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Neck Pain & Headache Truths

10 Reasons Why Your Neck Pain & Headaches Aren't Getting Better

1. You’re not receiving high quality, consistent, guideline-based care

At Sydney Muscle & Joint Clinic our approach is high quality, that is care that is effective, efficient, safe, patient-centred, timely, equitable, and delivered by practitioners who are respectful, communicate clearly, and involve patients in decision-making. High quality is care that is supported by research, is evidence-based, strives to be guideline-based and ultimately results in the better outcomes for patients.

For neck pain with or without headaches this means utilising movements during a thorough assessment that allows our physios to ascertain whether it is joint, disc and/or muscle mediated neck pain, the using joint mobilisations or manipulations together with exercise therapy and directional preferenced movements. Heat, massage, dry needling, stretching and taping are all not supported by the evidence and therefore are not helpful for neck pain and shouldn't be used by evidence-based physiotherapists.

Joint neck pian and headaches physio Pen
Cervicogenic headache neck pain Physio P

2. You’re not receiving impairment-based treatments

Impairment based treatments mean your treatment is not focused on a diagnosis. Neck pain and headaches can be the result of many irritated tissues and treatment should be focused more on things like "joint-mediated neck pain", muscle tightness, joint stiffness and weakness of specific muscles. Modern day physiotherapy management of neck pain and headaches should target pain, stiffness and weakness- not an C5/6 disc bulge.

Neck pain and headache treatment physio

3. You haven’t been educated in the directional preference of your neck

When your spine is painful, stiff and irritable it will always have a directional preference- this means it will prefer to move in one direction opposed to the other. In most cases of neck pain when the diagnosis is disc-related the spine does not like to flex, this means it does not like to look down or do stretches that pulls the head forward and down. Alternatively, your neck will love to retract and extend back and these movements should be encouraged and emphasised.


If your diagnosis is unilateral or one sided neck pain with arm pain the spine will not like to flex or shift away from the affected side. In this case your neck should be desensitised with contralateral lateral shift and when your arm pain has resolved, progressed to just cervical retractions. These directions and movements should be assessed in the initial assessment and be the cornerstone of your treatment plan. Our physiotherapists and exercise physiologists make a good habit of knowing the directional preference of your neck when it is painful, stiff and irritable.

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4. The treatment you have received or the relief strategies you employ are in direction contradiction to the directional preference of your spine

When your neck is painful and irritable and doesn't like flexing or looking down, then don't do shoulder and neck stretches to try and stretch your pain away. Use directional preferenced movements to reduce pain and irritability.

5. Stretching does not help back pain and possibly makes it worse

The majority of neck pain and headaches that our physiotherapists see is mechanical joint-related neck pain and cervicogenic headaches (neck generating) and as such 95% of the time these spines or necks don't like to bend or look down. Stretching your neck and shoulder muscles has no effect on your neck pain and if these stretches are pulling your head down then you'll be making it worse.

These stretches below will certainly make your neck pain and headaches WORSE and should not be given by any good physiotherapist.

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6. You receive passive treatments that are proven not to work- stretching, dry needling, foam rolling & massage.

Stretching, dry needling, foam rolling and massage for neck pain or headaches is not supported by evidence or are these treatments part of any guideline-based management. These may modulate your pain (tricks the brain to send an inhibitory neuron to block pain out), but long term they have no benefit on your neck pain or headaches. Directional specific movements, progressive overload in the form of exercise and education and advice on how your neck is getting aggravated is best practice.

7. You haven’t received a clear diagnosis like "mechanical joint-related neck pain" or "mechanical disc-related neck pain"

Having a diagnosis like C5/6 disc protrusion with lateral recess stenosis or C3/4 facet joint arthropathy is generally not helpful. Our physios and exercise physiologists give you a diagnosis that is more helpful at understanding why you have neck pain and headaches. This starts with a simple triage- serious pathology, nerve root involvement or mechanical. More often than not patients have mechanical pain (meaning specific movements can help or hinder) and based on symptoms and directional preference we ascertain whether it is disc or joint related. A muscle strain in the neck is very uncommon and rarely in isolation.

8. You haven’t used imaging to help understand what might be causing current presentation and how we might create a plan based on imaging conclusions.

Generally imaging isn't required with mechanical neck pain and arm pain, but often if treatment might change then getting an image can help explain and then formulate a plan. An example is a mechanical presentation with differing directional preferences- in one hand you may have a large disc protrusion (therefore bending the neck is irritable), but imaging might show this disc protrusion to be causing central canal stenosis (narrowing) and therefore you are cervical extension intolerant. Using imaging to help with education can help explain symptoms and a necessary plan of action. 

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9. You haven't tried nerve flossing movements to help with arm pain symptoms like pins and needles, numbness, burning or nerve pain

If you have nerve root involvement, radicular symptoms or a radiculopathy nerve flossing movements may be helpful in modulating or reducing pain in conjunction with a directional preferenced movement. Nerve extenders, sliders or gliders can be used on the unaffected arm first if highly irritable and then on the affected arm to help with centralisation. Nerve pain with neck pain can be common and understanding centralisation is an important concept to ensure you understand improvements look when participating in treatment.

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10. You haven’t built resilience to painful movements with graded exposure

At Sydney Muscle & Joint Clinic our philosophy is firmly entrenched in the theories of mechanotransduction- the processes through which cells sense and respond to mechanical stimuli by converting them to biochemical signals that elicit specific cellular responses. If we can add load (exercise) we stimulate cells to regenerate, rejunevate and to grow bigger and stronger. We can not elicit this response with stretching, dry needling, heat packs or therabands. We need good honest load and as heavy as tolerable to encourage resilience, tolerance and build capacity.


Regardless of the injury, condition or complaint our physios and exercise physiologists find a way to settle your neck pain down and then build it back up with exercises that will stimulate the greatest cellular response.

Just like with someone with a running injury, we would slowly return them to running with a progressive return to running program. The same applies to someone with neck pain and is intolerant to flexing or bending the neck, we return them to bending with a graded program- exposing the spine to movement to build its resilience to the movement.

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