What I'd Actually Look At If You Walked In With Neck Pain (Hint: Not Your Posture)

About the Author: Hannah Breal, PT, DPT is the co-owner of Made 2 Move Physical Therapy in Charleston and Charlotte. She helps athletes and active adults rebuild strength, mobility, and confidence so they can move pain-free for life.

Made 2 Move Physical Therapy – Charleston | Daniel Island | Mount Pleasant | Charlotte

In Part 1 of this series, we talked about tech neck and how it's not the villain it's made out to be, AND that chasing perfect posture might actually be part of the problem!

If you missed it - catch up here!

So now I'm sure you're probably wondering...

Okay Hannah, then what would YOU look at if I walked in with neck pain?

WELL I'm glad you asked.

3 Things I'd Look At If You Walked In With Neck or Upper Back Pain Here's 3 things I'd look at if you walked into my office today with neck or upper back pain - instead of blaming your posture.

A Quick Disclaimer This is what I'd look at (in general) in an assessment. it's not a self-diagnosis checklist, and it's definitely not me telling you to go test your own neck at home. if you're in pain, you deserve an actual evaluation.

Also - of course I'd look at more than these 3... but there's a reason our evaluations are in person for 90 minutes (and not just via email!)

1. How Your Neck and Upper Back Actually MOVES

I need to see how much motion you have and how it feels.

That means we're looking at alllll the motions a healthy neck/spine should be able to do:

sidebending, flexion, rotation, extension

and because our spines are little bones stacked on top of each other - a restriction up the chain might affect something down the chain, and vice versa. we need it ALL to move well.

Getting Out of Movement Jail

BUT it is SUPER common for people with neck pain to be stuck in a stiff, super-upright position all day with their shoulder blades down and back (aka movement jail) Most likely because they've been told this is good for them - but then they start losing comfortable access to other ranges of motion - and what I said a milllllion times in Part 1 is our bodies like to MOVE. they get sad when we are stuck in one position all the time.

I think you'd be surprised with how much better you can feel just by restoring normal neck/upper back motion.

A lot of the time, this is where we start before anything else.

I just want to get your head, neck, and upper back moving MORE, more comfortably, and free from movement jail!!

2. Neck & Nerve Specific Tests

This bucket is me being a detective and trying to rule in/out specific things - we need to figure out what exactly is going on because "neck pain" and "neck pain with radiating symptoms" are two veryyy different stories, and they SHOULD get treated differently, especially early on

Doing neck specific tests will tell me what problems we actually need to solve.

I recently had a patient with neck pain AND nerve symptoms. because of what these tests told me, we had to be really conservative in the beginning and modify a LOT of her movements so we didn't further irritate her nerve symptoms.

If I would have skipped this step, not addressed the nerve issues, and just thrown her into "neck strengthening," I would've made things much angrier.

That is why the assessment matters SO much.

3. How Your Neck Responds to LOAD

Honestly this is the part most people never get to because they spend alllll their time in "feel good" land instead of "build it up" land your neck needs to be able to handle the demands of life, sport, exercise, etc, so we have to make sure it has the capacity it needs for that.

A few things I like to look at:

• weighted shrugs with your neck in different directions (I call these multidirectional shrugs)

• neck lifts / chin tucks (lying on your back AND being in an all 4's position, eventually a plank)

• upper body lifts like an overhead press or bent over row - a lot of people get neck pain after upper body movement-heavy days so I want to look at this

How your neck responds to load tells me what your baseline is compared to what it actually NEEDS to be

Just like testing a runner's knee against the demands of running.

It's all about:

What can you handle

versus

What do you need to be able to handle (without pain)

What Treatment Usually Looks Like

And then alllll of that (and more, because again - we do a LOT in 90 minutes) helps me decide what exactly it is that we need to do to fix this.

This obviously looks different for everyone, but the general order usually goes something like this:

Step 1. Calm It Down + Get Things Moving Normally Again

We gotta get your neck and upper back (the whole neighborhood!) moving again.

aka get you out of movement jail.

Again, you'd be surprised by how much this step matters, but we CANNOT get stuck here!

Step 2. Build It Upppp

Once things have calmed down and you're moving more/normally again, we need to add load to challenge and train your neck and the muscles around it and progress you back into the movements you were originally struggling with, without further pissing things off (the dosage + plan here matters a ton)

For my patient with neck pain AND nerve symptoms: in the beginning, we modified almost everything so that we could calm things down and move without further irritating the nerve symptoms. we weren't gonna get anywhere if we just kept pushing.

And now that her symptoms have dramatically improved, we're inching back into upper body and neck loaded movements - bent over rows, planks, shoulder taps, overhead press, neck lifts - things that actually challenge the muscles around the areas that were irritated.

The goal isn't just "less pain." the goal is to be able to do ALL the things you want to do, without pain, and without fear.

Neck Pain Is NOT Something You Just Have to Deal With Forever

SO if you have neck pain and you've been told it's just a part of your life, you're always going to have it, it's your posture, "something is wrong with your spine," or you're gonna have to stop doing some sort of exercise/movement...

Please believe me when I say this is NOT something you just have to deal with forever.

You deserve an actual assessment from someone who knows HOW to get you back to moving again without pain.

And if that's what you're looking for, you know where to find me!

Want to understand your body better, move with confidence, and stay active for life?

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Written by Hannah Breal, PT, DPT, Co-Owner of Made 2 Move Physical Therapy, helping Charleston and Charlotte move pain-free for life.