Joan is a 47-year-old woman whose chief complaint is 3 weeks of central neck pain radiating to her right shoulder blade. She has had no trauma that might be the cause of her pain. As of today, Joan has:

Constant pain associated with intermittent headaches (frequency: daily; duration: 4 hrs)
Initial neck pain rating = 6/10
Limited right side bending and rotation
Neck Disability Index score = 25%


After examination, Joan’s provider prescribed impairment-based manual physical therapy and exercise for 6 visits over 3 weeks. Joan recieved soft tissue and joint mobilizations, manual based cervical stabilization and strengthening and posture/exercise instruction. Our PTs also incorporated ergonomic instruction for her workstation.


Joan’s neck and scapula pain is resolved (0/10)
and she now has full range-of-motion.
Headaches are resolving and are managed with stretching
Headache frequency is reduced to 2x per week

What Works:

Therapeutic exercise + manual therapy is recommended by the Cochrane Collaboration as the most effective intervention for mechanical neck pain(1). Therapeutic exercise + manual therapy results in less pain and greater patient satisfaction for up to 2 years compared to usual care or exercise alone(2).

What Doesn’t Work

Tylenol,ibuprofen, etc. is only slightly better than a sugar pill (placebo)(3).
Waiting to see if it gets better on its own.(4).
Massage or modalities such as heat, cold or ultrasound(5).
Exercise handouts and websites without PT instructions and guidance(6).

Patients need PT to take care of problem the first time for the best outcome!


– Gross AR, et al. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine. Aug, 2004, 29(14):1541-1548

-Evans R, et al. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine. Nov 1 2002;27(21):2383-2389

– Gross AR, et al. Conservative management of mechanical neck disorders: a systematic review. J Rheumatol. May 2007;34(5):1083-1102

– Jull G, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. Oct 1 2002;27(17):1835-1843; discussion 1843

– Ezzo J, et al. Massage for mechanical neck disorders: a systematic review. Spine. Feb 1 2007;32(3):353-362

– Gasner D, et al. A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain. Spine. Feb 15 2001;26(2):196-205