Stiff, locked or radiating?
Neck pain arrives in a few familiar ways. There is the neck that locks overnight and will not turn to one side. There is the slow, grinding stiffness that builds over a week of long days at a desk or behind the wheel. And there is neck pain that does not stay in the neck: it runs into the top of the shoulder, between the shoulder blades, or down an arm with pins and needles.
Each of these needs a slightly different plan. A locked neck usually wants settling and gentle movement. A neck that has been stiff for months usually wants a look at how you sit, sleep and hold your head, as well as treatment. Pain that travels into an arm needs a careful check of the nerves before anything else.
Neck pain often comes with headaches that start at the base of the skull. If that is part of your picture, our headaches and migraines page explains how we approach it.
What happens at your first appointment
Your first appointment takes about 30 to 40 minutes. It includes:
- Your history. When it started, what set it off, whether it travels, what makes it better or worse, and what you need your neck to do (work, driving, sport, sleep).
- A physical examination. How your neck, upper back and shoulders move, where it is tender, and neurological tests (reflexes, strength and sensation in the arms) when the pain travels or you have pins and needles.
- Posture analysis. Digital posture analysis for adults, including head position relative to the shoulders, so there is a baseline to compare against.
- An explanation. What we found, what we recommend and why, before you commit to anything.
- Your first treatment, when clinically appropriate. If there is a reason to wait, your chiropractor will say so.
We do not X-ray routinely. Imaging is requested when the history or examination suggests it would change what we do, for example after a significant injury.
How we treat neck pain
Treatment depends on what the assessment finds and what you are comfortable with. It may include:
- Adjustment or mobilisation of the stiff segments of the neck and upper back, by hand or with a handheld instrument.
- Soft tissue work for the muscles that run from the neck into the shoulders, which often hold much of the tension.
- Specific exercises: gentle range-of-motion work early on, then strengthening for the deep neck and upper back muscles.
- Practical advice on your desk and screen height, phone use, driving position and pillow, because these are usually what keeps a stiff neck stiff.
We check your movement at each visit and review progress with you. How many appointments you need depends on how long it has been going on and what is driving it, and if things are not improving as expected we will say so and talk through other options, including referral.
When to get neck pain looked at
A stiff neck from a bad night usually settles within a few days with gentle movement. If it has not shifted in a fortnight, keeps coming back, or is travelling into an arm, get it looked at.
- A significant injury to the head or neck, such as a car accident, a fall from height or a heavy tackle.
- A severe headache with a stiff neck and fever, or a rash.
- Weakness, numbness or clumsiness in the arms or legs, or difficulty walking.
- Dizziness, double vision, difficulty speaking or swallowing, or drooping of the face.
- A sudden, severe headache unlike any you have had before.
What the research says
Spinal manipulation and mobilisation are among the treatments reviewed in the research on neck pain, usually alongside exercise, which has the strongest support of all.
Research has found that spinal manipulation can reduce recent-onset neck pain more effectively than medication. In a trial involving 272 adults with neck pain lasting two to 12 weeks, manipulation produced better pain outcomes than medication at several follow-ups. Home exercises and advice produced similar outcomes to manipulation at most time points.
Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: A randomized trial. Annals of Internal Medicine, 156(1 Pt 1), 1-10. doi.org/10.7326/0003-4819-156-1-201201030-00002More on the research we rely on.
ACC and neck injuries
Neck pain that started with an accident, such as a car accident (whiplash), a fall, a rugby tackle or a lifting injury at work, may be covered by ACC. We are ACC registered, so no GP referral is needed. Your chiropractor assesses the injury at your first appointment and lodges a claim if it qualifies, or sees you under an existing claim if you bring the details.
If your claim is accepted, ACC covers part of the cost of your care.