Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Neck Pain & Stiffness Physical Therapy Guide

Neck Pain

A sudden-onset (acute) bout of neck pain is common. Two out of three of us will have neck pain at some time in our lives. In most cases it is not due to a serious disease or neck problem and often the exact cause for the pain is not clear. This is called ‘nonspecific neck pain’. Most are probably due to minor sprains or bad posture. Full recovery occurs in most cases. Common Types of Neck Pain include whiplash, nerve root pain, acute torticollis and disc related pain. 

What is Whiplash?

Whiplash is defined as an acceleration-deceleration mechanism of energy transfer to the neck. It is where the cervical spine forcibly hyperextends and then flexes, it is most commonly caused by road traffic accidents, but can also occur in sports when the cervical spine is suddenly extended when in contact with the ground or by a direct blow from an opponent.

Whiplash is a common condition which affects approximately 500 people per 100,000 of the population. In the UK around 300,000 cases of Whiplash occur every year.

The entire event of injury typically only lasts no more than half a second, by which time the cervical spine has been subjected to insulting forces. The lower cervical spine and upper thoracic spine are forced into extension, while the upper cervical spine experiences flexion. This results in a deformed “S shape”  through the neck and often leads to joint compression of the adjacent facet joints of C5-6 and C2-3.

People who are involved in road traffic accidents may not typically feel pain immediately post injury; however, symptoms may develop and increase gradually in the 48 hours following injury. Joints, ligaments, muscles and neural tissue may all be affected.

What Causes Whiplash?

Road traffic accidents are the main cause of Whiplash. This is due to the sudden stopping force of the collision which forces your head to move violently. Whiplash can occur in any direction, whether the head is thrown forwards, backward or sideways. It can also occur at very low speeds, simply because the neck cannot react quickly enough to the force that is applied through it.

As well as road traffic accidents, whiplash can also be caused by a sudden blow to the head or neck. This can occur in contact sports such as boxing or rugby, but can also be the result of a slip or fall.

Whiplash Symptoms

The most common symptoms of Whiplash associated disorders which we will be treating here include:

  • Neck pain
  • Headache
  • Decreased neck mobility.
  • Tight muscles around the neck

If you present with neck instability, worsening neck pain, hard neurological symptoms (pins and needles, numbness, muscle weakness) or any of the red flags detailed below; then a thorough medical examination is required.

What Is Acute Torticollis

This is sometimes called ‘wry neck’ and is the most common cause of neck pain in the adult population. A torticollis is when the head becomes twisted to one side and it is very painful to move the head back straight. The cause of acute primary torticollis is often not known.

However, it may be due to a minor strain or sprain to a muscle or ligament in the neck. Some cases may be due to certain muscles of the neck being exposed to cold (‘sleeping in a draught’). It is common for people to go to bed feeling fine and to wake up the next morning with an acute torticollis.


  • Tense and tender neck and shoulder muscles
  • Unwillingness to turn your head to one side
  • Referred shoulder pain
  • Neck cramps
  • Muscle tightness

What Is Acute Nerve Root Pain?

When the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region, the condition is known as cervical radiculopathy. As well as neck pain, there are symptoms such as loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain.

The common causes of a radiculopathy are cervical spondylosis and a prolapsed disc. (A prolapsed disc is sometimes called a ‘slipped disc’, but the disc does not actually slip. What happens is that part of the inner softer area of the disc bulges out (prolapses) through the outer harder part of the disc, pressing on the nerve as it passes out of the vertebra). If you expect that you have a prolapsed disc, and present with any of the red flags below, you should consult  a health care professional as soon as possible!


  • Pain that spreads into the arm, neck, chest, upper back and/or shoulders.
  • Muscle weakness and/or numbness or tingling in fingers or hands.

Red Flags

A “red flag” is the term given to the identification of dangerous or potentially dangerous findings during an examination. If a red flag is present during this examination, patients are usually referred to medical specialists for immediate assessment and treatment. When examining the cervical spine there are many red flags to look out for, these include:

  • Diplopia (double vision)
  • Dysphasia (difficulties speaking)
  • Dysphagia (discomfort swallowing)
  • Dizziness
  • Dysarthria (unclear articulation of speech)
  • Drop attack (fainting)
  • Bilateral numbness of upper or lower limbs or loss of function in upper limb (grip strength)
  • Extreme unexplained weight loss
  • PMH of cancer in the local area

If you present with any of these symptoms you should seek medical assessment immediately.

Does It Get Better?


Treatment options

The treatment options for neck pain have changed greatly over the last decade or so. The current treatment options stem from a large body of evidence demonstrating the benefit of early return to normal daily activities and early mobilisation. The previous school of thought that prolonged bed rest whilst wearing a cervical collar actually showed no clinical benefits in any scientifically controlled rigorous studies. Thus the new saying “Movement is Medicine!” was coined.

Your treatment plan should be based upon your symptoms, so if you are experiencing severe pain on all neck movements (10/10 severe pain), you must avoid working through the pain, and contact your local general practitioner who can prescribe a stronger painkiller. Once the pain has settled, you can continue your exercise programme.

In many cases, whiplash will eventually solve itself, however more often than not, people require some basic treatment and advice, this can be found below.

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Remember! Our guides are to be used in conjunction with a qualified medical professionals assessment. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

Neck Pain Exercises

1) Neck ROM 

Early mobilisation is highly recommended in the management of acute neck pain. It is advised that the patient commences cervical movements throughout their spinal range of motion within comfortable limits as soon as possible! Although the neck may be painful initially, keeping it mobile from an early stage will improve its movement and speed up the recovery. It is normal to experience pain on movements such as looking up to the ceiling or looking over your shoulder, however this pain won’t cause any further damage. Failure to move your neck adequately and following immobilisation protocols is likely to prolong the symptoms of whiplash and delay recovery rates. As a result, wearing neck braces / collars is no longer recommended.

How to do it:

  • Flexion: The movement in which the chin is lowered down towards the chest, stretching the neck extensors and opening up the spinal joints.
  • Extension: The movement in which the neck is extended and the patient is looking upwards towards the ceiling. In doing so, closes down the spinal joints and stretches the neck flexors.
  • Rotation: The movement in which the neck is rotated around the its axis and the patient is looking directly to their side or over their shoulders. In doing so, closes down the spinal segments to the side you have looked, and stretches the soft tissue on the opposite side.
  • Side Flexion: The movement in which the neck is laterally flexed. Best described as trying to place the ear upon the shoulder through sideways movement of the neck. In doing so, closes down the spinal segments to the side you have flexed, and stretches the soft tissue on the opposite side.

2) Nod Stretch

Following the initial inflammatory stage most neck pain patients will present with secondary complications. The most common of these is muscular tightness of the anterior/posterior neck, upper back and shoulder muscles, which in turn can make it harder for your neck to mobilise. The muscle group most commonly associated with this is the upper trapezius.

How to do it:

  • Sit with a good posture
  • Slowly rotate your head / neck so that you are facing left or right; as far as you can.
  • Once in this rotated position, slowly nod your head up and down, holding the stretch for 1 second at the top or bottom of each movement.

Repeat 10 nods up and down for 3 sets. Try to do 3 times per day.

3) Side Flex Nods

This exercise works in the same way as the rotation with nods; mobilising the joints in your cervical spine whilst stretching the muscles in the surrounding area.

How to do it:

  • Sit with good posture
  • Slowly side flex your head as if you are trying to place your ear upon your shoulder.
  • Once in this side flexed position, slowly try and take your chin towards your nearest armpit; holding for 1 second.
  • Slowly return back to neutral.
  • This exercise can be progressed by holding a small weight in the hand opposite to the side you are side flexing to encourage a bigger stretch!

Repeat 10 times for 3 sets. Try to do 3 times per day.

4) Shoulder Shrugs

A simple yet fantastic exercise to loosen up the upper trapezius and rhomboid muscles, whilst opening up the upper spinal joints.

How to do it:

  • Sit with good posture
  • Raise your shoulders up towards your ears; holding for 2 seconds

Repeat 20 times, every hour, aiming for 5 or more sets per day.

The Ugly” Exercises

It is vitally important that we strengthen the stability muscles that hold our head on top of our neck. A weakness of these deep stabilising muscles means that we place an extra load onto “non stability” muscles, causing poor posture, pain and headaches. The ugly exercises are so called simply because you can look silly doing them.

5) Deep neck flexors

This exercise works by completing the movement in which you give yourself a double chin, thereby activating the deep neck flexors. The exercise is completed with a 2 second hold to isometrically strengthen the muscle fibres and it should be felt at the base of your skull.

How to do it:

  • Sit with good posture
  • look down very slightly towards the floor
  • place your index finger on your chin.
  • Imagine you are trying to push your chin through your spine behind you until you feel the muscle tense in your posterior neck; holding for 2 seconds

Repeat 8 times for 3 sets, Try to do 3 times a day.

6) Deep neck extensors

This exercise is the opposite to the deep neck flexor exercise. This time activating the deep neck extensors and isometrically holding only for a couple of seconds.

How to do it:

  • Sit with good posture
  • Poke your chin forward as far as comfortable
  • try and look up towards the ceiling, holding for 2 seconds.

Repeat 8 times for 3 sets, try to do 3 times a day.

Neck Pain Prognosis

Untreated neck pain can last anywhere from weeks to months, with high chances of the condition returning if you commence a rehabilitation programme quickly. Medical research suggests that Physical Therapy and exercise are the most effective way of treating the condition, most patients show significant improvement after 6 weeks of treatment, however it can become a chronic condition which can last months. To stop this from happening, the neck needs to be as active as possible!

To reduce your chances of getting neck pain again, you must continue to complete range of movement, flexibility and strengthening exercises. Actively trying to improve your posture whilst at work can have a great impact on reducing your chances of re-aggravating your injury and also improving your general appearance!