Posts tagged neck pain
How Does Needle Depth Impact Treatment Effects From Dry Needling?

Dry needling is a treatment provided by Physical Therapists to relieve a patient’s muscular pain and associated symptoms. This intervention can be performed in both extremity and spinal regions within the body. Current research continues to investigate the mechanisms behind its’ effectiveness, as well as, the most appropriate patient populations and diagnoses for its’ utilization. In addition, authors are trying to determine which parameters of the treatment such as needle placement, needle number, duration of treatment, utilization of electrical stimulation and needle depth may be modified for optimal treatment effects.

Griswold and colleagues reviewed the available evidence behind needle interventions for spinal pain to determine if depth of needle placement influences treatment effects (JMMT. 2019). Authors included 12 studies in the systematic review and 10 studies in the meta analysis. They reported both superficial and deep dry needling improved pain but significantly better outcomes on pain where found for utilization of deep dry needling. In addition, there was a greater effect when needles were placed in the area of pain compared to a distal site on the body.

Contact the experts at MEND to learn more on how dry needling can improve your current symptoms

Higher Amounts Of Exercise Correlated With Greater Reductions In Neck Pain

With the hypervigilance in abstaining from opioid prescriptions due to the opioid crisis, there has been an effort in determining alternate ways of providing analgesic effects for those in chronic pain. One of the most consistent modalities to help benefit with treatment is exercise. There has been many studies exploring the analgesic effect of exercise on pain and dysfunction as compared to pharmacological treatment. However, there has not been any literature supporting the appropriate dosage and intensity of exercise.

A recent study (Polaski, AM et al. PLoS One. 2019) performed a meta-analysis of many studies using exercise to help treat and manage chronic pain. The studies ranged from many different durations and intensities with different populations, all experiencing chronic pain. The researchers found a positive correlation between duration of exercise and decrease in neck pain. Duration could be constituted for amount of time during exercise, and/or number times exercising throughout the week.

If you are experiencing chronic pain, please seek counsel with your health provider to help guide you in designing a exercises program with the appropriate duration.

The Importance Of Neck Strengthening In Patients With Neck Pain

Neck pain is a common source of musculoskeletal pain with up to 70% of Americans experiencing neck pain at some point in their lives. In the early or acute phases of pain, hands on treatment including spinal manipulation and joint mobilization have been shown to reduce pain and disability due to neck symptoms. If left untreated, neck pain begins to create muscles imbalances including weakness and tightness of the upper quarter muscles. Specifically, research has shown poor performance of the deep neck muscles along the front of the spine. The deep neck flexors provide strength and stability to the skull on the spine as well as the spinal vertebrae. Normally these muscles have a feed forward response where they fire before bigger movements of the neck, but in patients with neck pain these muscles fire late or may not fire perpetuating muscle imbalances and movement impairments at the neck. A new systematic review highlights the importance of the deep neck flexors for patients with neck pain.


Blomgren and colleagues examined the available evidence behind the utilization of deep neck flexor strengthening in patients with neck pain (BMC Musculoskeletal Disorders. 2018). Authors included 12 randomized controlled trials in their final analysis to determine the impact of these exercises on aspects of muscle performance including strength, endurance, coordination, and function. They reported strong evidence was found for the effectiveness of these exercises on coordination, but smaller effects were found for deep cervical strengthening on strength or endurance measurements. In addition, deep cervical flexor strengthening exercises were found to improve neck and head posture.

In our physical therapy practice in Boulder we commonly start with these exercises before rapidly progressing patients toward a higher level strength training program. In our practice experience, higher level strength training of the neck and shoulders is the most effective way to restore function and prevent recurrence in patients with neck pain.

To learn more on how to develop your neck strength contact the experts at MEND

What Is The Best Exercise For Painful Muscles?

Muscles can be a significant source of pain in our bodies. Chronic muscular pain may be found locally over the muscle or can be felt in an area distant from the muscle known as referred pain. Multiple Physical Therapy interventions including dry needling, foam rolling, and soft tissue mobilizations can be utilized in the short term to reduce these symptoms. Conversely, long term relief of muscular pain requires examination of the muscle to determine why it remains painful.

Muscle imbalances are a common reason behind these chronic symptoms. Muscles worked above and beyond their normal function will become painful over time. A common example in the hip is the TFL muscle in the presence of glut weakness. Short term solutions can target the TFL but long term relief is found by strengthening the glut muscles allowing them to perform their appropriate function at the hip in turn relieving forces across the TFL. A second muscle imbalance is found when the painful muscle is not strong enough to withstand the forces applied during activity. The long term strategy with this type of imbalance is to strengthen the muscle of interest. A recent research study examined the impact of strengthening this type of chronic muscle pain.

Anderson and colleagues examined the neck muscle performance of patients with neck pain compared to their pain free peers (Bio Med Res Int. 2014). Patients with painful neck muscles were randomized to either 10 weeks of high intensity neck strength training, general fitness training, or a control group. As expected, significant weakness was found in the patient’s painful muscles at baseline compared to their asymptomatic peers. Authors reported improved strength capacity of these painful muscles following the focused strength training program. Improved functional tolerance of the painful muscles allows these muscles to be more resilient to the forces applied to them each day.

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Deep Neck Flexor Weakness Found Predictive of Neck Pain

70% of Americans will experience neck pain symptoms within their lifetimes. The vast majority of these symptoms are secondary to the musculoskeletal system and effectively treated by Physical Therapists. Patient’s who experience multiple episodes of neck pain or have experienced symptoms for a longer duration (> 3 months) often present with weakness in the cervical muscles which support the spine. The deep muscles on the front of our neck (deep cervical flexors) have been shown to play an important role in neck range of motion and function. These muscles have a feed forward mechanism of action in pain free individuals allowing these muscles to contract in anticipation for the upcoming head or neck movement. Conversely, these muscles have been shown to contract late or insufficiently in patients with neck pain.


A recent article in the journal Pain Medicine examined 60 participants with and without chronic neck pain to determine the relationship between proprioception and motor function and chronic neck pain (Arimi et al. 2018). Participants’ joint position error, cervical endurance, muscle size, pain, disability, and fear of movement were assessed by researchers. Consistent with prior research the authors found smaller deep cervical muscle size as well as lower endurance scores in the participants with chronic neck pain. In addition, deep cervical flexor weakness was found to be a significant predictor of chronic neck pain development.

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Reducing Neck Pain With Resistance Training

Neck pain is an area consistently under treated by clinicians.  There are countless passive temporary remedies for neck pain including massage, manipulation, and dry needling, but only high level exercise is able to reduce the long term effects of neck pain.  When patients remain under passive care for their neck pain they will experience more recurrence and long term symptoms compared to an active group.  A recent randomized controlled trial examined the impact of neck (cervical) Physical Therapy strengthening exercises on patients with chronic neck pain.

Li and colleagues randomized 109 employed (computer users) women with chronic neck pain to either a fixed resistance training program, a progressive resistance training program, or a control group (Int Arch Occup Environ Health. 2017).  The participants in the Physical Therapy exercise groups performed cervical resistance training exercises in 4 directions over a 6 week period.  The progressive group had their resistance increased as tolerated throughout this period.  Both exercise groups demonstrated improved strength, mobility, disability, and pain at short and long term outcomes, but greater pain reduction was noted in the progressive resistance training group.  

Click Here to schedule an appointment with the experts at MEND to learn which exercises are most appropriate for your neck pain.