Back, neck and spine
Neck pain and stiffness
Desk necks, phone necks, slept-badly necks, and the ones that turn out to be a shoulder. Separating them is most of the first appointment and it changes the entire plan.
A neck that hurts and a shoulder that hurts frequently produce pain in the same place — the top of the shoulder blade, the side of the neck, sometimes down the arm. The examination that tells them apart is not complicated but it does have to actually happen, and a plan built on the wrong one of the two will not work however diligently you follow it.
Most mechanical neck pain settles well. What makes the difference is finding which movements provoke it, loading the tissue that has become intolerant, and dealing with the sustained positions that keep feeding it.
Neck, shoulder, or nerve
If moving your neck reproduces it, we have a neck. If moving your arm reproduces it and your neck is comfortable through full range, we probably have a shoulder, and the treatment is completely different. If it travels below the elbow with pins and needles or numbness, a nerve root is involved and that changes both the plan and the timescale.
The screening question sits underneath all of it: is this musculoskeletal at all. Neck pain with fever, with unexplained weight loss, following significant trauma, or with progressive weakness in the arm means a physician rather than a gym programme.
The posture conversation, honestly
Posture is a much weaker predictor of pain than the industry selling posture correction would like. People with textbook alignment get neck pain and people who sit badly frequently do not, and the studies looking for a strong relationship keep failing to find one.
What does matter is sustained position and load tolerance. A neck held in any position for four hours will complain, and a neck whose deep muscles have very little endurance will complain sooner. So the useful advice is not sit up straight, it is move more often and build the endurance — and the second half is the part that requires actual training.
What we do about it
Manual therapy to the segments that are stiff and provocative, which for most people produces immediate and temporary relief. Temporary is the honest word: it buys the range to train in.
Then endurance work for the deep neck flexors and the scapular muscles, progressed over weeks. This is unglamorous and it is what changes the recurrence rate.
And a workstation conversation that is about frequency rather than geometry. Getting up every half hour beats any chair.
If an arm is involved
Add three to six visits and expect a slower course. Nerve root irritation settles on its own timescale, and the useful measure of progress is not how much it hurts but how far down the arm it reaches — pain retreating towards the neck is improvement even when the intensity has not changed much yet.
Progressive weakness is different and it is not something to watch. A grip that keeps failing or a muscle that is visibly wasting means a physician, promptly.
A scan describes a structure; it does not describe your pain. A scan describes a structure at a moment; it does not describe your pain. Disc bulges, degeneration and rotator cuff tears turn up in large numbers of people who have no symptoms at all, and their prevalence rises steadily with age in people who feel completely well. So a report can be entirely accurate and still not be the reason your back hurts. We read your imaging, we take it seriously when it changes the plan, and we will not let a phrase from a radiology report become the story you tell yourself about your spine.
Included as standard
How we treat this
Neck and shoulder examined separately
Because they refer to the same place and the treatments have nothing in common. Getting this wrong is the commonest reason a course of neck treatment does nothing.
Nerve involvement screened properly
Reflexes, strength and sensation where the history suggests it, and a clear plan for what would make us escalate.
Manual therapy, described honestly
It helps, it is temporary, and it exists to buy the range you then train in. We will not sell it to you as the cure.
Deep neck endurance training
The unglamorous part that changes how often this comes back. Progressed weekly rather than handed over once.
A workstation conversation about frequency
How often you move, not the geometry of your chair. The evidence supports the first far better than the second.
Written progression, revised as you go
Three or four things with sets and days, changed when you have earned the change rather than on a schedule.
When to make an appointment
Signs this is worth an assessment
- It has lasted more than two weeks, or it keeps coming back every few months.
- You cannot check your blind spot without turning your whole body.
- The pain travels into the shoulder blade, the arm, or below the elbow.
- You wake with it several mornings a week regardless of pillow.
- You have headaches that seem to start at the base of the skull.
- You have been told it is your posture and correcting your posture has not helped.
Neck pain — how long a course usually takes
- A typical course for mechanical neck pain without nerve involvement. Add three to six visits where an arm is affected.5 – 10 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Neck pain — frequently asked
How many sessions will I need for neck pain?
Typically five to ten visits for mechanical neck pain without nerve involvement, and three to six more where an arm is affected. You get an estimate specific to you at the first appointment and we reassess at visit four.
Is my neck pain caused by bad posture?
Probably less than you have been told. The relationship between posture and neck pain is much weaker than the posture-correction industry suggests — plenty of people with poor alignment have no pain and vice versa. What matters more is how long you hold any position and how much endurance the deep muscles have, and the second is trainable.
Should I buy a special pillow?
If a pillow genuinely helps you sleep, use it, and we are not going to sell you one. Pillows change comfort rather than the underlying problem, and the evidence that any particular design fixes neck pain is thin. Spend the money on the training instead.
My neck pain goes into my arm. Is that serious?
It usually means a nerve root is irritated, which is uncomfortable and slow rather than dangerous in most cases. What changes that assessment is progressive weakness — a grip that keeps failing, a muscle visibly wasting — and that needs a physician promptly rather than more physical therapy.
Do you do neck manipulation?
We use joint mobilisation, which is a graded and controlled movement rather than the high-velocity thrust that defines chiropractic adjustment. If what you want is an adjustment, a chiropractor is the right person and we will say so rather than describe what we do as something it is not.
Related conditions
Often seen alongside this
Neck headaches
A minority of headaches are driven by the upper neck. Those respond well to physical therapy; the rest do not, and we screen for which you have.
6 – 10 visits
Shoulder pain
Five structures in a small space, all of which hurt in roughly the same place. The examination is what separates them.
8 – 14 visits
Low back pain
The most common reason anybody walks through this door, and the condition where the gap between what sells and what works is widest.
6 – 12 visits
Sciatica
Pain down a leg is a symptom, not a diagnosis. Four different things cause it and they do not respond to the same treatment.
8 – 16 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.