Pain in the Neck


The neck becomes a ‘pain in the neck’ (quite literally) for many people. It is estimated that 22% to 70% of the population will have neck pain some time in their lives with at least 30% of people developing chronic symptoms. The strongest risk factors for neck pain are female sex and prior history of neck pain. Other risk factors include older age, high job demands, smoking history, low social/work support, and prior history of low back pain.

Similar to the low back, neck pain is very complex and multifactorial. Consult a medical professional for advice specific to your condition.The topics in this blog are purely educational and not medical advice. The videos in this blog will cover dry needling, neck range of motion exercises, and neck strengthening exercises. 

The neck is one area that I find many trigger points and myofascial pain. Dry needling is often very effective for the neck! What is dry needling? How is it different than acupuncture? I am glad you asked. 

“Dry needling is short term needling to altered or dysfunctional tissues in order to improve or restore function.” I like this definition of dry needling from the Physiotherapy Acupuncture Association of New Zealand. Most often it is muscle tissue that is needled, including myofascial trigger points but connective tissues and periosteum can be needled as well. It is called “dry” needling because no fluid is injected.

How is dry needling different that acupuncture? The Traditional Chinese Medicine approach uses meridian or extra points along with Chinese medicine assessment methods and paradigms to dictate treatment. Western acupuncture also uses Meridian points but applies Western scientific reasoning instead of following Chinese approaches. Trigger point dry needling is the most common technique used in physical therapy. In trigger point dry needling, a needle is inserted directly into a trigger point and does not follow Meridian points. 

A trigger point is a taut band of muscle tissue that is palpable and tender to touch. The two different categories of trigger points are latent and active. Latent trigger points are not spontaneously painful, need to be activated with pressure, have smaller areas of referred pain, and are not as painful. Active Trigger points create spontaneous pain, can be hurting at rest, have larger referral pain areas, and are more painful. Most patients do not seek treatment for latent trigger points and often do not know they are there. Active trigger points are bothersome, and patients frequently seek treatment to resolve their pain by this point. 

Dry needling is never performed in isolation but supplemented with range of motion, strengthening, and/or motor control exercises. In the next video, Dr. Tim O’Connor demonstrates some effective exercises to improve range of motion for the neck. Neck flexibility and mobility exercises have consistently demonstrated effectiveness in evidence for the treatment of neck pain. The upper trapezius, sternocleidomastoid, and scalenes are muscles that are often tight! The hold time for a stretch really depends on the goal of the exercise (ie: reduce pain, improve flexibility). To improve range of motion based on evidence, you should perform 30-60 second holds per rep for a total of 2-3 reps per muscle group. A good target frequency of stretching should be at least 5 days a week for 4 weeks. 

As is usually the case, it is good to supplement range of motion exercises with strengthening exercises. The deep neck flexor muscles have been described at the ‘core of the neck’ because they help support the neck like the core muscles do for the back. In the video, I showed a deep neck flexor activation exercise and progression. The deep neck flexor exercises should be done for isometric holds. A way to start is for 10 second holds for 10 reps and progress time, reps, and sets based on the difficulty of the exercise.  I also showed a strengthening exercise for the cervical extensors with a band. You can hold these for isometric contraction as well or do for reps, instead. Neck exercises can feel awkward at first but stick with them to see the benefits!

In closing, neck pain does improve with conservative care for most people. If your pain is persistent or you want more guidance, it might be a good time to contact a physical therapist! 

Disclaimer: This content is designed for information & education purposes only and is not intended for medical advice.


1.Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017 Jul;47(7):A1-A83. doi: 10.2519/jospt.2017.0302. PMID: 28666405.

2. Thomas E, Bianco A, Paoli A, Palma A. The Relation Between Stretching Typology and Stretching Duration: The Effects on Range of Motion. Int J Sports Med. 2018 Apr;39(4):243-254. doi: 10.1055/s-0044-101146. Epub 2018 Mar 5. PMID: 29506306.

3. Simons DG, Mense S, Understanding and measurement of muscle tone as related to clinical muscle pain. Pain 75(1): p. 1-17, 1998.

4. PAANZ 2014. Physiotherapy Acupuncture Association of New Zealand: Guidelines for Safe Acupuncture and Dry Needling Practice. Wellington, New Zealand. 

Related Content

Subscribe to receive updates

Stay on the leading edge of physical therapy and wellness! Subscribe to Bull City PT’s newsletter for exclusive insights, tips, and updates delivered straight to your inbox. Join our community today and take the first step towards a healthier you!