Category Archives for "Neck Pain"

Neck Extension Mobility “SNAG”

Today’s exercise will give you a pain-free way to regain mobility in your neck, particularly in neck extension (looking up). The goal of this exercise is to allow you to either maintain the mobility in your neck after you see your physiotherapist or when you find that the extension motion is limited. 1) Find the right spot. Locate the fold in the bottom of your neck when you look up. 2) Use the edge of an unrolled towel pulling towards the direction of your eyes. 3) This exercise has to be 100% pain-free so maintain the direction of pull with your towel during the motion. 4) Start by pulling the towel towards the level of your eyes. Sustain this pull and look up. 5) Complete this 3 times for 3-5 second holds daily. Remember, you should feel NO PAIN during this exercise. If you find it painful, try modifying the angle of pull to find a pain-free zone. If you cannot find a pain-free zone, then do not perform this exercise and contact your treating therapist. 

Neck Rotation Mobility “SNAG”

Today’s exercise will allow you to maintain mobility in your neck after treatment or regain your neck rotation range of motion. This exercise is a pain-free way to mobilize your neck. If you have any pain with rotation, especially at the end of your range of motion, this will be very helpful. This exercise can also be helpful in cases of cervicogenic headaches. 1) Find where the hairline ends to locate a noticeable “bump” or point on your neck. This is your C2 spinous process spot. 2) Place the edge of an unrolled towel over that point. 3) This exercise has to be 100% pain-free. If it is not, then the direction of your pull is slightly off or this exercise is not suitable for you so consult with your therapist before starting this exercise. 4) Cross your hands over, making sure the top hand is the same side of the direction you want to rotate towards. 5) If you are turning to the LEFT side, the RIGHT arm will pull the towel DOWNWARDS towards the middle of your chest and the LEFT arm will pull the towel roughly towards your LEFT eye. 6) To avoid losing contact with the towel, make sure it covers your face at all times. 7) Complete a pain-free rotation with a sustained towel pull, hold it at the end of the rotation for 3 seconds and return to your starting point. 8) Complete this exercise 3 times per day towards the direction of restriction.

Upper Fibre Trap Stretches

This stretch is for your uppers traps. You’re going to start by placing your hand firmly on the chair and the other hand above your ear on your head and you’re going to lean away holding onto the chair and looking down to the floor on the right side, the side that you are stretching. You’re going to hold this stretch for 30 seconds and do three sets and you’ll feel that right on the upper traps.

Levator Scapula Stretch

Start by reaching your hand down your spine while pointing the elbow to the ceiling. Bring your left hand over the head by the base of the skull. Next, look down and away from the right side and gently pull the right ear away from the right shoulder. Hold for 30 seconds 3 sets. This stretch is great to increase the mobility of the neck for Whip lash injuries sustained from motor vehicle accidents or sports injuries, or tight and imbalanced muscles in the shoulder complex. 

Neck Core Stability Strength

This exercise strengthens core stability muscles of the neck. Lying down with your knees bent place a small towel behind the arch of the neck. Next, press the tip of the tongue up against the roof of the mouth and do a chin nod. It will feel like you are giving your self a double chin. Then pivoting off the towel, slightly lift the head off the mat while keeping the lower back flat. Next, bring your arms up while keeping the chin nod engaged and the lower back flat. With your fists shoulder width apart slowly bring them apart even more for another for 5 seconds and then take 5 seconds to slowly bring them back up to the start position again. Do 15 repetitions of this for 3 sets. This is great for neck injuries such as whiplash, acute and chronic neck strains and headaches caused from neck injuries.

Sitting Cat Stretch

This exercise stretches the upper back and rhomboid muscles as well as to increase mobility in the shoulder blades & upper back. Begin by engaging your inner core stability below your belly button. Then keeping the head up and chin slightly tucked, clasp your fingers together and reach forward and slight down arching the upper back. Hold for 30 secs, repeat 3 sets 3-4 times daily. This stretch is great to do if you are sitting down on your computer working all day, standing or doing a lot of repetitive lifting where your shoulders, upper back and neck are tight, stiff and sore.

Cat Stretch

This is the cat stretch for mid back. Start on your hands and knees both shoulder width apart. Keep your head up and your chin gently tucked with your inner core engaged below the belly button. If you have wrist pain then alternatively, you can go on your fists to support your body weight. Then arch your mid back towards the ceiling like a cat making your shoulder blades wide! Hold for 30 seconds and do 3 sets twice per day. This exercise is great for increasing mobility in the upper back, neck, stretching the Rhomboids and muscles of the neck & spine after injuries such as whiplash, neck, shoulder and mid and low back strains.

Wry Neck (Non Traumatic Neck Injury)

What is it?

Have you ever woken up with a sore or stiff neck because you slept on it funny? Have you ever done a prolonged activity such as driving, being on the computer or playing sports where you felt stiff or soreness in your neck afterwards? These kinds of injuries are usually non-traumatic in nature. It is commonly known as wry-neck or also referred to as “torticollis”, and is a condition in which muscle spasms occur from soreness and stiffness in the neck causing it to be out of alignment.[1]

What causes it?

Wry neck can occur due to the prolonged or sudden stretch of the neck for a few possible reasons. The shock absorbing cushion called the meniscoid structures within the zygoapophyseal joint of the neck vertebra can become blocked and jammed in its rest position, swelling and thickening of ligaments / capsules and the surround soft tissue around the joint(s), or a slow shift of the disc in the neck vertebra can all cause muscle spasms. Moreover, old injuries causing unstable joints, constant “self adjustments”, and hyperflexibility can all be contributing factors to developing wry neck.[1]

As well, it can also occur following an upper respiratory tract infection (mainly affecting children), which causes the lymph gland under the neck muscle to swell; this is known as “Grisel’s Syndrome”. Non-activity related causes of torticollis include neurological disorders or tumors.[1]

What to look for? (Signs and Symptoms)

There is usually a limitation of movement toward one side and the posture is slightly flexed away from the painful side. You can wake up with pain on one side initially which can then occur on both sides. Initially the pain can be localized but may later radiate to other areas in the neck, shoulders, arms, hands or fingers.[1] As well, you may experience a headache.


Using ice and resting your neck for the first 48 to 72 hours is the recommended first step. Swelling, pain and having the neck vertebra out of alignment can cause the joints to lose its normal range of motion. More over, the altered function of the neck causes imbalances such as muscle weakness and tightness to develop. Physiotherapy, through the use of manual therapy and specific exercises, has been shown to help in the restoration of the movement of the neck joints and the optimal functioning of the muscle imbalances that can occur.[2,3,4] The use of Intramuscular Stimulation (IMS) has also been shown to be beneficial in these types of neck injuries5. Overall, successful management of wry neck includes regaining joint mobility, muscle strength and flexibility, as well as retraining the coordinated movements.[2,3,4]

For more information about neck injuries please contact InSync Physio.

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  1. ^ Orthopaedic Division: Diploma of Advanced Orthopaedic Manual and Manipulative Physiotherapy. 2002; 45.
  2. ^ Gross AR, Hoving JL, Haines T, Goldsmith C, Kay T, Aker P et al. Manipulation and Mobilisation for Mechanical Neck Disorders. The Cochrane Library 2004; 4.
  3. ^ Magee DJ, Oborn-Barret E, Turner S, et al. A systematic overview of the effectiveness of physical therapy intervention on soft tissue neck injury following trauma. Physiotherapy Canada; (Spring): 111-130.
  4. ^ Kennedy C. Cervical Spine: Exercise interventions for the Cervical Spine. Ortho Div Review Nov 1998; 13-29.
  5. ^ Gunn C. The treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radicular Origin. 2nd Ed; 1996: 51-60.

Whiplash (Traumatic Neck Injury)

What is it?

Whiplash “Whiplash Associated Disorder (WAD)” occurs when a certain force is transmitted to the neck or “cervical spine”. Motor vehicle accidents, any sudden forceful movements of the neck, a fall causing impact on the head, or sports involving impact to the head can result in injury. Any acceleration and deceleration forces absorbed can cause damage to structures of the neck.[1]

A small amount of force can sometimes cause more significant injury than large amounts of sudden force. Reasons for this is largely due to the fact that the degree of damage depends on the amount of force involved as well as the direction of the force.[1]

Signs and Symptoms

Signs and Symptoms can occur immediately after impact or may take a day or two to develop.

Here is a scale to help you understand how whiplash signs and symptoms can be classified and how to grade its severity:[1]

Grade Signs and Symptoms
0 No complaints about the neck
1 Stiffness, pain or tenderness only
2 Stiffness, pain, increased soreness, loss in mobility
3 Stiffness, pain soreness, loss in mobility, Neurological Signs of weakness in shoulder, arm or hand(s), pain or loss in sensation in shoulder, arm, hand(s)
4 Stiffness, pain soreness, loss in mobility, Neurological Signs of weakness in shoulder, arm or hand(s), pain or loss in sensation in shoulder, arm, hand(s), AND Fracture or dislocation
Note Symptoms and disorders that can occur in all grades, but are not limited to: deafness, dizziness, ringing in ears, memory loss, difficulty with swallowing, and jaw pain (TMJ)
Treatment and Management For Whiplash

*** If you are experiencing symptoms that are similar to either grade 3 or grade 4 whiplash it is highly recommended that you see a doctor immediately. Radiology must confirm grade 4 classifications WAD.[3]

For grades 1-3 whiplash, immediately following your injury apply ice for 10 to 15 minutes every hour for the first 3 days. Early physiotherapy intervention using manual therapy to guide soft tissue and joint movements, therapeutic ultrasound, electrical stimulation, and specific home exercises are very effective.[2,4,5] Dry Needling intramuscular stimulation (IMS) is also effective in controlling pain and reducing muscle spasms and promoting therapeutic increase in mobility.[6] After the first few days and beyond if your function in activities and perhaps even sport participation increases it is important to continue to achieve functional mobility and strength of injured segments.[2,3,4,5] Progressive techniques using manual therapy, massage and specific home exercises and postural education is very effective to achieve this.[2,4] Dry needling (IMS) can also help to progress with your recovery.[6]

Full functional recovery from Whiplash can take anywhere from 6 weeks up to 12 weeks or longer depending on the severity and nature of the injury. As you begin to recover and resume certain activities, and even participation in sports within the first 2- 3 weeks, your joints, ligaments, and muscles are still healing.[1,4] By regaining joint mobility, strengthening muscles and retraining the coordinated movements of injured areas you will get back “InSync” to your active lifestyle.

For more information about neck injuries please contact InSync Physio.

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  1. ^ Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine 1995; 20(8 Suppl): 1S-73S.
  2. ^ Gross AR, Hoving JL, Haines T, Goldsmith C, Kay T, Aker P et al. Manipulation and Mobilisation for Mechanical Neck Disorders. The Cochrane Library 2004; 4.
  3. ^ Magee DJ, Oborn-Barret E, Turner S, et al. A systematic overview of the effectiveness of physical therapy intervention on soft tissue neck injury following trauma. Physiotherapy Canada; (Spring): 111-130.
  4. ^ Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine 2003; 28(22): 2491-2498.
  5. ^ Verhagen AP, Scholten-Peeters GGM, de Bie RA, Bierma-Zeinstra SMA. Conservative treatments for whiplash. The Cochrane Library 2004; 4.
  6. ^ Gunn C. The treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radicular Origin. 2nd Ed; 1996: 51-60.

What is whiplash?

Whiplash of the cervical spine or neck is common among patients who have been involved in rear-end motor vehicle collisions, and also can also affect those who participate in contact sports such as rugby and football, or those who have experienced other physical trauma affecting the neck.

The most common cause of whiplash injury happens in response to a rear-end vechicle collision. As such, most studies that have been conducted have simulated a rear-end vehicle collision. During the collision, the spine of the person(s) being hit behave much like a cracking whip in the way that the spine moves in response to the sudden force. At impact, the torso continues to travel forward towards the steering wheel. The chin tucks downward and the skull travels backwards, causing an almost ripple-like motion through the spine, towards the head. That is a lot of different directions for your body to be trying to go all at one time. This movement causes the normal curvature of the cervical spine or neck, which is usually slightly convex to become more concave in shape. The sudden force pushes the spinal vertebrae into a sudden and unnatural alignment. This in turn causes surrounding muscles to tense up to try to stabilize the neck, which can cause muscle strain. The ligaments and discs in the neck can also be affected from the force.

Symptoms of whiplash may be delayed. Generally, you may experience the following as a result of a whiplash injury:

* Neck pain and stiffness
* Headaches
* Pain in and around the shoulder joint or between the shoulder blades
* Low back pain
* Pain or numbness in the arms/hands
* Dizziness
* Difficulty concentrating or remembering or irritability or sleep disturbances (concussion symptoms)

Whiplash injuries are assessed and graded due to the severity of symptoms. Further information regarding severity and the grading scale can be found here on our website.

Since whiplash injuries can involve a variety of tissues and can differ greatly from one person to the next based on the exact mechanisms (e.g. amount of force, direction of force, pre-existing conditions, speed of the vehicle or vehicles in question, etc.), there is no single way to treat a whiplash injury. The best thing you can do is visit your doctor or physiotherapist to assess the injury and work with you to build a treatment plan that is specific to you. We treat many whiplash injuries at Insync Physiotherapy and do accept ICBC claims. We would love to meet you and work with you to get you back to feeling your best.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.