Neck pain is one of the most frustrating conditions to live with. This is many people seek help from chiropractors in Singapore.

While it may be a scary experience, you don’t have to worry just yet! Most neck aches and stiffness are very treatable, and can be addressed with an evidence-based recovery.

For those of you who have been living with neck aches or stiffness, today we will discuss everything you need to know about neck and shoulder pain:

• What is neck pain?
• What is pain?
• What causes neck pain?
• How do you know if neck pain is serious?
• Can chiropractor fix my neck pain?
• What neck pain treatments are available in Singapore?

Enjoy!

What is neck pain?

Neck pain refers to any unpleasant sensation you may have around your cervical area.

For most of you, the back of the neck region the upper trapezius (shoulder region) is where you experienced the most discomfort.

In some cases, a person may also experience headache as a result of their neck pain.

Pain is not damage!

Before we talk about your neck symptoms, it is important for you to understand that pain is complex. Your neck strains and soreness is likely an interaction of multiple physical and non-physical factors.

The latest paper published in Lancet emphasised that chronic pain is NOT an indicator of ongoing damage.

It’s common for people to assume pain equals something is damaged or broken. However, research tells us this is not the case.

To help you understand your pain better, here are quick three facts for you to keep in mind.

1. Pain refers to any unpleasant experience. This means all the soreness, aches, stiffness and tightness you experience fall within pain.
2. Pain is not an indication of damage. Most people think of pain as a sign that something wrong is going on in the body (e.g. my joints are “worn out“). This is not supported by the latest research. Pain and damage are two distinctively separate things.
3. You can have pain without damage and damage without pain. Take for example, stepping on a piece of lego. There is a lot of pain with zero damage.

For more information about how pain works, check out Pain Neuroscience Education.

Pain is like an alarm system.

Your pain works like an “alarm system”. It is a survival mechanism that is designed to warn you of actual or potential threats. However, having pain doesn’t mean there will be damage.

If you bump hard into a car and the alarm goes off, does that mean the car is being broken into?

No.

This is because car alarms don’t actually detect theft.

Car alarms detect impact. When a car alarm goes off, it means there has been sufficient impact to trigger the alarm. It doesn’t mean that the car is being broken into.

When you experiences neck stiffness with prolonged sitting, your brain interprets the sitting experience as a potential threat and gives you the uncomfortable experience.

The longer the sit for, the more intense the sensation. But does that mean there is an ongoing damage occurring?

No.

Despite how sitting is said to be bad for you, there is no research to support this!

Narratives around poor posture and text neck are not evidence-based. They are likely marketing scare tactics used to push sales.

There is no good research to suggest that poor posture is bad for you.

Who is best to see for neck pain?

The best person you can see for neck pain is an evidence-based doctor. An evidence-based doctor will be able to assess your case and help you or point you to the right person to help you.

As a chiropractic clinic, we specialise at working with spinal conditions including neck pain. Our unique approach of using exercise, education, and lifestyle coaching, within an evidence-based framework, allow our clients to get long-term results.

When should I be concerned about neck pain?

You should be concerned about your neck pain if it doesn’t go away within 12 weeks. This usually means something more serious is going on and that your condition is a chronic one.

Many chronic neck pain patients are fixated on trying to find a root cause for our neck aches and soreness. However, research tells us that there are a lot of factors that contribute to a pain experience!

More often than not, trying to find a root cause (e.g. x-rays, MRIs) lead to poorer treatment outcomes.

You may think your neck alignment is off, your poor posture is the culprit, or maybe you think there is wear and tear in your neck joints because of age. The good news is all of these are false! While it is common to read about the harm of “text neck” on social media, research has consistently shown that you don’t need good posture!

“Text neck” is nothing more than broscience and marketing fluff.

Postural strain is not to be confused with “poor posture”

Postural strain refers to being in a position that is taxing for your body for long periods. This is the muscle pain most people experience with sitting.

For example, neck and shoulder soreness from a long flight or a long drive.

It is true that may experience discomfort due to the way you are sitting for prolonged period of time. However, this sensation will subside once you are able to return to your usual posture and way of moving.

Sitting in a “good posture” position that is uncomfortable for you for an extended time will also lead to postural strain!

Why won’t my neck pain go away?

Your neck pain is not going away because you are not doing the right thing for it. If it has been more than 12 weeks, you should consider professional help.

Most people try to help themselves by doing home stretches or self-medicate. While your efforts are commendable, these strategies are often not enough for you to achieve long-term outcomes.

As a chiropractor that focuses on long-term solutions, we work with clients with chronic pain and help them develop self-management strategies. After taking a thorough medical history and physical examination, we work with you to develop an effective neck pain treatment programme.

Instead of asking you to come back multiple times a week until you feel better, we use a test-retest process to find out what’s going on. This allows us to develop a truly personalised solutions for you.

Based on how you respond to various exercises and advice, we are able to predict how your unique symptoms behave, and subsequently design a recovery programme that works just for you.

Does stress cause neck pain?

We know about the biopsychosocial model for health for some time now.

However, not many — if at all — chiropractors or physiotherapists actually address pain in a holistic, whole-person approach.

The status quo is chiropractors trying to adjust or manipulate your joints or physiotherapists trying to breakdown scar tissue or release tension.

Both structural (and problem-based) approaches are considered to be outdated not not congruent with best evidence practice.

With advancement in neuroscience, we know that people your state of mind can change how your brain process pain. Similarly, we also know that you can change your brain — even to a structural extent — with mindfulness practice.

Other research has shown that stress can make a person more susceptible to pain and it is only of the potential reasons why some people experience chronic pain.

A 2018 study looking at 2339 neck pain sufferers and 3290 healthy participants found that anxiety/depression symptoms are associated with neck pain.

A later study in 2019 examining depression and anxiety in lower back pain patients found anxious and depression patients to experience more severe pain.

In short, the neck discomfort you experience is NOT strictly physical.

Take a few minutes to consider your own experience.

Are you able to identify stressful or busy periods when you experience more severe symptoms than usual?

Acute neck pain

Occasionally, we may accidentally strain our neck muscles or sprain the joints in our necks in our day-to-day life (e.g., poor sleeping position).

This is totally normal and part of the human experience.

The sensation is usually very painful at the onset but will subside with time. Such muscle spasm and ligament pain episodes can last for a couple of days to up to six weeks. In such cases, do consider applying some load management principles to avoid aggravating your pain.

A heat pack will also help.

Current clinical guidelines suggestion avoiding bed rest and neck brace, and to keep active as much as possible.

Cervical radiculopathy

Some of you may have been told that you have a pinched nerve.

It is indeed possible for pinched nerve roots or bone spurs (e.g., narrowing of spinal canal) to contribute to your neck pain experience.

They typically come with numbness and tingling (known also as radiculopathy) down your arms.

As uncomfortable as they may sound, pinched nerve are minor problems that mostly resolve on their own with time.

If you are worried about slipped disc, understand that herniated discs will resorb over time. That is, it will “unslip” itself back into place.

For more information about radiculopathy and the various treatment approaches for that, check out our post on sciatica.

When to worry about your neck problems

Over 90% of neck pain are not serious medical conditions. While the pain may be intense and feels worrisome, most patients with neck symptoms do not need immediate medical attention.

If you experience one of the following “red flags” signs and symptoms, please seek medical advice as soon as possible:

• Unexplained weight loss or weight gain
• Unexplained fever, chills, or night sweats
• Unable to bend your neck forwards
• Loss of bladder or bowel control
• Numbness or weakness on only one side of your face, arm, or leg
• Difficulty speaking or swallowing
• Visual disturbances – sudden loss of vision, tunnel vision
• Sudden tension headache onset that is unlike those you have had before

If your neck muscles hurt for more than six weeks, you may want to consider seeking professional help from a chiropractor or physiotherapist.

Your chiropractor will be able to help you manage your symptoms.

A good chiropractor will prescribe you with exercises to give you long-term relief. They may also address the lifestyle changes (e.g. better sleep quality, more physical activity, better stress management) to help you manage your symptoms.

It is unlikely that you will need to consult a spine surgeon. In the rare cases where there may be brain and spinal cord involvement (e.g. spinal stenosis), your chiropractor will refer you to an orthopaedic surgeon or neurologist.

What exercises help neck pain?

I know your neck soreness is real and it is a distressing experience. The best thing you can do for yourself at this stage is to relax. If you are having trouble directing your attention away from your cervical spine, you might want to consider mindfulness practice.

Once you are fairly relaxed, there are a few neck pain exercises you may consider trying:

1) Resistance Neck Exercises

2) Range of Motion Exercises

3) Resisted Range of Motion Exercises

(Videos to come.)

The latest clinical practice guideline for neck injury does not support the use of pain killers.

Can chiropractors help neck pain?

The biggest difference between a chiropractor and a massage therapist or stretch therapist is the training they received. Chiropractors are musculoskeletal (i.e. muscle and joints) health experts who had undergone years of chiropractic clinical training to diagnose and treat your symptoms.

On the other hand, masseuse do no have clinical training and by extension cannot diagnose your neck pain. It is common for massage therapist to treat your pain with only manual therapy (soft tissue massage, trigger point therapy, etc).

Chiropractors are trained to provide  an array of treatments such as chiropractic adjustments, dry needling, exercise rehabilitation, physical therapy, ultrasound or laser therapy.

To become an accredited doctor of chiropractic in Australia, chiropractors trained for a minimum of five years at a university level.

How can I relieve my “stiff neck”?

If you are thinking of choosing between a chiropractor or a massage for your stiff neck, choose neither.

Believe it or not, the best treatment for neck pain is actually exercise.

While common passive treatments as such chiropractic adjustments, dry needling, IASTM, trigger point therapy are great for providing some short term relief, exercise + education/coaching is the best approach to long term pain free living.

Instead of focusing solely on pain relief, exercise therapy also takes into consideration your capacity for your current lifestyle.

A good massage may help you feel better for a few days but the discomfort almost certainly always comes back.

Forget the “stiff neck remedy”, a good exercise prescription program will address factors that contributes to your pain so you can achieve long term results.

If you spend eight hours at the computer and your neck starts to ache after two hours, a bad chiropractor or physiotherapist will ask you to spend less time at a computer.

Focus on increasing how much you can do rather than how little pain you feel.

On the other hand, good chiropractors will look at why your symptoms start after two hours and increase your capacity to sit to beyond eight hours. This can be achieve through neck strengthening exercises.

The direct result? You get less pain.

Manual therapy tend to focus on relaxing the muscle strain in neck or removing trigger points. None of these approaches are supported by current research. A paper published earlier this year on the 11 best recommendations for musculoskeletal pain advise for hands-on therapy to be used only as an adjunct.

As for what you can do for yourself at home, you may want to gentle stretching to relieve pain.

If you have a heat pack or heating pad, they tend to help with aches and soreness as well.

I do not recommend that you apply ice because evidence to support icing – even in acute or sport injury cases – is lacking.

Chiropractic treatment for neck pain

Traditional chiropractors believe that chiropractic subluxations are the common cause of neck symptoms. Their approach to your pain consequentially revolve around treatments to remove subluxations. However, no reasonable quality research to date has been able to demonstrate the existence of chiropractic subluxation.

Read more about how subluxation is dogma rather than science.

In addition to that, results with subluxation-based chiropractors tend to be slow and/or short term. It is not uncommon to hear about them selling packages from 12 up to over 40 sessions.

Unfortunately, there are few chiropractic adjustment benefits. Most of which are short-term. This may be why chiropractors who only do adjustments need to sell packages. To learn more, check out our blog post on spinal manipulation.

Chiropractor for stiff neck

Evidence-based chiropractors are completely different from the traditional chiropractors. We take into consideration the latest research on what works the best for your neck pain.

Because we are willing to adapt and embrace the latest research, we offer more than just spinal adjustments. As a result, you get better results with us than traditional chiropractors.

Square One is one of the only practices in Singapore to offer an evidence-based approach to your neck pain. Over 80% of our clients will experience resolution of their symptoms within four to seven visits. This could be you.

In your treatment program, I will take into consideration your current lifestyle (sedentary vs. athletic) and work with your goals.

If your goal is to sit at the computer for eight hours, I am going to help you achieve that.

If you have a tendency to sprain your neck during your weekly tennis games, I will work with you to address the factors that are contributing to your neck sprain.

Square One likely offers the most holistic approach to neck pain relief and we deliver true long term results.

What now?

Take your time to process what it means to be living with neck pain. If we are looking to start chiropractic treatment for neck pain with Square One, you can book an appointment with us via the form below. We are located at Bukit Pasoh Road, just two minutes away from Outram Park MRT (purple line, Dorsett Hotel exit).