Chances are if you are reading this, either you or a loved one is suffering from neck pain or any of the many things that could be a neck issue in disguise. This could be migraines, tension headaches, TMJ(jaw pain), and even dizziness, shoulder pain, or nerve issues like carpal tunnel or ulnar nerve neuropathy.  These conditions can be all consuming.

It can be impossible to find a comfortable position to sit, stand, or sleep let alone try to make it through the day. 

It often feels like it will never go away(at least that’s how I felt when dealing with it). Though each morning you wake up hoping that today will be different. 

There are so, so many voices giving advice, often contradicting each other. 

Is it posture? Is something out of place? Where’s the best place to take care of the issue? Do I need imaging? What’s really going on? 

Hopefully this guide will help you start to figure out the right answer for you. 

In addition to this guide, we are publishing 4 articles in our series, use these links to learn more about: 

How Migraines are often Neck Headaches in Disguise

Treating the cause of TMJ without Thousands in bite guards, splints, or orthodontists(coming soon)

Better than Botox? Dry Needling is a Natural Solution for Headaches and Trigger Points

When Shoulder Pain is Really Neck Pain in Disguise

Reproduction ethos: Feel free to share this E-Book with family, friends, enemies, or all three. It would be less cool to copy it and pass it off as your own. 

I make every effort to ensure that we accurately represent the injury advice and prognosis displayed throughout this book. However, examples of injuries and their prognosis are based on typical representations of those injuries that I commonly see in my physiotherapy clinic. The information given is not intended as representations of every individual’s potential injury. As with any injury, each person’s symptoms can vary widely and each person’s recovery from injury can also vary depending upon background, genetics, previous medical history, application of exercises, posture, motivation to follow your physio’s advice and various other physical factors. It is impossible to give a 100% complete accurate diagnosis and prognosis without a thorough physical examination and likewise the advice given for management of an injury cannot be deemed fully accurate in the absence of this examination from me as a Doctor of Physical Therapy at Body Mechanics Physiotherapy and Fitness, LLC. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this e-book and no treatment relationship is implied by this book. 

When Neck Pain Might Be an Emergency

I want to start this book off with who this book is not for. The following are examples, though not exhaustive, of when you should not wait for a consult with a Physio or Physical Therapist but should rather seek urgent medical care. 

FAST: Face drooping, arm weakness, slurred speech. Time to go to the ER. Sudden, crushing headache-Think of a thunderclap-especially after a trauma, no matter how small-Go to the ER. 

If you are experiencing increasing clumsiness to your hands or are noting what seems to be a power outage(drop attack), no matter how minor to your legs. 

If you notice a change to your ability to control (think starting/stopping) going to the bathroom. 

If you get an electric shock to your spine when you bend your neck. 

If you are experiencing any of the above, please don’t continue reading. Once you have the all clear from your Physician, then read on. 

This guide’s goal is to help you understand not only what’s going on when you’re dealing with neck pain, headaches, jaw pain, and arm issues but also to be empowered in making decisions to find the relief you’re looking for. 

The Purpose of Pain is Protection: Understanding Neck Pain

The question most everybody really wants to know is “Why am I in pain?”. Before about 2000, our understanding of pain was very different than it is today. We used to think that pain is all about damage. And, the more the pain, the more damage you had. This was often supported by imaging, especially MRIs where they could “see why you hurt”. 

But soon doctors and researchers started noticing something. Degenerative disc disease(DDD), bulging and herniated discs, stenosis, arthritis and scoliosis were found in people with absolutely no pain. What’s more, the older you got, the more likely you were to have these findings. 

On top of that, as people got older, fewer reported neck pain to their doctors i.e. the number of older people with neck pain was actually smaller than the number of younger people. In fact, the number of people suffering from neck pain peaks around age 50 and it goes down after that. 

This doesn’t mean that older people don’t get neck pain, it just means that age does not matter as much as what we once thought. . 

So, if neck pain isn’t just about discs and arthritis, what is it about? 

Your body has a living alarm system called your nervous system. While some parts of your nervous system focus on movement, some parts focus on seeing or hearing things, one part focuses on keeping you safe. Its job is to notice anything that seems dangerous and let the rest of you know about it. 

While their fancy name is a nociceptor, I prefer to call it our “danger detector”.  This danger detector wakes up when it is stretched, pressured, or has something happen really close to it. This can come from actual damage(think stepping on a nail or spraining your ankle), moving awkwardly and pulling a muscle, or from inflammation(which comes from your immune system). 

This lets the rest of your nervous system know that something dangerous might have just happened. What it doesn’t do is let you know that the body part is in pain…just possibly in danger. Our alarm system can also get tricked that there’s a threat(more on that in a bit) 

The rest of our nervous system including our spinal cord and brain now have to figure out just how dangerous the alarm is.  To do this, it figures out if pain actually helps you. For example, if you are walking across Thomasville Rd and you sprain your ankle…and there’s somebody driving right at you(texting) your nervous system says that the car is the bigger danger and actually shuts down the ankles danger signal so you can run and get out of the way(then it allows you to feel pain once the threat is gone).

There’s a lot of cool neuroscience going on with this.  Long story short, your brain and spinal cord have ways of shutting down the message about the ankle(or any other part of your body that’s in danger) if there’s a greater danger. 

For somebody dealing with chronic neck pain, the brain and spinal cord can also amplify the signal coming in because they are convinced that the neck really needs protecting.  This spinal amplifier makes it so that even small movements become excruciating because it creates a protective bubble around your spine to keep you from getting anywhere close to damage. 

In fact, pain’s job is to keep you from getting to damage. It acts like a fence along the edge of a cliff. Usually this fence is right along the edge. With chronic pain, the fence moves back 20-30 feet or more so you are nowhere close to danger(but it still hurts). 

What’s more, several things can either move the fence closer or further away from the “cliff” meaning some days your pain is aggravated by 30 minutes of sitting while other days you just can’t get comfortable even with just a few minutes. 

Why? Your alarm system and danger detectors have several sensors on them to let them “know about the world around them”. These sensors get triggered by several things. You have sensors for temperature change, stress chemicals, immune system activation(like when you’re sick), pressure, and blood flow. 

This is why:

Cold fronts flare your neck pain

Stress makes it worse

Sitting for too long makes it worse or go into your arm, creep over your head, or get you to start clenching your jaw. 

If you get sick, everything seems to hurt or if you have an auto-immune condition your symptoms seem to flare when it does. 

What’s more is that some days the pain seems to be worse in your arm or hand, other days in your shoulder, some days it even jumps to the other side of your body and goes down the other shoulder and arm. There doesn’t seem to be any pattern, rhyme, or reason. 

But, when my patients tell me that their pain changes from day to day, hour to hour, or even from minute to minute, I can confidently say that the changeability of their pain is the best thing they could have told me. 

Why?

Because the past 25 years of research into pain show that your MRI doesn’t look different on a good day as compared to a bad day. Your X-ray doesn’t look different on a good day as compared to a bad day. What changes is how protective your alarm system is that day. 

One example. Think about what would happen if you stepped on a nail. You’d have this piercing pain which would make you stop, pull the nail out, and take care of it, right? Your alarm system doesn’t immediately go back to normal. It stays extra-protective for days just to make sure you don’t go stepping on any more nails or do anything dangerous with your feet. But…it eventually calms down. 

And for many people with neck pain, their spine does the same thing. They pull a muscle, cause a disc bulge, get some inflammation but it eventually calms down and they are OK. 

But

The truth is that for a lot of people, their alarm system never calms down(for lots of different reasons). Even though their spine has likely healed(Research alert: Herniate a disc today and in 3 months 50% healed, 6 months 75% to 100% healed).

It isn’t their fault

Many were told to

“Take 6 weeks off and rest their neck”

“Take some medications or steroids and if it hasn’t gone away we’ll talk about surgery”

“That they have to “fail” physical therapy before they can get an MRI”

“They’ve got “bad posture” or a “weak core””

Unfortunately, if we just rest or take time away from exercising, we just come back weaker and able to do less and less

If we just take medications, we’re just putting a band-aid on it. 

If the doctor tells you that you have to fail therapy in order to get what they think is the right answer…you were set up to fail. 

Posture experts can’t even agree on what the right posture is and the core feels weak because of the pain(see the myths section). 

Understanding Imaging

If you look up issues surrounding your spine on Dr. Google or Chat, you may notice that the results that jump to the top of the search are usually the worst case scenarios full of scary images of disks and angry red nerves etc… 

What you also may notice is an abundance of information telling you how fragile your spine is and how you need protection from life if you want to be able to do something as simple as walk. 

The simple truth is that the spine is remarkably strong, even when you are in pain. Ever rolled your ankle or skinned your knee?  It heals, right? One of the things we understand about the spine is that it heals too. 

 So, a little bit about how you are built. Your spine is made of 5 different sections. 

Your neck is known as your cervical spine. It has 7 levels.  If you’ve had a neck MRI they may say things like C6-7 or C7-T1. This refers to the space between the bones where the nerves come off the spinal cord.  

Your mid back your thoracic spine  It has 12 levels and is what helps you twist your torso. 

Your low back is the lumbar spine and it has 5 levels(though some will have 4 and some people will have 6 levels). 

The part or your spine at your pelvis is your sacrum and coccyx and SIJ(the Sacroiliac joint).

What most pictures don’t show is that on top of these bones is a lot of really strong connectors (ligaments, fascia, muscles). On top of that is, of course, your skin. Each one of those can contribute when we have neck pain. But, more on the make up your spine. 

The Cervical Spine(or neck) is made up of usually 7 segments (sometimes 8) called vertebrae. In between is the disk which allows for you to bend, twist, and do all the things you want to do and it serves as a bit of a shock absorber. 

In addition, there are two other joints on either side called the facet joints.

Each one of those can be sensitive and be an input to your pain.

On top of those, the muscles serve like the rigging on the mast of a ship-some resisting you going forward, some to the side, and some resisting going backwards. In your low back, those muscles are known as your core. You can think of it as a box with your diaphragm at the top (your breathing muscle), your abs in the front, your low back muscles, and your pelvic floor muscles on the bottom. In your neck, you have your trapezius(you see this on top of your shoulders and it attaches to your back of your head-and it usually has tight knots), around the front, you’ve got a bunch of tiny muscles, some cause trouble, some don’t and these are often tight and responsible for a lot of TMJ issues. 

In addition, if you’re dealing with a rounded mid-back or Thoracic spine, you automatically make your neck work harder in order to support your head’s weight

Off the back of your head is the “headache fusebox” which is a series of muscles that overlay several nerves going to the top of your head. If you want to see them, look up Suboccipital Triangle or visit the headache article

All of these work together to help you do all the stuff you want to do. In many people, they are strong enough to do everyday activities. In fact, the myth of the “weak core” is one of the most disabling myths out there. But before that, let’s cover some terms you might see in your X-ray or MRI and what they mean for you. 

What is Degenerative Disc Disease or DDD: When we first started using MRIs to look at the spine, they noticed that some discs were narrower than others. This loss of height along with it having less fluid in it caused radiologists to give it a name, degenerative disc disease. With a name like that, it is implied that your disc is falling apart and is only going to get worse. The truth is that you’ll find DDD in nearly everybody as they get older(68% of 40 year olds have degenerative disc disease, 80% of 50 year olds and 88% of 60 year olds), most of them are not in pain from it. In fact, this is a case of our wrinkles on the inside. 

What is Spondylosis: This is also known as facet arthritis. The facets are the tiny joints on either side of the spine that let you twist and bend. The arthritis that can develop in this joint is called spondylosis and is also found in many people without neck pain

What is Stenosis: This is basically a narrowing of the hole that your nerves exit the spinal cord through(unless it is called central canal stenosis-this is the hole your spinal cord travels through). As the discs lose height, this space narrows. For many, it never leads to any problems because we have a lot of space to begin with and so there is a lot of buffer before we ever have any symptoms. 

What is a Foramen: This is the hole that your nerves exit your spine through. You may see it on your radiologist report as foraminal stenosis which is just a narrowing of the hole. 

What are Nerve Roots: All of our movement and sensation is commanded or travels through our nerves. The nerve root is a structure where it is attached to the spinal cord. It often has a letter and a number that tells you what level it is.  On MRI reports, you’ll see it as a C1, C2, C3, C4, C5, C6, C7 or you may see a C0-C1(where the nerve goes between your skull and the top of the spine), C5-6 is often where symptoms start going into the shoulder while levels below can cause symptoms into the hand. 

What is a bulging disc: When somebody is talking about a bulging disc, often on an MRI you’ll see an area where part of the disc is sticking out and not straight up and down. It is the spines version of a sprained ankle in that there is often a lot of swelling about the disc which then makes the nerve root sensitive through the inflammation and pressure on it. 

Are bulging discs and herniated discs the same: While some refer to bulging discs and herniated discs interchangeably, others will refer to them relative to their size or whether some of the fluid in the disc has come out and is pressing on a nerve. Most of the time, with a disc bulge, the gel in the disc doesn’t come out while in a herniated disc it does. When the gel comes out it is called an extrusion(or extruded). You may see it referred to as a Herniated Nucleus Pulposis or HNP(the HNP is the gel part of the disc).

Are bulging discs and slipped discs the same?  Most people use these terms interchangeably. However, the disc is very well attached to the bones above and below the vertebrae. In addition, they are supported by muscles and ligaments surrounding them so they actually can’t slip in and out of place(even if it feels like it has gone out of place).  

What is an annular fissure: The disc has 2 main zones. The annulus fibrosus  is the outer tough skin of the disc. An annular fissure is when there is a tear or break in the annulus. 

What is spondylolisthesis: This is a condition where the spine has actually shifted. It is graded on a 1 through 4 grading scale with the grades getting bigger with a larger shift. It happens far less often than most other back conditions. 

Facts about MRIs and Neck Pain

The cervical spine (neck) shows some of the most surprising statistics in asymptomatic people. While we often think of "bulging discs" as a serious injury, in the neck, they are actually the statistical norm starting as early as your 20s.

The following data is primarily based on the landmark study by Nakashima et al. (2015), which performed MRIs on 1,211 healthy volunteers with no neck pain, and the Brinjikji et al. (2015) systematic review.

Age-Specific Prevalence of Asymptomatic Cervical Spine Findings (%)

Key Takeaways for the Neck

• The "Bulge" Paradox: Cervical disc bulges are significantly more common in young, healthy people than lumbar (lower back) bulges. Roughly 3 out of 4 people in their 20s have at least one bulging disc in their neck despite having zero pain.

• Spinal Cord Compression (SCC): While "compression of the cord" sounds terrifying, it is found in about 15% of healthy 60-year-olds. Clinicians usually only worry if this is paired with neurological symptoms (like balance issues or hand weakness).

• Foraminal Stenosis: This is the narrowing of the "exit holes" for the nerves. Notice the sharp jump between age 40 (20%) and age 70 (70%). This is highly related to normal bone remodeling as we age.

• The Most Affected Levels: In almost all asymptomatic subjects, the most common levels for these "abnormalities" are C5-C6 and C6-C7, which are the segments that handle the most mechanical stress.

Important Clinical Context: Because these findings are so nearly universal, the presence of a "bulging disc" on a neck MRI should almost never be used as the sole reason for surgery or intensive treatment. It is simply how the human neck ages.

Understanding Your Neck 

A little bit about the anatomy of your neck starting with the bones. Your neck is made up of 7 bones called vertebrae. Supporting it are an amazingly strong series of ligaments (connecting bones to bones), tendons (connecting muscles to bones), and fascia (the glue that holds it all together) as well as muscles that allow for it to be both amazingly mobile(think looking over your shoulder) and strong(holding up a head). 

From it come nerves that inform you on what is happening in your skin and controlling your muscles. They come from the top of your neck to go over your head and from the middle and bottom of your neck to your arms, upper back, and chest. Our nerves are also what sends the signal to your brain prompting it to pay attention to a part of your body. 

On a side note, coursing through both sides of those bones are also 2 arteries supplying blood to the back part of your brain. Your Physio may also assess how well those are doing especially if you are having severe headaches or are accompanied by dizziness. 

Remember those nerves coming off the top of your neck? There are 3 main ones and they can be aggravated by being squeezed by several muscles coming off the top of your neck. This is your headache fusebox and once it is tripped, these muscles squeeze the nerves which can cause headaches, TMJ issues, or even dizziness. 

If you have those tender spots between your shoulder blades, guess what, you can get those in every one of your muscles and there is a good chance that the muscles on the top of 

your neck attaching to the bottom of your skull have those knots that are putting the squeeze on your nerves kicking off yet another headache. 

This may have you locked in a pattern of taking some pills that barely work, resting and missing out on life again, and repeating that the next day. The cool thing is that by understanding pain and performing a few relatively simple exercises, you can tame that tiger and get back to life. 

Just as problems can arise in the top of your neck, they can also occur in the middle and bottom of your neck and affect not only your neck, but also your shoulders, arms, mid back, and hands. 

You may have heard of your brachial plexus. This is a bundle of nerves that course down the front of your neck and through your armpit on their way to your arm. 

It Isn't All in Your Head 

You know how this starts, maybe light seems a bit too bright or you are getting more sensitive to sound and you know it is time to find a dark quiet place to ride the storm out. This is what some people who experience migraines live through every day. 

Let’s return to the top of your neck for a minute. Do you experience headaches that cover an area on your head that occurs anywhere a hood could touch if you wearing a hoodie (think of an area from your forehead, up and over the top, and down the back)? This could be a sign that your migraine or headache isn’t coming from your head but rather your neck. 

Whether it is pain going towards your head or limiting your use of your arm, one of the main takeaways that I want you to know is that the longer you have had your pain, the more likely your pain is due to your nervous system being more sensitive (think of how easy it is to provoke your pain) than damage that is more significant than the kisses of time (which your MRI will say big words like spondylosis, stenosis, or arthritis). 

Posture Power 

Are you concerned about your posture or have you been encouraged to improve it? Posture is one of the biggest subjects to which we have almost no agreement as to what makes good posture. One of the big takeaways about posture that you need to know is that it, in and of itself, does not produce pain. It can, however, make certain areas more sensitive. If you have pain and you change position and it 

makes things better, chances are that it may be relevant to you. 

It can go the other way as well, the person who is stiff and very conscious about their posture can also make things more sensitive. Seems like you are danged if you do and danged if you don’t, right? One thing I want you to understand is that if you assume one position for a long time, eventually you develop some sensitivity either in your neck or your low back. We are built to move and motion is lotion. 

Just before this, those nerves exit on either side of your neck and can be affected by issues in the neck. If you have pain in your arm that moves up or down (one day it is in your shoulder, another time it spreads down to your elbow, then another time it is just the neck) it is likely you have something that is easily treatable with some gentle, hands on care combined with the right kind of exercises targeted at the source of your shoulder, arm, or hand pain, your neck. 

Key Point The Best Position Is The Next Position 

Facts about Neck Pain

Key Observations & Sex Differences

1. The "Reproductive Window" for Migraines

Migraine prevalence in women is roughly 2–3x higher than in men, particularly during the 20s and 30s. This is heavily linked to hormonal fluctuations. Interestingly, after menopause (60s+), the gap between men and women narrows significantly, though women still maintain higher rates.

2. Neck Pain Peaks Later

Unlike migraines, which peak in the 30s, Neck Pain tends to peak in the 50s and 60s. This aligns with the "Facet Degeneration" we saw in the imaging tables—by the time the joints show significant wear in your 50s, the likelihood of that wear becoming symptomatic is at its highest.

3. TMJ: The Young Adult Burden

Temporomandibular Joint (TMJ) disorders are unique because they often peak earlier than other musculoskeletal issues. The highest prevalence is found in women aged 18–44. Research suggests this is a combination of biological factors (estrogen receptors in the jaw joint) and psychosocial stressors (university and early career stages).

4. The "Headache" Umbrella

The "All Headaches" column includes Migraine, Tension-Type Headache (TTH), and Medication Overuse Headache. While TTH is more common than migraine, it is generally less disabling. By age 30, nearly 1 in 2 women and 1 in 3 men will have experienced a significant headache disorder in the past year.

Summary of the "Gender Gap"

• Neck Pain: Females are ~33% more likely to report symptoms.

• Headaches: Females are ~2x more likely to report symptoms.

• TMJ: Females have a ~1.75x greater likelihood of disorder.

Note on 2026 Trends: Recent data indicates a slight rise in neck pain and TMJ among younger cohorts (20s), likely due to increased sedentary "tech-neck" postures and the rising prevalence of bruxism (teeth grinding) related to global stress levels.

Neck Pain Myths

These days, it can be really hard to know what to believe when it comes to neck pain.

 Is it my age? 

Is something out of place? 

Do I need an MRI? 

Should I stretch it? 

Should I strengthen it? 

Is it my core????? 

The sad truth is that many of the things we once thought about neck pain, headaches, and more have gone the way of bigfoot, myths that are hard to shake. Heck, even AI will tell you to stretch your traps, strengthen your core, and “fix” your posture to get rid of neck pain but in this section, we’ll talk about what the science says about neck pain(and what to do about it)

Myth: You need an MRI or X-ray to “see what’s going on

Have you been told that you have changes on your x-ray or MRI? These usually go by the names of Degenerative Disc Disease, cervical Stenosis, bulging discs, herniated discs,  loss of lordosis, or too much of a curve in your spine. Often these words are tossed around pretty casually and usually not explained in any great detail...which then leads people to ask Professor Google what those words mean and guess what is top of the search rankings? A picture that looks like this. So, let’s break down some of the real meanings of these terms and what they tell us about our backs.

Degenerative Disc Disease...sounds bad, right? Makes you think that it is only going to get worse and that if it is a disease and it is in my neck...maybe it is the cause of the neck pain? What if I told you that it is neither degenerative or a disease? When we first started using MRIs, doctors coined this phrase to talk about changes that they saw in the spine, especially as somebody got older. What they didn’t know at the time was that those changes were also in people without any neck pain at all. In fact, some of those changes, in people who are pain free, can be found in people in their 20s. 

What’s more, when we target these discs with medical treatments, they often have no effect. I’ve even heard of doctors telling their patients that, because of what they saw on an MRI, that they have the spine of an 80 year old and that often stops their patient in their tracks because

...if it is degenerative…

and their spine is already that of an 80 year old…

they better play it safe and make sure they rest as much as possible and do only “safe” things…

Because when they wanted to lift or run, their back would hurt. When they did this, they created a self-fulfilling prophecy because now their support system for their spine got weaker and weaker until doing basic things would set off their neck pain. 

Unfortunately, this group is often shunted off to “pain management” and a lifetime of shots, dependency on medications, and ultimately surgeries...some of which the surgeons wouldn’t even have on themselves.

What about stenosis? This one often comes along with Degenerative Disc Disease. Did you know that the spine has a lot of space? And if the doctor sees some narrowing, more often than not, you still have enough free space in your spine to do just about anything(even if you may feel a bit stiffer when you start moving). In fact, for your nerves to move freely, you only need about ⅓ of the space available. 

What’s more, is that the older you are, the more likely you are to have this happening and not know it(because you didn’t have pain).

How about bulging discs? Did you know that they heal? Think of a bulging disc as the spine’s version of a rolled ankle. When you first roll it, it is red, swollen, and it hurts to move. But it heals, right? The spine is the same way. In fact, after about 3 months, the disc bulge is about 50% smaller than it was, at 6 months about 75% and finally at a year, it is fully reabsorbed as the body gets rid of the excess fluid. Some feel better long before full healing and many have chronic pain long after the spine has healed. What’s more, due to the way your back is wired(nerves), your pain may actually be coming from a level above or below where you have your disc bulge. 

Your insurance company is aware of this myth too because they see that an MRI is usually the pathway into more and more invasive procedures, shots, or dangerous painkillers. That is why they are having people go to the more effective and less expensive(how often to you see those together) of seeing a Physiotherapist first before going to do more invasive procedures.

Don’t get me wrong, MRI’s do have a role, especially if your Physician suspects something serious going on but as a Physio, I treat the person, not their picture. 

Myth: You hurt because something’s out of place

Did you know that it takes over 2000 pounds of force to stretch fascia(or the glue that holds you together) by 1%. 

Or that it takes over an hour with a hammer and chisel to separate an SI joint with 2 people on a cadaver(that’s not fighting back)? 

But yet, when we’re dealing with neck pain it can feel like something is out of place, like one level of your neck is “locked’ and needs to be put back in place

What we've understood for about the last 20 years about pain is that it has very little to do with positioning of the joints. So what is really happening when you hear all those pain relieving pops when you get an adjustment??? 

Or how about when those knots disappear after a massage? 

Or how about if you've been "shown" an X-ray with the "answers" as to why you hurt. Maybe you've "lost the curve in your neck". 

The simple truth is that when we get an adjustment or a massage, we give our joints, muscles, and especially nerves the three things they need to thrive. We give them movement, blood, and space. I don't mean that the adjustment somehow "opened" up anything or that you've now made your muscles longer or even "broken up scar tissue" unless you or your massage therapist or chiropractor is superhuman and  can move a ton with their bare hands.  

What they've really done is move your muscles, joints, or nerves in a certain way that "resets" your body's living alarm system i.e. your nerves. Unfortunately, without you doing the right kind of movement to reinforce this, your alarm system will often "trip" requiring another trip to the massage therapist or chiropractor and the cycle begins again.

This "reset" to your alarm system is why you feel more aligned, with better posture, and feel looser and with less pain after an adjustment or massage. This is a good thing in that it means that you are a rapid responder to the right kind of movement and that you have the ability to heal yourself and get back to running, lifting, and enjoying life. You just have to make sure for a short period of time to minimize the movements that provoke and feed your system the right movements. Have questions? Speak with a neck pain specialist for free. 

Myth: Rest is Best when it comes to pain

When it comes to neck pain, motion is lotion. Yes, the first day or 2(tops) after a neck injury, resting seems to help but if you’ve been resting greater than a couple of days, often this makes it worse and makes it last far longer than it should. Now the question comes, what movement should I do to deal with neck pain especially if everything hurts(especially turning your head or looking down). 

This is highly dependent on what causes it to spasm, ache, or have pain shooting down your arm or up and over the back of your head(neck headache). Often the best place to start is by laying on your back on your bed, often without a pillow under your head  and doing several gentle, slow breathing exercises. If you notice your pain goes down, gently push your head into the bed tucking your chin slightly.  If you notice no change-don’t worry, it could be that your spine wasn’t ready for that just yet(but checking in with a pain specialist like a physio wouldn’t be a bad idea to find out what would help). You can pick a time that works to get the help you deserve here.

Myth: You hurt because you’re getting older

Does this story sound familiar? I just recently was working with a 31 year old who had neck pain and was told by her doctor “You know, you’re getting older and neck pain is part of that”? The doctor didn’t stop there. This person is a runner and a mom who wanted to be active and be able to play with her kids and also get the stress relief that she got from running. 

But her neck pain made it so that she was not even able to bend over and lace up her shoes let alone make it out the door. But her doctor told her to “rest 6 weeks, take some anti-inflammatories, and maybe think about giving up running”. 

And this person wasn’t alone. 

I’ve heard this way too many times from 20 and 30 year olds. 

And if this wasn’t bad enough, once you reach your 40s and 50s, you’ll often be told you have the spine of an 80 year old.  

Often this is because they see on the MRI more “wrinkles” than they might have expected. But when we study when people actually report neck pain the most, it happens to be around 50 years old and the trend of neck pain actually goes down from there even though our spines keep showing more wrinkles on the inside the older we get. 

Myth: You hurt because you have a weak core

For about 20 years, from the late 90s there was a focus on the core as being the source of neck pain or better put, a weak core. Hence a focus on things like planks, sit ups, posture exercises, and more. Yet, even with a focus on strengthening, neck pain did not get better. Often the weakness was a result, not the cause of the neck pain. Often the body would limit how much power the core could produce because your alarm system wasn’t sure it was safe for you to tighten your abs.

Why Neck Pain Persists and becomes Chronic Pain

When people have been studied who have pain, at least 25% of them will have their pain become chronic(longer than 12 weeks). As of the writing of this, we aren’t quite sure why this 25% has their neck pain become chronic pain but there are a couple of things that make it more likely to happen. 

One of the first things to understand is that things other than new damage(or old damage) can contribute to pain. If you remember the sensors that I talked about on your alarm system earlier, this is where they contribute to pain(even when you’re resting and trying to not bother your back). 

So you don’t have to scroll back, these sensors are for stress, temperature change, immune system activation(like when you’re sick and fighting off an illness), pressure(like sitting), and blood flow(the nerve is compressed and not getting as much blood flow as it likes). 

One of the metaphors I use in the clinic when explaining pain is that of an overflowing cup. Imagine that everything you can handle is represented by a cup. There are things that can fill up your cup and when it overflows, you’re in pain. If you think about your pain over the last week or so, you might notice some trends.  If I’m under a lot of stress from work, family, expectations then my stress sensor on my danger detector will get poked(and with our cup metaphor, stress is filling up my cup). Or if I’m fighting an auto-immune condition or dealing with something like fibromyalgia now my immune system is filling up my cup as well. 

The cup might be nearly full and you haven’t even moved yet. And then you turn your head just a little bit and it is agony. Your cup just overflowed but other things filled it up. 

Now, if your pain has gone on a long time, your cup is steadily getting smaller and can handle less. So you try to do the right thing and exercise but the cup is so full that everything you do seems to set you back. 

So you rest some more and your cup gets even smaller. 

It is not your fault-and there is hope. 

Frequently Asked Questions: Neck Pain

1. Why is my neck pain not going away on its own?

It is common to hope neck pain will disappear "like magic," but waiting often makes the suffering worse. Many people mistake the initial injury (like lifting something heavy) as the cause, when the root issue is often decades of poor posture and weakened muscles. Without addressing these underlying causes, the pain is likely to persist or return.

2. My doctor told me to rest and take painkillers. Is this good advice?

While rest and medication are common suggestions, they are rarely the best long-term solutions. Painkillers often mask the problem rather than fixing it. Prolonged rest can actually lead to increased stiffness and weakness. Most patients find that once the medication wears off, the chronic pain returns because the root cause was never addressed.

3. Is neck  pain just a normal part of getting older?

No. While many people accept neck pain as an inevitable part of aging, it doesn't have to be. Accepting it as "normal" often prevents people from seeking the treatment they need to live a pain-free, active life.

4. Why didn’t my previous treatments (Chiropractic, Massage, or YouTube exercises) work?

• Chiropractic/PT: If the root cause wasn't identified, the relief may only be temporary.

• Massage: While it feels good in the moment, it often fails to provide a long-term fix for structural or muscular issues.

• YouTube Exercises: Exercises found online are not tailored to your specific condition and can sometimes make the pain worse if they aren't the right movements for your body.

5. What are the common reasons neck pain lasts longer than it should?

The text identifies 7 key reasons, including:

• Waiting too long to seek help.

• Relying on pills that only mask symptoms.

• Following generic advice to "just rest." Generic advice gets generic results

• Using "fixes" that only address the effects rather than the cause (like temporary massages).

6. How can physiotherapy help me avoid surgery or injections?

Physiotherapy focuses on finding the root cause of your pain through movement analysis. By using hands-on manual therapy and specific exercises to rebuild strength, many patients can eliminate the need for dangerous spinal surgeries or painful injections.

7. What can I do today to start feeling better?

1. Make a decision to get help: Don't wait weeks or months for the pain to worsen.

2. Avoid sitting for long periods: "The best position is the next position." Movement is key, especially if you feel stiff in the morning.

3. Perform the right exercises: Focus on movements that "turn off" the pain and rebuild strength (consult a professional to find which ones are right for you).

4. Seek hands-on therapy: Professional manual therapy is proven to help with stiffness and pain.

8. What specific results can I expect from treatment?

Patients typically experience:

• The ability to sleep through the night without tossing and turning.

• Ending reliance on daily pain medication.

• Returning to activities like golf, tennis, or running pain-free.

• The ability to walk or sit for long periods without the feeling that your the old familiar pain creeping up over your head, aching down your shoulders, or causing your teeth to grind. 

How to know if you are a “rapid responder” and Physiotherapy will help you?

5 things you can do today to ease neck pain(Start doing this)

Take a movement break-Sometimes it can be hard to just get up and go around the house or go for a walk when our neck is hurting but that is usually exactly what it needs. This is especially true if your pain improves after walking around the house. Key-fill up a 16 ounce water bottle and drink 1 per hour, that way you have to get up to go use the bathroom and this gives your spine some exercise.

Check your posture. If your pain improves when you move around, there is a good chance that your posture is contributing to the intensity and duration of your neck pain.

Plan for 7-8 hours of sleep per night. Did you know that lack of sleep increases the body's sensitivity the next day. It isn't just that we're grumpy or need 6 cups of coffee just to make it through the day but it also shuts down your body's natural painkillers, amps up the sensitivity of your sensors, and reduces your ability to move well.

Lumbar support-if changing your posture improves your neck pain then lumbar support is the next step for when we are sitting and get tired (because nobody can keep perfect posture all the time). I like the McKenzie Lumbar Roll or make your own by tightly rolling a bath towel at your body width (so fold it as wide as you are), roll it tight, then use a strip of painter's tape to hold it together. Place in the small of your back(but don't sit on it) and sit with your hips to the back of your chair.

See a Physiotherapist. If your pain gets worse or better (i.e. has any variability even from bad to worse) there is likely some pattern that a Physiotherapist can find in what you are doing then give you the exact treatment your back needs to kickstart the healing process while also reducing pain, helping you sleep better at night, improve mobility, and feel great.

Top 5 mistakes people make when dealing with neck pain(Stop doing this)

Just because something is considered a “treatment”, it does not necessarily mean that it’s in your best interest to try it.

This is especially true if you have not yet been accurately diagnosed by an expert physiotherapist.

Either way, if you have neck pain, I’d recommend avoiding these common treatment mistakes or risk further pain and injury.

Mistake #1 Prolonged Rest

I get it-resting and lying down seems to help but...there is a ton of evidence that prolonged resting is one of the worst things you can do to recover from your neck pain. It leads to

• Higher levels of pain and stiffness

• Reduced flexibility and muscle strength

• A slower(and often worse) recovery

• More time away from work

By performing gentle exercises and staying active, your pain will recover faster than just resting

Mistake # 2: Focusing too much on MRI or X-ray results

A common question we get is "Do I need an MRI" to "see what's going on". In most cases, an experienced Physiotherapist will be able to determine what is happening by having you move through a couple of simple tests. In addition, research shows that many people without neck  will have changes on their MRI or Xray which means they may not be the cause of your pain or require surgery. In addition, the results of the scan rarely change a Physiotherapists plan of care because often you can be helped to feel better with no change to how your spine looks on an MRI.

Mistake #3 Reliance on Medications

Painkillers may initially be helpful, however they are only masking the pain and not treating the cause of the problem. Long-term use of potentially harmful medications can create dependence and require you to take more for same effect while giving you unwanted side effects impacting on your quality of life. Recent studies show that many are no better than Tylenol. The best medicine we know is the right type of exercise and stretching.

Mistake #5 Waiting until it is too late

While it’s true that some types of neck pain can get better over a few weeks, don’t make the mistake of ignoring it for too long. This is especially true if you have recurrent episodes of acute neck pain as it is your body’s way of telling you something is wrong. It could be something simple, such as you're sitting or lifting posture, which could easily be addressed with some advice and a few exercises.

However, if you continue to ignore it, you risk significantly increasing the amount of time to heal, which will require multiple treatment sessions and time away from work, not to mention preventing you from doing the things in life you enjoy most. It is important to see an expert physiotherapist (as soon as you have neck pain) for an accurate diagnosis and so a treatment plan can be established

Confused about where to start? Book a call from the comfort of your home or office and  on your schedule with one of our Neck Pain Specialists. You can schedule your call here.  Need help now? Come by and talk with one of our Doctors of Physical Therapy at no charge. We offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.

Here are just a few of the things you will learn in one of our free consultation:

• What is the underlying cause of your pain? (hopefully nothing too serious!)

• Roughly, how long will it take to fix the problem?

• What to do to help – which doesn’t include painkillers, resting or surgery etc.

• What other, natural, drug free methods are there to speed up recovery alongside treatment?

Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.

If you’d like one of our limited free consultation sessions, please click here to schedule your free consultation or CALL us on 850-765-2779 to make a no-obligation enquiry.

About the Author

Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 23 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town.  He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.