in the neck, upper back, shoulders, arms, hands
  • Painful or discomfort when coughing, sneezing, reaching, or sitting
  • Difficulty sitting or standing upright
  • Neck feeling locked, blocked or stuck in a certain position (such as bent one side, rotated)
  • Headaches
  • Difficulty sleeping or "finding a comfortable spot"
  • Pain worse in morning or night
  • Difficulty remaining in a position for a length of time, due to increasing neck discomfort or pain

How to diagnose neck pain

Neck pains are the kind of injuries that we always take our time to deep-dive and determine the underlying issues, and cannot just treat and go. 

We will need to do a thorough examination which will include:

Taking an in-depth health history, to find out:

  • When did your neck pain start (how long ago)
  • How did you first get your neck pain
  • What is the type of neck ache or discomfort you felt and has it changed
  • Where is the location of the neck pain, has it moved
  • Is there a specific time or temperature or activity that aggravates or triggers the neck pain
  • What specific activities you cant do right now in your work, life, play because of your neck

Next, physical and neck assessment to check for neck problems such as:

  • Range of motion: how much can you actively bend, extend and rotate your neck. Check if there's any blockage and locking of neck joints or structures or pain
  • If there's any nerve triggered with neck movements
  • For weaknesses in the muscles of and around the neck
  • Sensory losses or deficits or numbness
  • Reflexes
  • Cervical joint stiffness
  • Muscle tightness
  • Postural issues and tightness
  • Difficulty moving such as standing, sitting, walking etc

If there's any or multiple of the neck problems above, we will plan out your neck physio treatment (it's part of our spinal back and neck physiotherapy program) and get you back to normal working, living and playing again.

If we suspect any more potential severe problems during your neck cervical assessment and treatments, we will refer you to a neck orthopedic doctor who we trust to get an MRI done. 

how our senior neck physios can help your neck pain

Medical and physiotherapy research is showing that spinal physio is the best treatment for neck pains and aches compared to neck injections or surgeries. This is likely because 

  1. most cases are not severe (only a small percentage are very severe who medically requires neck injections or surgeries)
  2. neck physiotherapy works
  3. the risks-vs-outcomes of neck injections and surgeries may not be good enough unless its medically necessary

We're NOT against neck injections or surgeries especially when it's medically necessary. When is it necessary? When the pain is too much to bear, be it due to intensity or duration (some patients have pain 24/7), or there is too much risk to not do surgery, such as severe instability etc. 

In fact, we work with a number of orthopedic doctors in Singapore, and we have number of trusted ones that we have built relationship and trust over years, so we are more than happy to refer you to a neck orthopedic doctor if you want to have their opinion on your neck pain.

A large number of orthopedic doctors actually refer most of their neck pain patients to us to treat patient's necks to avoid surgery and medication. Most of the time, it works. 

In the rare event where patients need neck surgery, the patient will undergo:

  1. Pre-surgery neck physio,
  2. Neck surgery
  3. Post-surgery neck physio

To accelerate recovery of range of motion, pain relief and strength / function of their necks.

Our neck physios will work with you to speed up your neck pain recovery, and you can expect to also get specific cervical neck exercises and treatments that you need to do between neck physio sessions with us.

We will work with you to:

Pain relief / reduction, manage neck-related symptoms

The first and most immediate thing to do is to get you some neck pain relief and pain reduction, so that it will free up some energy for you to be able to participate more in self care, activities, sleep and even work.

We may use gentle hands-on techniques, known as manual therapy, to work on the soft tissues in the neck in a careful manner to improve range of motion and pain.

We may also use some rehab technologies such as 

Depending on what will benefit your neck most and what is most suitable.

Avoid neck surgery

In all neck pain cases, our neck physios will create a neck rehab program for your neck, even if you have severe cervical radiculopathy (pain from nerves in the neck that radiates downwards to shoulder, back, arm and hand) to help prevent neck surgery or even injections where possible.

Improve posture

For patients with poor posture that aggravates and causes neck pain, after relieving the neck pain, we will start specific neck strengthening exercises for you so that your neck will regain the full strength and power it needs to support your head and shoulders.

Patients report higher alertness and awareness with the improved head-neck-shoulder strength.

Restore neck movements and motions

Working on improving neck movements, which are

  1. neck flexion
  2. neck extension
  3. neck rotation 

is the 2nd thing that we will work on for neck aches and pain physiotherapy.

We will start with soft tissue gliding and stretches first, which are passively done by us to your soft tissue, this is to increase the flexibility and stretch of the neck joints, muscles, tendons and ligaments...

...followed by active stretches which are done by yourself between neck physio sessions, to maintain and keep the neck supple.

Improve your neck flexibility

This is slightly different but related to neck movement - often there are tightness or tight structures in the neck causing neck stiffness, pain and mobility issues.

For these, we will also have to work on the movements as above in restoring neck movements, but with 1 additional treatment: to treat the tightness AND the find out what's causing that particular tightness. You see, tightness has a cause, be it due to posture, compensation, injury - something.

We will have to palpate and find out and treat.

Improve neck muscle and joint strength

This is slightly related to neck flexibility, in the sense if there's weakness and/or compensatory strength - we need to find out what's weak, what's overstrong to compensate, and why -- then we can treat with the correct specific exercises that will gently but surely restore your neck muscle and joint strength.

Patients report being able to hold up their heads longer to work, play, etc without neck fatigue or ache or pain setting in very fast. You may be placed under a program of core stability and strengthening to restore the strength and coordination of muscles around your spine.

Improve stamina and endurance in your neck

Once we're working on neck pain, then movement and then power...next, we need to work on improving your neck stamina and endurance.

Ie you help your neck build tolerance for activities, work and sports -- whatever you want or need a stronger and pain-free neck to do.

Return to Activities

In the end, all neck physio activities is aligned and geared towards

  1. firstly, getting you back to activities you do such as work, responsibilities as an individual / parent / kid etc
  2. secondly, getting you to performing at sports, play and even work, with less risk of reinjuries or new injuries to your neck

What you can expect is discussions and goals with the neck physio that will get your neck treatment program.

As your neck pain improves, it will be important for you to continue your new posture and movement habits to keep your neck healthy and pain free.

After your neck surgery

As I mentioned earlier, neck injections or surgeries are pretty rare, but there are those that are medically necessary, especially to relieve pressure on a compressed cervical nerve or unstable neck joint.

If you need to do neck injections or surgery, be assured that when you come in for your neck physiotherapy, we will assign you a neck-experienced / expert to work with you.

How Many Sessions?

One of the most common questions that patients ask us is how many neck physio sessions they need, and sometimes we cant answer it straightforward because everyone's

  1. neck is different and unique
  2. healing rate is different
  3. compliance and life responsibilities differ
  4. surgery or not
  5. if there's complications from surgery eg infections, inflammations
  6. flare ups or additional injuries
  7. etc

What we can do is to give you a range, very mild cases may need up to 6 sessions, and very severe ones may need up to 30 or more. Most fall into a range of 6-12 sessions, more or less.

some neck physio advice

  • Stop, decrease, increase rest between activities that aggravate or worsen the neck pains or other neck-related symptoms
  • Definitely definitely stay as active as possible. Do not only rest in bed where possible - go for short walks, stay active around the house, work as much as you can...all with one caveat: avoid triggering the pains as much / often as possible. Movements often help with pain relief and stiffness, and can help you sleep better at night.
  • Do the neck stretches and exercises you are taught
  • Sit in solid firm chairs
  • Use heat therapy whenever you can to help with blood flow and pain relief, every 2-4 hours (we recommend Bremed electric heatpack for the convenience).
  • Come consistently for your neck physiotherapy so that we can continue to treat and progress your neck pain recovery