Physiotherapy · Cervical spine
Neck Pain: Causes, Types and How Physiotherapy Helps
Neck pain affects 70% of the population at some point in their lives and is the second most common reason for a musculoskeletal consultation after lower back pain. The vast majority of cases resolve well with an active approach — without indefinite rest or long-term medication.
The neck is one of the most demanding structures in the human body. It supports the weight of the head — between 4 and 6 kg in a neutral position, and up to 27 kg when tilted forward — while maintaining a wide range of movement across multiple planes. This combination of load and mobility makes it especially vulnerable when factors overload it: many hours in front of a screen, a sustained tense posture, prolonged stress or a sudden movement.
The good news is that the vast majority of neck pain cases have a benign musculoskeletal origin and respond very well to conservative physiotherapy treatment. The key is correctly identifying the type of pain and acting with the right approach from the outset.
Why does the neck hurt?
The cervical spine is made up of seven vertebrae — C1 to C7 — which house the spinal cord and give rise to the nerves that supply the arms, head and part of the thorax. The structures most frequently generating pain are the cervical muscles and fascia, the intervertebral discs, the facet joints and the supporting ligaments.
Most common causes
Muscle overload from sustained posture, sedentary lifestyle, accumulated stress, sudden movement or trauma such as whiplash.
Typical profile
People aged 30 to 55 with office or computer-based work. Also frequent in people who use their phone a lot with the neck bent forward.
If you ignore it
An acute episode may resolve on its own, but the risk of recurrence is high. Early treatment significantly reduces that risk.
Types of neck pain
Not all neck pain is the same. Distinguishing between the different types has a direct impact on treatment choice:
Non-specific mechanical neck pain
This is the most common type, accounting for 85–90% of cases. The pain is of muscular or joint origin, without an identifiable structural cause. It typically worsens with certain movements or sustained postures and improves with moderate movement. This is what is commonly known as a "neck strain" or "stiff neck". It responds very well to active physiotherapy.
Neck pain with a disc component or radiculopathy
When a cervical disc herniation or protrusion irritates a nerve root, the pain can radiate towards the shoulder, arm or hand — accompanied by tingling, numbness or loss of strength. This is sometimes called "arm sciatica". Physiotherapy is also the first-line treatment in these cases, unless there are serious neurological deficits.
Cervicogenic headache: when the neck causes head pain
Some headaches originate from cervical structures: the C0-C1-C2 joints and the suboccipital muscles can refer pain to the head, mimicking a migraine or tension headache. Cervicogenic headache responds specifically to manual physiotherapy treatment of the upper cervical spine.
Warning signs requiring urgent medical evaluation: sudden intense neck pain without prior trauma, loss of strength or sensation in the arms, difficulty walking or coordinating movements, loss of bladder or bowel control, fever, or pain that does not improve with rest and appears at night. If you have any of these symptoms, go to A&E before starting any treatment.
What to do when neck pain appears
The first reaction to an acute episode is usually to put on a cervical collar and rest. However, the scientific evidence is clear on this point: prolonged rest and immobilisation worsen the prognosis. What actually helps in the first 24–72 hours is:
- Stay active within the limits that pain allows. Avoid movements that clearly aggravate the pain, but without immobilising yourself.
- Local heat on the area for 15–20 minutes can ease muscle tension and reduce pain.
- Avoid a cervical collar unless expressly indicated by a doctor — it is only indicated in traumas with suspected fracture or instability.
- Consult a physiotherapist if pain does not improve within 48 hours or limits basic activities such as driving, working or sleeping.
«Early guided movement is the most effective intervention for acute neck pain. Prolonged rest delays recovery and increases the risk of the pain becoming chronic.»
— Childs et al., Clinical Practice Guidelines, JOSPT 2008 (updated 2023)How physiotherapy addresses neck pain
The goal of physiotherapy is not only to relieve pain in the short term: it is to understand why it appeared and give the patient the tools to prevent it from returning. Treatment is structured according to the phase of the process and the individual characteristics of each person.
Cervical manual therapy
Joint mobilisation and manipulation techniques, deep tissue massage, neurodynamic techniques and myofascial release have solid evidence for reducing pain and restoring cervical mobility in the acute and subacute phases. At Fisioin20, we combine these techniques with a global movement assessment to identify the patterns that contributed to the injury.
Therapeutic exercise: the cornerstone of recovery
The deep cervical flexor muscles — especially the longus colli and longus capitis — act as active stabilisers of the cervical spine. When they are weak or poorly coordinated, the load is distributed inadequately and pain appears or persists. The exercise programme for neck pain is designed progressively:
- 1Deep flexor muscle activation
The first step is re-establishing motor control of the deep cervical flexors, which tend to be inhibited after a pain episode. Worked with gentle retraction and cervical nod exercises at minimal load, before progressing to more demanding positions.
- 2Motor control and cervical stabilisation
Exercises that train coordination between the deep and superficial cervical musculature, and between the neck and the shoulder girdle. Weakness of the scapular musculature — trapezius, serratus anterior — is one of the most frequent factors in chronic neck pain.
- 3Progressive strengthening
Rows, pull-downs, press and pushing exercises integrate cervical and scapular strength into real movement patterns. This phase is key to preventing recurrence in people with sedentary work or those who do high-impact physical activities.
- 4Return to activity and sport
The final phase adapts training to the usual activity level: from working without pain at a computer to returning to swimming, tennis or martial arts without fear of relapse.
Indiba Activ for neck pain
High-power Indiba Activ radiofrequency accelerates tissue recovery processes, reduces muscle tension and decreases neck pain immediately in many patients. We routinely combine it with manual therapy and therapeutic exercise to shorten the acute phase and enable faster progress.
Neck pain and computer work: the most common factor
In the Salamanca district of Madrid — with a high proportion of professionals with office-based work — neck pain related to prolonged computer use is by far the most common reason for consultation. Hours with the neck flexed forward, shoulders raised from tension and a poorly positioned screen create cumulative overload that ends in pain.
Treatment in these cases cannot be limited to relieving the acute episode: the postural pattern must be corrected, the supporting musculature strengthened and, often, workstation ergonomics reviewed. Without those changes, the neck pain comes back.
How to prevent recurrence
Every 45–60 min of screen time, 2–3 min of cervical mobility and a change of posture.
Monitor at eye level, keyboard that allows elbows at 90° and relaxed shoulders.
2–3 weekly sessions of rows and scapular retraction exercises reduce the load on the neck.
Chronic stress increases cervical muscle and trapezius tension. Sleeping well matters as much as exercise.
Using your phone lying down with the neck in sustained flexion is one of the most frequent factors in nocturnal neck pain.
The pillow should keep the neck in a neutral position — neither too high nor too low for your sleeping position.
When should you see a physiotherapist for neck pain?
Don't wait until neck pain stops you turning your head. Early intervention — in the first days of the acute episode — reduces recovery time and the probability that the pain becomes chronic. Consult your physiotherapist if:
- Pain persists for more than 48–72 hours without improvement
- You have difficulty sleeping, driving or working because of the pain
- You notice tingling, numbness or loss of strength in the arm or hand
- You have had several episodes of neck pain in the past year
- The pain is accompanied by frequent headaches
Neck pain that won't go away?
Book your assessment at Fisioin20 — specialist physiotherapy in the Salamanca district, Madrid. We can see you same day or next day.
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