Neck pain can be caused by a number of factors, including muscle strain, ligament sprains, arthritis, or a “pinched” nerve. Approximately 10

percent of adults have neck pain at any one time. The majority of patients, regardless of the cause of pain, recover with conservative therapy. Pain

severity may not correlate with abnormalities seen on imaging of the neck.The neck’s susceptibility to injury is due in part to biomechanics.

Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or

head, normal aging, and everyday wear and tear.


neck anatomy


The cervical spine (sometimes abbreviated as c-spine in the medical world) begins at the base of the skull. Seven vertebrae make up the

cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6, and C7. The cervical

nerves are also abbreviated; they are C1 through C8.The cervical bones (the vertebrae) are smaller in size when compared to other spinal

vertebrae (in your thoracic or lumbar spines). The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and

enable diverse head movement (eg, rotate side to side, bend forward and backward).A complex system of ligaments, tendons, and muscles help to

support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury.

Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses

originating in the brain.Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous

system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal

or spinal cord into the organs, arms, legs, fingers—throughout the entire body.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles (eg, deltoids, biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

*sign & symptoms :-



>Muscle spasm

A spasm is a sudden, powerful, involuntary contraction of muscles. The muscles feel painful, stiff and knotted. If you have neck muscle spasms,

you may not be able to move your neck — sometimes people call it a crick in the neck. Your doctor or physiotherapist may call it acute torticollis or wry neck.

>Muscle ache

The neck muscles are sore and may have hard knots (trigger points) that are tender to touch. Pain is often felt up the middle of the back of the neck, or it may ache on one side only.


The neck muscles are tight and if you spend too long in one position they feel even tighter. Neck stiffness can make it difficult or painful to move your neck.

>Nerve pain

Pain from the neck can radiate down the arms, and sometimes, the legs. You may feel a sensation of pins and needles or tingling in your arms, which can be accompanied by numbness, burning or weakness.


Headaches are common in conjunction with neck problems. They are usually a dull aching type of headache, rather than sharp pain. While the headaches are often felt at the back of the head, the pain may also radiate to the sides, and even the front of the head.

>Reduced range of motion

If you can’t turn your head to the side to the same degree towards each shoulder, or you feel limited in how far forward you can lower your head to your chest, or how far you can tilt your head back, you may have reduced range of motion. Your doctor will be able to test this.


a) Muscle tension and strain

This is usually due to activities and behaviors such as:

poor posture
working at a desk for too long without changing position
sleeping with your neck in a bad position
jerking your neck during exercise

b) Injury

The neck is particularly vulnerable to injury, especially in falls, car accidents, and sports, where the muscles and ligaments of the neck are forced to move outside of their normal range.

If the neck bones (cervical vertebrae) are fractured, the spinal cord may also be damaged. Neck injury due to sudden jerking of the head is commonly called whiplash.

c)Heart attack

Neck pain can also be a symptom of a heart attack, but it often presents with other symptoms of a heart attack, such as:

shortness of breath
arm or jaw pain

If your neck hurts and you have other symptoms of heart attack, call an ambulance or go to the emergency room immediately.

d) Meningitis

Meningitis is an inflammation of the thin tissue that surrounds the brain and spinal cord. In people who have meningitis, a fever and a headache

often occur with a stiff neck. Meningitis can be fatal and is a medical emergency.

If you have the symptoms of meningitis, seek help immediately.

e) Other causes

*Other causes include the following:

> Rheumatoid arthritis causes pain, swelling of the joints, and bone spurs. When these occur in the neck area, neck pain can result.
> Osteoporosis weakens bones and can lead to small fractures. This condition often happens in hands or knees, but it can also occur in the neck.
> Fibromyalgia is a condition that causes muscle pain throughout the body, especially in the neck and shoulder region.
As you age, the cervical discs can degenerate. This is known as spondylosis, or osteoarthritis of the neck. This can narrow the space between the vertebrae. It also adds stress to your joints.
When a disk protrudes, as from a trauma or injury, it may add pressure on the spinal cord or nerve roots. This is called a herniated cervical disk, also known as a ruptured or slipped disk.
> Spinal stenosis occurs when the spinal column narrows and causes pressure on the spinal cord or the nerve roots as it exits the vertebrae. This can be due to long-term inflammation caused by arthritis or other conditions.


a) Carotid artery dissection
b) Referred pain from acute coronary syndrome
c) Head and neck cancer
d) Infections: retropharyngeal abscess, epiglottitis, etc.[4]
e) Spinal disc herniation : protruding or bulging discs, or if severe prolapse.
f) Spondylosis : degenerative arthritis and osteophytes
i) Spinal stenosis : a narrowing of the spinal canal
j) Stress : physical and emotional stresses
k) Prolonged postures : many people fall asleep on sofas and chairs and wake up with sore necks.
l) Minor injuries and falls : car accidents, sporting events and day to day injuries that are really minor.
m) Referred pain : mostly from upper back problems
n) Over-use : muscular strain is one of the most common causes
o) Whiplash
p) Pinched nerve

>diagnosis :
1. X-rays:- X-rays can reveal areas in your neck where your nerves or spinal cord might be pinched by bone spurs or other degenerative changes.

2. CT scan:- CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal

structures of your neck.

3. MRI :- MRI uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues, including the spinal cord and the

nerves coming from the spinal cord.

4. Electromyography (EMG) :- If your doctor suspects your neck pain might be related to a pinched nerve, he or she might suggest an EMG. It

involves inserting fine needles through your skin into a muscle and performing tests to measure the speed of nerve conduction to determine

whether specific nerves are functioning properly.

5. Blood tests.:-   Blood tests can sometimes provide evidence of inflammatory or infectious conditions that might be causing or contributing to

your neck pain.

1. Cervical Distraction test 

Cervical Distraction test

test for the presence of Cervical Radiculopathy.Supine or sitting upright.Patient lies supine and the neck is comfortably positioned.

Examiner securely grasps the patient’s either by placing each hand around the patient’s mastoid processes, while standing at their head, or place

one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a

distraction force.A positive test is the reduction or elimination of symptoms with traction .

2.Cervical Flexion-Rotation Test   

Cervical Flexion-Rotation Test

Patient is relaxed in supine
Examiner fully flexes the cervical spine with the occiput resting against the examiners abdomen
The patient’s head is then rotated to the left and the right. If a firm resistance is encountered, pain provoked, and range is limited before

the expected end range, then the test is considered positive, with a presumptive diagnosis of limited rotation of C1 on C2

3.Cervical rotation lateral flexion test 

Cervical rotation lateral flexion test

The purpose is to test for the presence of 1st rib hypomobility in patient’s with brachialgia
The test is performed with the patient in sitting. The cervical spine is passively and maximally rotated away from the side being tested.

While maintaining this position, the spine is gently flexed as far as possible moving the ear toward the chest. A test is considered positive when

the lateral flexion movement is blocked

4.Sharp Purser Test 

Sharp Purser Test

This test specifically assesses the integrity of the Transverse Ligament.
The patient is seated. The examiner places the palm of one hand on the patient’s forehead, and the index finger or thumb of the other hand

on the tip of the spinous process of the axis (C2). The patient is asked to slowly flex the head performing a slight cervical nod, at the same time

the examiner presses posteriorly on the patient’s forehead.

A sliding motion of the head in relation to the axis indicates atlantoaxial instability. A positive result may also be accompanied by a reduction in

symptoms, a “clunk” sensation, or patient reports of a “click” or “clunk” felt in the roof of their mouth. It is thought that this technique reduces

atlantoaxial subluxation caused by forward flexion of an unstable cervical spine.

5.Spurling’s Test  

Spurling’s Test

The Spurling’s test (also known as Maximal Cervical Compression Test and Foraminal Compression Test) is used during a musculoskeletal

assessment of the cervical spine when looking for cervical nerve root compression causing Cervical Radiculopathy
neck in extension, lateral flexion and axial compression that provoked arm symptoms

6.Vertebral Artery Test  

Vertebral Artery Test

The vertebral artery test is used in physiotherapy to test the vertebral artery blood flow, searching for symptoms of vertebral artery insufficiency and disease To test the blood flow in the vertebral artery (VA), one should put the patient on his back and perform an passive extension, followed by a passive rotation of the neck. The rotation should be performed in both directions.
Patient rotates head opposite to tested side maximally and holds position for 10 seconds. Patient returns to neutral for 10 seconds. Patient extends head for 10 seconds. Patient returns to neutral for 10 seconds. Patient extends and rotates head (again opposite tested side) maximally for 10 seconds. Positive symptoms include dizziness, diplopia, dysarthria, dysphagia, drop attacks, nausea and vomiting, sensory changes,nystagmus, etc.


> Analgesics : such as acetaminophen or NSAIDs are recommended for pain.Muscle relaxants are often prescribed and are known to be

effective. However, one study showed that one muscle relaxant called cyclobenzaprine was not effective for treatment of acute cervical strain (as

opposed to neck pain from other etiologies or chronic neck pain). Over the counter topical creams and patches may be effective for some patients.

>Cervical collar :— A soft cervical collar is a piece of foam covered with fabric that is worn around the neck to support the head. Routine use of a

cervical collar is not recommended because it may delay recovery or allow the neck muscles to weaken. In addition, collars can make neck pain

worse in some people due to the fit of the collar.
At night, a rolled towel under the neck or a neck pillow can provide comfort and keep the neck in a neutral position. The ear should be aligned

with the middle of the shoulder when lying on the back. When lying on the side, the nose should be aligned with the middle of the chest bone.

Using one or two regular pillows is not recommended because it can cause too much forward or side-bending of the neck.

> Posterior cervical laminectomy:-

Posterior cervical laminectomy

This surgery is done through the back of the neck and involves the removal of a lamina, which is the back part of a vertebra. A potential

advantage to this surgery is that more flexibility in the neck can be retained if a spinal fusion can be avoided. However, sometimes a spinal fusion

is still done in conjunction with laminectomy.

> Posterior cervical laminoplasty:- 

Posterior cervical laminoplasty

This surgery is similar to the laminectomy, except the lamina isn’t completely removed. Rather the lamina is cut and restructured to make

more space in the spinal canal.

> Posterior cervical foraminotomy :- 

Posterior cervical foraminotomy

This surgical procedure goes through the back of the neck and a small part of the foramen is removed. If a nerve is irritated by a herniated

disc, then the surgeon might remove part of the disc. If a nerve is irritated by a bone spur, then the surgeon will chisel away that bone spur. No

spinal fusion is needed.

1.Ice and/or heat therapy :-
Ice or cold packs may be applied to help reduce pain and swelling. Heat packs may be applied to increase blood flow and loosen stiff muscles.

In some cases, heat and cold therapy may be alternated, depending on the patient’s injury or preferences.

2.Massage therapy :-
A massage can help loosen and relax muscles, which may reduce pain and stiffness. When treating neck pain, it is common for the back of the

neck and surrounding areas to be massaged, including the back of the head, shoulders, and back.

3. transcutaneous electrical nerve stimulation (TENS) :-
which sends electrical pulses to the sensory nerves beneath the skin with the goal of altering pain sensations into a more tolerable feeling.

4.Ultrasound :-
A cold gel is typically applied to the painful or swollen area, then a handheld device is gently rubbed against the skin while sending high-

energy soundwaves beneath the surface and into the tissues. Some people find that ultrasound gives a mildly warm sensation that relaxes

muscles and reduces pain.


1.Neck tilt : 

Neck tilt

Tilt your head down to rest your chin on your chest.
Gently tense your neck muscles and hold for 5 seconds.
Return to a neutral position and repeat 5 times.

2.Neck tilt (side to side) : 

Neck tilt (side to side)

Tilt your head down towards your shoulder, leading with your ear.
Gently tense your neck muscles and hold for 5 seconds.
Return your head to centre and repeat on the opposite side.
Repeat 5 times on each side.

3.Neck turn

Neck turn

Turn your head towards one side, keeping your chin at the same height and moving within comfortable limits.
Gently tense your neck muscles and hold for 5 seconds.
Return your head to the centre and repeat on the opposite side.
Repeat 5 times on each side.

4.Neck stretch  

Neck stretch

Keeping the rest of the body straight, push your chin forward so your throat is stretched.
Gently tense your neck muscles and hold for 5 seconds.
Return your head to the centre and push it backwards, keeping your chin up.
Hold for 5 seconds.
Repeat 5 times.

5.Upper Trapezius Stretch

trapezius STRETCH

Sit up tall with good posture keeping shoulders down. Grasp the bottom of the seat with one hand. Slightly turn your ear to your shoulder until a

comfortable stretch is felt on the opposite side of the neck. Hold that position for 20 seconds. Repeat to each side 3 times. Perform this exercise 2

times per day.

6.Levator Scapular Stretch 

LEVATOR scapular stretch

Sit up tall with good posture keeping shoulders down. Grasp the bottom of the seat with one hand. Slightly turn your chin toward your armpit until

a comfortable stretch is felt on the opposite side of the neck. Hold that position for 20 seconds. Repeat to each side 3 times. Perform this exercise

2 times per day.

7.Wall Push Up 

Wall Push Up

Start with feet approximately shoulder width apart. Place hands against wall slightly below shoulder level and elbows straight as shown in the

picture. Bend elbows while keeping head in a neutral position. Repeat 10 times with 1-2 sets. Perform this exercise 2 times per day

8.Prone Rows 


Lie on your stomach with your arms dangling off the side of the bed (try angling your body so your head is facing the corner of your bed). Use a

pillow under your stomach for comfort. Begin by pulling arms back while bending elbows and squeezing shoulders blades together then slowly

return to starting position. Do not lift head up while pulling arms back. Repeat 20 times. Perform 2 times per day.

*DO’S & DON’TS :-

Maintaining a good posture
Simple exercises to relieve pressure and strain on the structures within the neck – Gently stretch your neck from side to side or up and down
Maintain a good overall health and nutrition status
Don’t let stress levels get the better of you
Don’t roll your neck
Don’t bend your head to one side while talking on the phone
Don’t use hard pillows while sleeping

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