Active Physical Therapy for Neck Pain

When treating neck pain, the primary focus of physical therapy is to improve the neck’s strength and flexibility. These goals are best achieved through active exercises designed to work the neck and surrounding muscles, gradually increasing the workload over time. The type and amount of exercises can vary, and sometimes exercises are included to work other areas of the body as well.

Types of Active Physical Therapy

Some common types of active physical therapy for neck pain include:

Neck stretches and exercises

Numerous stretches and exercises may be prescribed to train the muscles that attach directly to the cervical spine. The most common example is the chin tuck, which involves looking forward (not up or down), then gently pulling the chin straight back.

See Neck Stretches and Neck Strengthening Exercises

Core and back strengthening

If physical therapy is recommended to improve neck strength and functioning, it is likely that the back and core muscles around the trunk also would benefit from strengthening. In addition, these muscle groups all work together to support the spine and contribute to improving posture.

See Core Body Strength Exercises

Aerobic activity

This type of exercise elevates blood flow and breathing levels as the heart and lungs work harder for the duration of the workout. Some common examples of low-impact aerobic activities, which do not jostle the spine, include cycling on an upright or reclined bike, swimming using a mask and snorkel to eliminate neck rotation, and brisk walking.

See Low-Impact Aerobic Exercise

Aquatic exercise

Some exercises can be performed in a pool. The buoyancy of the water can help take pressure off the spine while still allowing the muscles to work. If neck pain is severe or accompanied by shoulder and/or back pain, aquatic exercise might be recommended.

See Water Therapy Exercise Program

These types of active physical therapy, as well as others, can be combined or used at different phases of the treatment plan, depending on the patient’s specific therapy goals.

Potential Risks or Complications of Active Physical Therapy

An active physical therapy program under the guidance of a licensed physical therapist or other certified medical professional is typically safe, but it is not without risks. Some potential risks and complications to know about include:

• Pain and/or stiffness may initially worsen. It is normal for muscles to develop some soreness and swelling after beginning a new exercise routine. Starting a new physical therapy program slowly and then gradually increasing the workouts in following sessions can help mitigate the pain and stiffness.
• Improper technique may worsen injury or cause a new one. Performing exercises the wrong way can potentially lead to injury by overloading joints and/or soft tissues. Care must be taken to perform the exercises exactly as directed.
• Continuing treatment can be difficult. It is common for people to quit physical therapy too soon. For example, a treatment program might be planned for 2 months, but if the person becomes discouraged and quits after 1 month, the increased strength, flexibility, and healing that might have been achieved after the second month cannot be reached. If the time commitment involved with physical therapy is a potential challenge, it may help to set up a regular schedule for physical therapy sessions in advance, or work with a physical therapist to learn exercises that can be done at home with fewer in-office appointments.
• An undetected medical condition may continue to worsen. If a serious underlying medical condition, such as cancer, is causing the neck pain but has not been diagnosed, physical therapy cannot work and could lead to a dangerous delay in seeking an effective treatment.

Performing active physical therapy should not feel unusually uncomfortable or increase pain while doing the exercises. Any exercise that causes pain should be discontinued immediately. In some cases, an exercise can be resumed at a later date if more healing has occurred or a medical professional gives the OK.

Continuing Exercises After Physical Therapy Ends

Whenever a physical therapy program involves building strength and mobility in any area of the body, such as the neck, it usually requires continuing some type of maintenance program at home after the formal physical therapy ends. For example, if years of poor posture led to the current neck pain, several weeks of physical therapy may help eliminate the pain but home exercises and lifestyle changes for good posture must be maintained to prevent the pain from coming back.

See How Poor Posture Causes Neck Pain