The Joint Ventures' Blog

A Common Pain In The Neck

Wednesday, August 22, 2018

As a physical therapist, I find myself answering questions about the hot topics in the rehabilitation world. The topics can range from Michael Phelps' use of cupping, to the use of dry needling for low back pain. ‘Sitting is the new smoking’ is a phrase that has been credited to Dr. James Levine, a professor of Medicine at the Mayo Clinic, and since has gained popularity as something I often get asked about. That phrase is based off, and backed by, multiple studies including a recent one conducted by Diaz KM, et al in 2017. The study concluded that the total volume of sedentary time, and its accrual in prolonged, uninterrupted bouts, are associated with all-cause mortality. In plain English, the longer you stay in a seated position, the increased your risk is of an early death. That's a huge finding!  But have no fear, there are a few steps in between sitting and death!

A study by Quek et al. in 2012 found that an increased thoracic kyphosis (the bump in the middle of your back when you slouch while sitting) resulted in an increase in forward head posture and decreased cervical (neck/head) range of motion. We often see that increased thoracic kyphosis with people who are sitting for a prolonged time. This comes back to regional interdependence which is a theory that says “seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint”.  In other words, you may complain of tingling or weakness in your hands, but the cause is coming from your back/neck!

So yes, that limited neck movement, neck pain, shoulder pain or even headaches may be able to be treated by making a change in the thoracic spine. How do we fix that?

One way is with a spinal mobilization or manipulation. The Guide to Physical Therapist Practice defines mobilization/manipulation as skilled passive movements to joints and/or related soft tissue that are applied at varying speeds and amplitudes, including small-amplitude/high-velocity therapeutic movements.  Most common people call these "manipulations" or "cracking my neck".  As physical therapists, we are trained and qualified to perform these small-amplitude/high-velocity movements. The benefits of these maneuvers were looked at by Cross et al. in 2011 and they reported on the effects of thoracic (mid back) manipulation and the management of neck pain. Their results indicate that thoracic spine thrust manipulations may be utilized in the management of acute or subacute mechanical neck pain to reduce pain, improve cervical range of motion, and improve function. Positive effects were shown to occur immediately following the first intervention and continued for up to 6 months after with a set program. These findings suggest that if we are able to improve the quality in the thoracic spine via manipulation, we can improve movement in the cervical spine (neck), decrease pain and return people to improved functional movement.

If you have questions or would like more information, you can call our office at 617-536-1161, or email me, Colin Fields, at

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