This phase is normally the first 24-72 hours after the symptoms start and its aim is to settle any neck pain whilst maintaining the range of motion and function you have. 

When performing the exercises it is OK for there to be a little discomfort or the sensation of stretching to occur. Any feeling of discomfort should settle within 30 minutes of performing the movements, and over time the exercises will become easier. If you experience any sharp pain, attempt another exercise in the phase, and reattempt this movement at another time. Perhaps reducing the range you perform the movement or the amount of repetitions will help your symptoms. Remember the aim is to perform some mobility as this will help the neck return to its normal function. The treatment options in this phase and the entire programme, will hopefully show you options on how to relieve neck pain, along with some of the best exercises for neck pain.

Medication

In the initial phase the use of over the counter medication may be an option. Medications such as simple pain relief and anti-inflammatories may allow the condition to be more manageable.  Please consult your family doctor if you have any concerns with this impacting your current medication, or if any medical history may be impacted by the option of including this medication.

Wheat Bag

Depending on the level of discomfort in your neck and loss of range, you may find it helpful to use a wheat bag to ease any irritation and also help with any muscular neck pain in the area. The heat generated from the wheat bag may help reduce any tightness in the muscles of the neck which can go into spasm as they try to protect the area. Using the wheat bag two to three times during the day, especially applied before performing the neck mobility exercise may make things a little easier. Be careful the bag isn’t too hot and check your skin for any signs of a reaction.

Exercises

The focus of the exercises in this phase is to maintain the movement you have in your neck, whilst trying to ensure the muscles surrounding the joints remain as mobile as possible. If you follow the videos for these exercises it will show you how to fix a stiff neck. During the exercise if you notice that your neck clicks, as long as it is not painful, you are OK to continue. 

With neck pain it's quite common for the surrounding muscles to tighten up which can result in further discomfort. You also may find that any reduction in movement has a knock on effect to the shoulder joint as you are generally less active, and the muscles connecting between the neck and shoulder can also tighten up.  We have included some basic shoulder mobility exercises which will hopefully address this.    

Some things to consider with the exercises:

• The first exercise is one which may act as a neck pain reliever.  A little discomfort or the feeling of your muscles around your neck stretching is not uncommon, but this should settle quickly after you have stopped. What can be helpful to make sure you are doing the movement correctly is to ask someone to view from the side as you are doing the exercise, or instead filming yourself on your phone and then checking how you look when you watch it afterwards.
• The second exercise will help maintain the rotation of the neck. Performing this movement in lying will reduce the load going through the neck joints as the weight of your head is taken out of the movement, and is one of the best exercises for a stiff neck. If you have side neck pain, or neck pain and stiff neck, this can help reduce your tight neck.
• The exercises for the shoulder are to simply ensure the joint below your neck remains mobile and the muscles which attach from your shoulder to your neck remain loose. 
• How long and how often you do the exercises at this stage is not too important. The key is little and often, and as long as you get something done every couple of hours to maintain the range that will be beneficial. 
• If you get any sharp pain in neck when moving it during these exercises, you should stop, and retry the movements later in the day to see if that improves things. 
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

This phase we are looking at increasing the neck mobility exercises whilst still being mindful that certain movements could still be irritable. This will be roughly the first 2-4 weeks of your rehab. If you have neck pain after injury, you may take longer on this phase, depending on your symptoms. 

Education

When someone is suffering from neck pain it can be difficult not to irritate it with daily activities, such as looking left or right when driving a car. Try initially to avoid repeatedly performing movements or tasks which constantly aggravate your symptoms. As the neck pain settles down these irritations will become less frequent, but you may have to initially adapt how you perform certain tasks. There will be some activities which you cannot avoid and others which it takes you by surprise, don’t be too hard on yourself here as sometimes it is unavoidable. But where you can, try and reduce activities which will repeatedly cause you pain. 

As you improve the range of movement in your neck, you should find that your general neck mobility improves throughout the day, and the direction which was causing you the most irritation will also settle. As you become less irritable with neck movements you will be irritating the stiff joint less, which will cause your symptoms to settle over time.

You also need to be aware if the pain starts travelling down your arm, or if you notice any pins and needles or numbness developing. These are generally the symptoms you see in the difference between neck strain and pinched nerve. If these neck pain radiating to shoulder symptoms resolve or settle with the neck exercises this is a good sign, and you should continue doing the movements. However if the exercises make things worse, or produce these symptoms, you should stop doing them and make an appointment with your family doctor or physiotherapist to ensure you are doing the right exercises, as they could in fact be making things worse.  If you do not experience any pain down your arm, or altered sensations, then you are OK to continue. 

The aim for these first few weeks is to make sure we gain full movement in the neck, you should find that as this improves your symptoms will settle. 

The timelines here are merely a guide and you may find you can progress from this phase before 2 weeks, but equally it may take longer than 4 weeks, and this will depend on the level of restriction and the amount of tissue damage caused. A good marker on when to progress to Phase 3 is when you can move your neck for full range during the exercises. Most people want to know how to cure neck pain fast, but in some circumstances it can take a number of weeks. 

There will be some movements which you find easy and may even offer some relief in the discomfort you are experiencing, others may be more challenging. You may also find it helpful to offer some variety on the angle you perform these exercises as it may make things a little easier. The point here is there is no set way to perform mobility exercises, and no two days will be the same. Don’t get discouraged by this and just make sure that you get something done at least once a day. 

These movements shouldn’t cause any spike in pain, but a little bit of discomfort is expected as you move into the restricted range.

Exercises

The aim of these exercises is to offer some basic mobility to the neck without increasing your pain. Remember to start off easy and only increase the range after performing a few reps of each movement as a warm up. 

You can continue the shoulder mobility exercises from Phase 1 but it is likely that these would have less benefit as time moves on, and if you don’t notice any restrictions in tightness between your left and right arms when moving them, you can stop this exercise altogether. 

Some things to consider with the exercises:

• The neck retraction exercise is continued from phase 1. However we are now performing this in sitting. A little discomfort or the feeling of your muscles around your neck stretching is not uncommon, but this should settle quickly after you have stopped. A mistake people often make with this exercise is poking their chin forward, which you don’t need to do, and they often instead of doing retraction end up just looking down. What can be helpful to make sure you are doing the movement correctly is to ask someone to view from the side as you are doing the exercise, or instead filming yourself on your phone and then checking how you look when you watch it afterwards. If you do find this exercise too irritating you may find it easier to  return to lying. When you can perform this movement with ease, you can increase the range by putting a little bit of overpressure with one of your hands when you get to the end of the movement. This will ensure you have full range into retraction. If you get neck pain when turning head or your neck hurts when looking up, this exercise may help relieve that pain. 
• The second exercise is a progression from Phase 1 where we are now performing this in sitting. If you find this difficult you could continue performing this in lying until your range improves. If your neck hurts looking around, this exercise should hopefully address any neck stiffness you may have. 
• The final exercise ensures that the muscles on the back and side of your neck remain strong. When you perform this movement these muscles will need to contract to stabilise the movement. If initially this causes the muscles to go into spasm around the upper shoulder or side of your neck. Perform this with a light resistance band or less tension, or perhaps give it a few days rest before reattempting. 
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

Acupuncture

Both Western and Chinese acupuncture may be helpful in this stage to alleviate some muscular tightness you may be experiencing, or if you have neck pain and headaches. There could also be a place for acupuncture should you be struggling with sleep as it has been shown to aid sleep later in the day after the session. However, any joint tightness will not be affected by acupuncture alone, and the exercises will be best placed for this. Contacting your local acupuncturist who is appropriately trained may help you here if progress is slow.

Symptoms

During this phase your symptoms whilst resting should start to settle and generally you will only find an increase in pain when performing movements which are restricted. You will also notice that general daily activities which were once limited, will slowly become a little easier. 

If you are struggling to progress through this phase, or if you have neck pain when swallowing, neck pain and dizziness, or neck pain when sleeping, it may be helpful to seek a face-to-face medical appointment. This will ensure you are on the right path and if required, any hands-on assessment and treatment can be performed to help with your recovery. If however your symptoms are reducing and function improving, you can continue with this programme and onwards onto Phase 3 when you are ready.

Pacing

At this stage you should find you can do more day-to-day activities pain free. The temptation here is to go a bit overboard. A nice reminder to pace activities so that you don’t over do it, and that you spread these activities out as much as possible throughout the day.

This phase will be roughly 4 weeks from the start of your rehab and its aim is to build on the increased range from Phase 2.

Education

A good marker on when to progress onto this phase is when your neck mobility for both rotation and retraction is full. You should have no pain or restriction when performing the retraction exercise and be able to add in the overpressure with the other hand. At this stage the pain in your neck should have settled but it is not uncommon that certain movements could still be irritable. We will address any potential further loss of range in this phase. Generally discomfort with neck flexion is due to the soft tissue or joints in your neck being irritated when stretched. As you move through the healing stages this movement will improve with time. 

The timelines on when to start this phase are only a guide, where some people can start before the 4 weeks but others may take a little longer. 

After a period of reduced activity due to the pain you have been experiencing, you would expect there to be a general loss in strength in your shoulder. We will in this phase be reintroducing some basic strength work to help address and weakness. 

You can continue the mobility exercises from Phase 2 still, especially if any of the movements offer relief. 

Exercises

You can continue the neck mobility exercises from Phase 2 if you find they still offer some benefit.

Some things to consider with the exercises:

• The first exercise is a progression from the retraction exercise you performed in the previous stage. You may find it helpful to do a set of just the retraction movement as a warm up before doing the extension portion of the exercise. You may also find that the number of reps too high initially so reducing it to a number which is more appropriate is absolutely fine. It’s quite normal when you start performing this exercise to have a bit of discomfort in the base of your neck when you go to full extension. Build up slowly and don’t overdo things at the start, and this will ease over time. It’s important that when you do this movement you do the retraction portion of the movement, and hold that position whilst you move into extension. 
• The second exercise has continued from the previous phase, and aims to maintain the strength of the muscles around the upper shoulder into your neck. Aim to perform the number of reps for each direction. 
• We are now including all movements of the neck with the third exercise. Start off slow and build up the range over time.  Aim to perform the number of reps for each direction. 
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

This phase would be roughly 8 weeks from the start of your rehab.

Education

This phase may not be appropriate for everyone and if you can perform all your daily activities pain free and have no intention of returning to sport, you can stop at Phase 3. However after a period of reduced activity you would expect your general strength in your upper body to be reduced, so it may help with certain activities you are struggling with. 

If you intend to return to sport, especially one which requires an element of upper body strength such as racquet or contact sports, you should continue with these exercises. 

Similar to Phase 3 the timelines here are merely a guideline and may vary. You may find that you are able to start this phase before 8 weeks if the symptoms have settled and you aren’t challenged by the exercises.

You should continue the mobility exercises from Phase 3, with the aim to maintain full range of motion. However you would not necessarily need to do as many sets as you previously did, and you may not need to do all the mobility movements every day, you could potentially alternate which days you perform certain movements. 

The aim in this phase is to increase the strengthening exercises through range.

Exercises

You should continue the mobility exercises from Phase 3, and you can use the strength exercises from Phase 3 as a warm up before attempting these new exercises. 

The focus of these exercises is to further challenge the strength of the shoulder and neck muscles, and introduce some strength work with your arms above your head. 

Some points to consider with the exercises. 

• All the exercises should be performed in a slow and controlled manner. 
• The final exercise may be the hardest, so start off with an easy resistance and only increase if it’s pain free. You can also use dumbbells for this exercise instead. 
• To make the exercises harder you can use a band with greater resistance, or simply move further away from your anchor point. 
• These exercises should not cause a spike of pain, but you may find that there is a bit of discomfort for roughly 30 minutes after exercising, which is OK.

Return to Sport or Activity

Depending on your sport or activity of choice, you may want to perform some upper body weight bearing exercises such as a plank or press ups. It may also be suitable to do higher level dumbbell strengthening exercises to further increase your strength. 

As a general rule, try and aim for two pain-free training sessions at a reduced duration or intensity before increasing. 

For example, if you normally play 60 minutes of tennis, aim to play for 30 minutes in a non-competitive environment for two non-consecutive days. 

Having a day's rest between sessions allows you to have appropriate rest and for your body to repair and become stronger. 

Once you have found a duration or intensity you can tolerate with no flare up, aim to increase the next session by 10%. This can seem like a slow and conservative process however the research has shown this is the optimum level of increase to avoid an overuse injury. Increasing duration or intensity by more than 10% significantly increases your chance of injury, so only increase one or the other by this amount. As you will have been away from your sport for a number of months, you will have lost some of your fitness conditioning in this time and will need to build up slowly.

Over time you will be able to slowly return to your pre-injury level of activity without regressing back to any acute flare-up.