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Physical Therapy in Northern Virginia for Neck Pain Welcome to Dynamics Physical Therapy's patient resource about Neck Pain.

Neck pain is a common reason people visit their doctor. Neck pain typically doesn't start from a single injury. Instead, the problem usually develops over time from the stress and strain of daily activities. Eventually, the parts of the spine begin to degenerate. The degeneration can become a source of neck pain.

This document will give you a general overview of neck pain. It should help you understand:

Human Spine The cervical spine is formed by the first seven vertebrae. Doctors often refer to these vertebrae as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom edge of the skull. The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine. This is where the chest begins.

Cervical Spine Spine Curves 

Vertebrae Body Bony Ring 

One way to understand the anatomy of the cervical spine to look at a spinal segment. Each spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints (described later) that link each level of the spinal column.

Spinal Segment An intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. In some cases, the collagen fibers join together to form a structure like a rope. In other cases, the fibers are arranged like a piece of cloth, or knitted materials such as you find in a sweater. The disc is a specialized connective tissue structure that separates the two vertebral bodies of the spinal segment. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting.

Two Parts of Intervertebral Disc 

Facet Joint 

Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen. (The term used to describe more than one opening is neural foramina.)

Neural Foramen Why do I have neck pain?

There are many causes of neck pain. Doctors are not always able to pinpoint the source of a patient's pain. Your doctor will make every effort to ensure that your symptoms are not from a serious medical cause, such as cancer or a spinal infection. Below is a brief overview of some of the most common causes of neck pain.


Most neck problems happen after years of wear and tear on the parts of the cervical spine. At first, these small injuries are not painful. But over time they can add up. Eventually they begin to cause neck pain.

Doctors sometimes call these degenerative changes in the spine spondylosis. Spondylosis can affect the bones and soft tissues of the spine. However, it is important to know that most problems with spondylosis are a normal part of aging.

Degenerative Disc Disease

The normal aging process involves changes within the intervertebral discs. Repeated stresses and strains weaken the connective tissues that make up a disc. Over time, the nucleus in the center of the disc dries out. When this happens, it loses some of its ability to absorb shock. The annulus also weakens and develops small cracks and tears.

Often these changes are not painful. But larger tears that reach to the outer edge of the annulus can cause neck pain. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. At some point the disc may finally lose its ability to absorb shock for the spine. Then forces from gravity and daily activities can take even more of a toll on the disc and other structures of the spine.

As the disc continues to degenerate, the space between the vertebrae becomes smaller. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints.

The nucleus may push through the weakened and torn annulus and into the spinal canal. This is called a herniated or ruptured disc. The disc material that squeezes out can press against the spinal nerves. The disc also emits enzymes and chemicals that produce inflammation. The combination of pressure on the nerves and inflammation caused by the chemicals released from the disc cause pain.

As the degeneration continues, bone spurs develop around the facet joints and around the disc. No one knows exactly why these bone spurs develop. Most doctors think that bone spurs are the body's attempt to stop the extra motion between the spinal segment. These bone spurs can cause problems by pressing on the nerves of the spine where they pass through the neural foramina. This pressure around the irritated nerve roots can cause pain, numbness, and weakness in the neck, arms, and hands. Muscle Strain

Mechanical Neck Pain Mechanical neck pain is caused by wear and tear on the parts of the neck. It is similar in nature to a machine that begins to wear out. Mechanical pain usually starts from degenerative changes in the disc. As the disc starts to collapse, the space between the vertebrae narrows, and the facet joints may become inflamed. The pain is usually chronic. (Chronic pain builds over time and is long-lasting.) The pain is typically felt in the neck, but it may spread from the neck into the upper back or to the outside of the shoulder. Mechanical neck pain usually doesn't cause weakness or numbness in the arm or hand, because the problem is not from pressure on the spinal nerves.

Radiculopathy (Pinched Nerve)

Pressure or irritation in the nerves of the cervical spine can affect the nerves' electrical signals. The pressure or irritation can be felt as numbness on the skin, weakness in the muscles, or pain along the path of the nerve. Most people think of these symptoms as indications of a pinched nerve. Health care providers call this condition cervical radiculopathy.

Several conditions can cause radiculopathy. The most common are degeneration, disc herniation, and spinal instability.

Related Document: Dynamics Physical Therapy Patient's Guide to Cervical Radiculopathy

Cervical Myelopathy Spinal Stenosis (Cervical Myelopathy)

Spinal Stenosis However, stenosis can also develop when a person of any age has a disc herniation that pushes against the spinal canal. When the spinal cord is squeezed in the neck, doctors call the condition cervical myelopathy. This is an alarming condition that demands medical attention. Cervical myelopathy can cause problems with the bowels and bladder, change the way you walk, and affect your ability to use your fingers and hand.
 What are some of the symptoms of neck problems?



The diagnosis of neck problems begins with a thorough history of your condition. When you visit Dynamics Physical Therapy, you may be asked to fill out a questionnaire describing your neck problems. Then our Physical Therapist will ask you questions to find out when you first started having problems, what makes your symptoms worse or better, and how the symptoms affect your daily activity. Your answers will help guide our physical examination.

Your Physical Therapist at Dynamics Physical Therapy will then physically examine the muscles and joints of your neck. It is important for us to see how your neck is aligned, how it moves, and exactly where it hurts.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at Dynamics Physical Therapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Dynamics Physical Therapy provides services for Physical Therapy in Northern Virginia.


Our Treatment

Non-surgical Rehabilitation

Nonsurgical treatments can maximize the health of your neck and prolong the time before some type of surgery is needed. At Dynamics Physical Therapy, a Physical Therapy program is often prescribed for two to four weeks for patients with neck pain, although each patient's recovery time varies. Our treatments are designed to help ease pain and to improve mobility, strength, posture, and function.

If your pain is severe, we may recommend a soft neck collar to keep your neck still for short periods of time. Resting the muscles and joints can help calm pain, inflammation, and muscle spasm.

Your Physical Therapist in Northern Virginia may also advise you to intermittently place a cold pack on your neck, or you may be shown how to do a contrast treatment. Contrast treatments involve switching between a cold pack and a hot pack.

When your Physical Therapy program is nearly completed, we may provide you with exercises to do at home on a regular basis to help control your symptoms and protect your neck in the years ahead. Post-surgical Rehabilitation

One of our Physical Therapists can visit you in your hospital room soon after surgery. These initial in-hospital treatment sessions help our patients learn to move and do routine activities without putting extra strain on the neck.

Many surgical patients need Physical Therapy outside of the hospital as well. Although the time required for rehabilitation varies for each patient, as a guideline, you may expect your recovery to take one to three months, depending on the type of surgery. Our Physical Therapy treatments are designed to calm pain and muscle spasm, teach patients to move safely, and help patients develop strength and mobility.

As our Physical Therapy sessions come to an end, your Dynamics Physical Therapy Physical Therapist may help you get back to work. We can do a work assessment to ensure you can do your job safely. Some patients may need to modify their work or other activities to avoid future problems.

At Dynamics Physical Therapy, our goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your neck. When your recovery is well under way, regular visits to our office will end. We will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.



Physician Review

Radiological Imaging 

CT scan

The computed tomography (CT) scan is a special type of X-ray that lets doctors see slices of bone tissue. The machine uses a computer and X-rays to create these slices. It is used primarily when problems are suspected in the bones.


The myelogram is a special kind of X-ray test where a special dye is injected into the spinal sac. The dye shows up on an X-ray. It helps a doctor see if there is a herniated disc, pressure on the spinal cord or spinal nerves, or a spinal tumor. Before the CT scan and the MRI scan were developed, the myelogram was the only test that doctors had to look for a herniated disc. The myelogram is still used today but not nearly as often. The myelogram is usually combined with CT scan to give more detail.

Bone Scan

Other Tests & Treatments

Laboratory Tests


Some doctors ask their patients to work with a Physical Therapist. Therapy treatments focus on relieving pain, improving neck movement, and fostering healthy posture. The therapists at Dynamics Physical Therapy can design a rehabilitation program to address your particular condition and to help you prevent future problems.


Many different types of medications are typically prescribed to help gain control of the symptoms of neck pain. There is no medication that will cure neck pain. Your doctor may prescribe medications to ease pain, fight inflammation, and to help you get a better night's sleep.


Spinal injections are used for both treatment and diagnostic purposes. There are several different types of spinal injections that your doctor may suggest. These injections usually use a mixture of an anesthetic and some type of cortisone preparation. The anesthetic is a medication that numbs the area where it is injected. If the injection takes away your pain immediately, this gives your doctor important information suggesting that the injected area is indeed the source of your pain. The cortisone decreases inflammation and can reduce the pain from an inflammed nerve or joint for a prolonged period of time.



Only rarely is cervical spine surgery scheduled immediately. Your doctor may suggest immediate surgery if there are signs of pressure developing on the spinal cord or if your muscles are becoming weaker very rapidly.

For other conditions, doctors prefer to try nonsurgical treatments for a minimum of three months before considering surgical options. Most people with neck pain tend to get better, not worse. Even people who have degenerative spine changes tend to gradually improve with time.

Surgery may be suggested when severe pain is not improving. Related Document: Dynamics Physical Therapy's Guide to Cervical Foraminotomy Related Document: Dynamics Physical Therapy's Guide to Laminectomy 

Related Document: Dynamics Physical Therapy's Guide to Cervical Discectomy

Cervical Fusion

Small Graft of Bone Posterior Fusions 

Locking the Bones in Place Corpectomy and Strut Graft Related Document: Dynamics Physical Therapy's Guide to Cervical Corpectomy and Strut Graft

Portions of this document copyright MMG, LLC.

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