Neck pain is a very common symptom and one for which many people consult a physiotherapist. Initially in the subjective examination the physio will want to know how the pain came on and how long ago. Some people can recall a particular event such as cricking their neck or injuring themselves in some way, but many neck pains come on gradually with no precipitating factor.

The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be a joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.

Many diseases and conditions could mimic neck, shoulder or arm pain so physios exclude serious underlying conditions by checking the patient's medical history, how well they sleep, any change in their appetite or weight, control of their bladder and bowel function, general health and use of drugs. Once cleared the physiotherapist will start the examination by looking at the postural shape of the cervical spine, trunk, arms and shoulders. Typical poor posture is a slumped trunk, poking head and round shoulders, often seen at a computer and which leads to problems.

Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physio understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.

Manual palpation of the neck is an advanced skill shared by manual therapists and gives information about the more defined location of the neck lesion. The physio will lie the person on their front and press down gently on each spinal level from the high neck down to the upper thoracic levels. By palpating the central bony processes and the small joints at the sides the physio hopes to bring on the patient's symptoms by pressing on a specific structure, pointing to the guilty structure.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Other treatment techniques commonly employed by physiotherapists are strengthening exercises for the deep neck flexor muscles, generalized exercise to get fitter, neural exercises to ease nerve related problems, mobilization of the thoracic spine, postural correction and pacing activities to prevent overdoing one position or function for too long at one time. In severe cases of nerve root pain in the arm, which is similar to sciatica in the leg, manual traction of the neck may be used to reduce the pressure around the sensitive nerve or autotraction kits can be used, allowing patients to give themselves traction regularly.