As an athlete, few things are more frustrating than dealing with injuries that keep you from performing at your best. Whether it’s a nagging ache or sharp, debilitating pain, neck issues can significantly affect your training and performance. What makes neck pain unique is that its cause isn’t always as obvious as other injuries. For many people, pain and tightness develop gradually over time, often without a specific triggering event. When there’s no clear cause, we need to dig deeper to uncover the root issue, which is often linked to poor posture, repetitive movements, and the way we carry our bodies throughout the day. In this article, we’ll explore the common causes of neck pain, how everyday habits contribute to its development, and how physical therapy at The Charlotte Athlete can help you resolve these issues and get back to peak performance.
Common Types of Neck Pain
Neck pain can present in various ways, and the location of the pain is a key indicator of its contributing factors. Outside of the neck itself, some of the most common areas where neck pain manifests include:
- Upper Trapezius Area: AKA the “shneck” pain. This is perhaps the most frequently affected area. It’s where tension tends to accumulate due to poor posture or extended periods of inactivity, like sitting at a desk or scrolling on your phone. The most overlooked cause if pain here is a dysfunctional 1st and 2nd rib.
- Between the Shoulder Blades: Sometimes, neck pain can radiate into the upper back, causing discomfort around the shoulder blades. This pain pattern is often exacerbated by poor scapular mobility and strength.
- Arm Pain or Numbness: In more severe cases, irritation of the nerves in the neck can cause pain that travels down the arms and into the hand and fingers. This can feel like shooting pain, tingling, or numbness, and it’s often linked to nerve compression in the cervical spine and a “double crush” from an additional nerve insult somewhere else along its pathway.
Now, what’s important to note is while symptom location can vary quite a bit, the neck tends to present with the same root cause over, and over, and over again, making cervical spine pain one of, if not the easiest body regions to treat as sports physical therapists. Because of this, its important to take a moment and explain some of the anatomy and biomechanics surrounding this.
The Importance of the Upper Cervical Spine: C0-C2
Stick with me—I promise it’ll be worth it if you want to understand the root cause of your neck pain. The top two segments of the cervical spine, C0-C1 (where the skull meets the atlas) and C1-C2 (where the atlas meets the axis), play a crucial role in maintaining a pain-free neck. What’s key is that these segments are responsible for the majority of the neck’s mobility. Specifically:
- C0-C1 (atlantooccipital Joint): This segment contributes almost 50% of the neck’s TOTAL flexion and extension (nodding motion) range of motion.
- C1-C2 (atlantoaxial Joint): This segment contributes approximately 50% of the neck’s TOTAL rotation (ability to rotate side to side) range of motion.
So, half of your neck’s ability to flex, extend, and rotate comes from just two of its seven segments. Here’s the catch: when these two segments become stiff (hypomobile) due to poor head/ neck positions, the other segments are forced to compensate. However, those segments aren’t designed to handle the extra workload. Over time, this overload compensation leads to hypermobility (excessive joint movement) in those areas, which can eventually cause pain. So, the upper cervical spine – C0-C1 and C1-C2 – are the most important areas to address from a treatment perspective – more on this later.
For a deeper dive into hypermobility and hypomobility, check out the main blog in this series, HERE.
The Cascade of Neck Pain: How Poor Habits Lead to Dysfunction
The body is highly adaptable and will compensate for the imbalances it encounters; however, it can only handle so much. This pattern of compensation is often referred to as the “cascade effect,” where small, repetitive movements and bad habits accumulate over time to create significant dysfunction. This is why neck pain often doesn’t occur after one incident—it’s the result of thousands of small misalignments and poor movements that ultimately lead to discomfort.
The Root Causes of Neck Pain & Impact of Repeated Movements and Postures (RMPPs)
The body is highly adaptable and will compensate for the imbalances it encounters; however, it can only handle so much. This pattern of compensation is often referred to as the “cascade effect,” where small, seemingly insignificant repetitive movements and bad habits accumulate over time to create significant dysfunction. This is why neck pain often doesn’t occur after one incident—it’s the result of thousands of small misalignments and poor movements that ultimately lead to discomfort. Without an identifiable event, the question of, “what caused this injury?” becomes the most important component to consider in the rehab process. If there is no mechanism of injury, then the root cause is simply what we do on a regular basis, day in and day out. These movements create subtle imbalances within the body which compound over time, making recognition of these patterns early on an essential component in preventing a long term, more frustrating issue.
We call these patterns the RMPPs – the repeated movements and prolonged postures (discussed in detail in THIS POST). When it comes to the cervical spine, we tend to hold our bodies, particularly our head, in certain positions for very long periods of time—often without thinking much about it—which leads to joint and muscle imbalances, strain on supportive ligaments, and stress on the nervous system. Over time, these imbalances disrupt healthy movement and put undue stress on certain areas within the neck, eventually leading to tightness and pain. The most common RMPPs around neck pain are described in the next few paragraphs.
The Role of Technology
Technology has become an integral part of our daily lives, but it comes with its own set of challenges for our necks. Whether it’s looking down at a smartphone, leaning over a computer, watching TV, or staring at the tracking screen on the assault bike, these activities promote forward head posture that can strain the muscles and joints in the neck. When we tilt our heads forward to view a screen, we’re effectively increasing the distance between our head and the spine. This forward head position puts additional strain on the neck muscles, forcing them to work harder to support the head. It’s kind of like holding a bowling ball with an outstretched arm, vs close to the body – the ball will feel way heavier when held away from out body. Our heads are similar and far heavier than you think! The further our chin is from our throat – forward or upward tilting – the higher the strain is on our neck. And the longer we engage in these poor postural patterns, the more likely we are to develop imbalances that lead to pain.
Repeated Movements: Head Positioning When Working Out
The position of your head and neck, along with where you focus your eyes during exercises, plays a key role in neck pain and stiffness. Extending your neck upward increases the risk of discomfort. For instance, looking up at the ceiling during squats or deadlifts, lifting your chin over the bar during pull-ups, or staring straight ahead during planks or push-ups can all contribute to the problem. Repeating these poor movement patterns over and over during every workout only increases the likelihood of developing neck pain over time.
Sleep Positions: A Top Risk Factor Often Overlooked
The positions we sleep in each night can have a major impact on the muscles and joints in the neck, and in my opinion, it’s one of the biggest contributors to neck pain overall. Most people don’t consider their sleeping posture, but it plays a critical role in neck health. For instance, sleeping on your stomach forces your neck into a twisted position for hours, leading to joint stiffness, muscle imbalances, and ligament strain (known as creep), rendering them more flexible than they should be. Even the wrong pillow can worsen the problem by pushing your neck into unnatural positions, adding stress to the cervical spine. Poor sleep posture is a commonly overlooked cause of neck pain, and fixing it is essential for long-term relief. Get off your stomach, and sleep on your back. You’ll thank me later.
Woke up with neck pain? Check out this blog on why and what to do about it!
Why Stretching Alone Won’t Fix Your Neck Pain
When dealing with neck pain, many athletes (and even physical therapists) often turn to stretching as a first-line treatment. It makes sense, right? Your neck feels tight, so you stretch it out. While stretching can offer temporary relief, it doesn’t address the root cause of the pain—and will often make things worse, slowing your recovery. Neck muscles, especially those affected by forward head posture, are often already in a lengthened position. If your head is forward, your neck muscles become elongated. When weak muscles are stretched for long periods, they develop tension. That’s why people often stretch them to relieve tightness. However, stretching only lengthens already lengthened muscles, feeding into the issue. And when you lengthen a weak muscle, you develop a feeling of tension, known as “stretch weakness.” Instead of stretching, focus on strengthening these muscles to address the underlying problem. Don’t waste time on temporary fixes—it’s more effective to tackle the root cause by strengthening the muscles and addressing your RMPPs.
A Better Approach: Targeted Manual Therapy, Strengthening Exercises, Address Your RMPPs
To truly address neck pain, it’s essential to take a comprehensive approach that focuses on both manual therapy and corrective exercises, all while making changes to the root cause of what got you into this mess to begin with – the RMPPs.
Manual Therapy: Restoring Mobility and Reducing Tension
Manual therapy is one of the most effective treatments for neck pain, using hands-on techniques to improve mobility and relieve tension in the joints and muscles. Techniques like joint mobilizations and targeted manipulations help restore proper movement in the cervical spine and ease stiffness, while soft tissue mobilizations reduce tension and cool off overworked muscles.
At a physical therapy clinic like The Charlotte Athlete, we take a precise, focused approach to manual therapy. We don’t just try and get as many “pops” and “cracks” as possible, because this may induce further mobility in already hypermobile segments. By targeting specific areas—like C0-C1, C1-C2, the CT junction, thoracic spine, first and second ribs, and soft tissues like the suboccipitals, paraspinals, scalenes, SCM, levator scapulae, and upper traps—we provide relief while avoiding aggravation of hypermobile regions that may contribute to your pain. Every manual therapy technique is performed for a reason, specific to your individual needs. Manual therapy lays the groundwork for healthy movement, so we almost always pair it with targeted strengthening exercises to ensure long-term results.
Strengthening the Neck Muscles: The Chin Tuck Exercise
Once the mobility issues are addressed, strengthening exercises become essential. One of the most important exercises for neck pain is the chin tuck. This exercise targets the deep neck flexors, which help support the head in a more neutral position. The chin tuck strengthens the muscles that control the head and neck, helping you maintain better posture throughout the day. We teach athletes how to perform the chin tuck in a controlled, isolated manner at first. Over time, as your strength and mobility improve, we progress the exercise to more dynamic movements that replicate the demands of your sport. This ensures that your neck can maintain proper alignment under load and fatigue, reducing the risk of re-injury, and providing the highest probability for long term success.
Preventing Future Neck Pain: Building Healthy Habits
The key to preventing neck pain from recurring is to build healthy habits into your daily routine. This involves being mindful of your head positioning, both during active activities like driving, working out, and computer work a phone, and passive activities like sleep. Maintaining a neutral neck position throughout the day, strengthening the muscles that support the cervical spine, and using proper ergonomic techniques can go a long way in preventing future injuries.
Conclusion: Getting Back to Your Best
Neck pain doesn’t have to sideline you from your athletic goals. By understanding the root causes of your pain, addressing mobility issues through manual therapy, and strengthening the muscles that support your neck, you can resolve pain and prevent future issues. It’s all about building better habits, whether that’s improving posture during the day or adopting better sleep positions at night.
If you’re an athlete dealing with neck pain, don’t let it hold you back. Take control of your recovery and get back to doing what you love with the right treatment and support. The Charlotte Athlete is a physical therapy clinic here in Charlotte, North Carolina, which specializes in treating neck pain. We’re here to help guide you through the process and ensure that your neck is healthy, strong, and ready to perform at its best. Simple select a date below to set up a free 20 minute phone consult, or CLICK HERE to learn more about us.
Thanks for reading,
Dr. Andrew