At some point or another we all search for the “one thing” that will completely relieve pain. The holy grail of “FEEL GOOD!” Every so often someone will tell me that their friend found total relief from traction, or dry needling, even meditation. We are all different, and what works for one person won’t work for the next. Without knowing you personally, I would never tell you that something would definitively work. We are complex creatures. Our body and brain will require little tweaks to get things just right. Today I want to give you an overview of what current research says regarding neck pain and how to get relief. Most of these treatments are provided by an array of different medical providers.

Avoiding excessive use of medication and not relying on surgeries is the name of the game here.

In the 2017 Clinical Practice Neck Guidelines I noticed a trend that seems like a no brainer. Still we overlook its importance. Treatments work best when combined with other treatments. It is no coincidence that many chiropractors are incorporating exercise into their treatments. Just as chiropractors are using exercise, physical therapists are performing manipulations. Not to mention the fact that almost every type of medical provider has started using a dry needle.

In the past we have criticized certain treatments because of “limited” research. However, with opioid use on the rise we need to rethink other options for managing pain. Will a TENS unit or Ultrasound be the cure-all for your pain? Likely not. Will it complement another treatment to provide better results? Possibly if used right. Below we will discuss treatment options that have shown to be the most effective with neck pain. Before we get ahead of ourselves we need to address a couple things.

1. Pain IQ

What is your Pain IQ? Our understanding of how pain works is continually developing. Most medical providers still have an outdated understanding of pain. If you think the body creates pain you have a lot to learn. Our brains create pain, whether we like it or not. Does the body influence what our brain feels? Yes it does. Can our understanding or lack of understanding of pain influence how much pain we feel? Yes it can. Unfortunately, this can be a time consuming process and insurance does not like to pay for talking! If you don’t understand pain your ability to benefit from any treatment is severely limited.

A pain mechanism model. From Gifford (1998).

2. Medication Usage

Most of us are aware of the current opioid epidemic. Medical providers want to make you feel better. It is why most of us got into our current profession. Unfortunately, many of you leave appointments with pain medications without understanding the long term implications of its use.

Pain killers definitely serve a purpose. Anyone suffering from appendicitis or a fractured limb can tell you that it serves a purpose. However, they do come with some short and long term side effects.

Short-Term Side Effects: Nausea, dizziness, sedation, sweats, constipation, and respiratory depression.

Long Term Implications:

• Increased tolerance to the medication, meaning you need to consume more to feel an effect.
• Addiction is also a possibility. You may find yourself unable to meet family, work and social obligations. You may also notice withdrawal symptoms when attempting to discontinue use of medication.
• Degeneration in areas of the brain responsible for pain, cravings and emotions. Making it harder for you to wean from medications and tolerate less painful inputs.

(Volkow, 2016)

3. Lifestyle

We are going to sound like a broken record with this one. Please understand that if you are having difficulty sleeping you are less likely to see positive outcomes from treatment. The same goes for a poor diet. Putting things in your body that result in excessive inflammation are detrimental to your success.

Also, do not overlook the impact of your emotional pain on physical pain. “The body cries when the eyes cannot.” Getting professional help is thought to be taboo by many, but it is often the key toward a more fulfilling life physically, spiritually and emotionally.

Top 5 Treatments For Neck Pain:

1. Exercise

After reading a bunch of fancy and expensive research the conclusion is that exercise is beneficial! Your mind is blown right? What is even more interesting is that studies are showing positive outcomes despite the complexity or specificity of the exercise. Three main considerations are necessary when performing exercise:

1. Technique: Whether it is exercise or sitting, you need to understand how to get into good positions. Throwing loads of exercise on poor positions is a waste of time. When you are performing exercises take a look in the mirror to see if what you feel is actually real!
2. Strengthen and Lengthen: Strengthen what is weak and lengthen (or soften) what is tight. Often times, gravity and desk work put us in a slumped position. Our goal is to counteract our friend… gravity.
3. Smart Training: Know when to push and when to back off. If you are experiencing pain you need to consider #1 and #2 (not that number #1 and #2). I am talking about technique, strength and flexibility. Adding a lot of repetitions to bad technique and a body that doesn’t have appropriate strength and flexibility is a recipe for disaster. Seeing a medical or fitness professional can be a great way to figure this out.

 

Stretch Tight Muscles:

Strengthen Weak Muscles:

 

2. Neck Manipulation and Mobilization

Manipulations are commonly associated with chiropractors. This is your good old fashion neck “crack.” Physical Therapists and Osteopathic Doctors can also provide this service. Mobilizations can include a host of different treatments. This generally includes treatment of the soft tissue around the neck or the joints without providing a thrust, or “cracking” the neck.

The big takeaway here is that manipulation and mobilization are significantly more effective when combined with EXERCISE.

3. Thoracic Manipulations

Performing a manipulation to the upper back was shown to be a nice complement to your neck treatments. People often report less neck pain and reduced disability. Often allowing you to be a more active participant in your home exercise plan. This treatment is more effective when combined with manipulation and mobilization of the neck, and exercise. If you want to start mobilizing your upper back today, use your foam roller. 

4. Traction

Traction does not have much evidence to support its use when used alone. However, when combined with manual therapy and exercise it does much better. Are you starting to see a trend? If you are receiving traction, make sure that you are receiving other forms of treatment as well. Studies have shown increased likelihood of success with traction when used with people who have been diagnosed with cervical radiculopathy. Your physical therapist can perform a few tests on you to determine what your chance of success may be with this treatment option (Raney, et al).

 

5. Dry Needling/Laser

Dry needling and low level laser treatments snuck their way into the updated 2017 Clinical Practice Guidelines for Neck Pain. This is pretty remarkable considering all of the other treatments that were not specifically recommended. Laser was shown to have benefits in both the acute (less than 6 weeks) and chronic (more than 12 weeks) stages of pain. In 2008, neither of these treatments were mentioned in the Neck Pain Guidelines. This really goes to show that high quality evidence is beginning to accumulate in support of these treatments.

 

Overview

We have data to support the fact that patients spend less money on medical services and demonstrate less dependency on drugs when getting conservative care first. This can include chiropractic, physical therapy, massage therapy and acupuncture to name a few. Now, some insurances will require that you see a physician first. Before accepting pain medication please consider these other services.

Please use this article to guide you in your future decision-making. Many different medical providers offer similar treatments. The big takeaway here is to make sure you are receiving these treatments in combination! Recall that having a proper understanding of how pain works is fundamental for seeing success. Please, please, please if you are paying good money for treatment do not neglect diet and nutrition. It is the equivalent of punching yourself in the neck repeatedly and then seeing a professional to treat it.

 

 -Dr. Michael Infantino, DPT 

 

Ellis, R. F., & Hing, W. A. (2008). Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy. The Journal of Manual & Manipulative Therapy, 16(1), 8–22.

Graham, Nadine & Gross, Anita & Goldsmith, Charlie. (2006). Mechanical Traction for mechanical neck disorders: A systematic review. Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 38. 145-52. 10.1080/16501970600583029.

https://www.jospt.org/doi/abs/10.2519/jospt.2014.5229 

Mejuto-Vázquez et al, titled “Short-Term Changes in Neck Pain, Widespread Pressure Pain Sensitivity, and Cervical Range of Motion After the Application of Trigger Point Dry Needling in Patients With Acute Mechanical Neck Pain: A Randomized Clinical Trial,” J Orthop Sports Phys Ther 2014;44(4):252–260.

https://www.ncbi.nlm.nih.gov/pubmed/25042309 

https://www.jospt.org/doi/abs/10.2519/jospt.2013.4668 

Raney NH, Petersen EJ, Smith TA, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise.

Volkow ND, AT ML. Opioid abuse in chronic pain—misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63.