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Neck Injuries

Wry Neck

The term “wry neck” describes a condition whereby the neck suddenly becomes stiff and painful.  Turning the head to the side (usually one side more than the other) and looking up can cause a severe “catching” pain.  The muscles on one or both sides of the neck may also go into spasm and pain may be felt from the base of the skull right down to the shoulder blade and outwards to the top of the shoulder.


There are numerous causes, the most common being:

  • Poor sleeping posture.
  • A sudden flicking or jerking of the head
  • Viral Infection.
  • Exposure to cold breezes.



In most cases if treated immediately, wry necks respond exceptionally well to treatment in 3-4 days. Mobilisations and heat are applied to loosen the neck joints and reduce the pain and muscle spasm.



  • Go out in the cold without being well wrapped-up.
  • Hold the neck still without moving it.
  • Sit or lie with the neck in an awkward position


  • Keep warm.
  • Use a hot water bottle wrapped in a towel or hot showers for pain relief.
  • Keep your neck moving within the limit of pain.
  • Take pain medication if your pain is severe.






Whiplash is the term used to describe injuries caused by the sudden change of direction of the movement of the head. This is most commonly seen in Car Accidents, but can also occur in other situations.

When you are hit by another car your head will continue to move forwards as it takes a few microseconds for your neck muscles to react and stop this movement. The muscles have to work extremely hard to stop your head and protect your neck and often your ligaments will also be stressed, especially with higher speed crashes.

Consequently the muscles, ligaments and joints can become extremely sore and stiff. Even what appear to be relatively minor car accidents can cause a whiplash due to the forces involved in these sorts of accidents.

Symptoms can include;

  • Pain in the neck and/or upper back.
  • Tenderness to touch in these regions.
  • Restriction in the range of movement in your neck.
  • Headaches.
  • Blurred Vision.
  • Dizziness.



Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.



Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome (TOS) is a difficult condition to describe as the symptoms are variable. TOS is caused by compression of the nerves and/or blood vessels as they leave the neck to enter the upper limb.

TOS causes pain, pins and needles, and sometimes numbness down the arm and into the hands and fingers (usually the little and ring fingers).  A feeling of weakness or heaviness of the upper limb may also be felt as well as pain in the neck, shoulder blade, chest and facial region.  Rarely symptoms of colour changes and / or swelling in the hand may also be present.   Usually pain is aggravated by holding the arm up in a raised position for prolonged periods (such as hanging up the washing), carrying things by your side, sitting for a prolonged period of time (such as using the computer) or lying on your side at night. So with this long list of aches and pains and other assorted symptoms, which may or may not be present, TOS can be a difficult condition to diagnose.

The cause of TOS is usually multifactorial and can be a combination of the way you were born (such as an extra rib in your neck, which isn’t that uncommon) and acquired factors (such as muscle weakness due to overuse, trauma or poor posture).  The pain is usually created by the shoulder girdle drooping, creating a pulling force on either the nerves or blood vessels of the upper limb (or a combination of both nerves and blood vessels being involved).

Your doctor and physiotherapist will assess you to determine what is contributing to your TOS symptoms and this may involve some further tests.


Most often TOS can be very well treated with a combination of shoulder blade taping or bracing, shoulder girdle strengthening exercises and postural correction. Some of these exercises and taping techniques are very specific and need to be closely supervised by your physiotherapist and doctor.  Some modification of activities may be required for a short period until symptoms are under control.

Usually patients are significantly improved within 3 months provided they are correctly managed and comply with the advice and exercises from their treating practitioners. In some patients an ongoing home exercise programme is required.

For more information contact us


Studying, A Pain In The Neck

Yes it’s that time of year again when students throughout Western Australia are hitting the books hard and sitting through long stressful exams. It’s hardly surprising, that so many of them get headaches, back and neck pain.

The combination of sitting, which we know is one of the worse postures for your back and neck, along with the use of computers, and leaning over books is made even worse by the added stress that exams inevitably cause.

Stress tightens the muscles, particularly around the neck and upper back and this just adds more pressure to joints and muscles already strained by prolonged sitting.

Headaches, neck pain, back pain, and even arm pain can all be attributed to these problems.

Posture usually doesn’t help the situation with many students already being somewhat rounded in the shoulders.

The final nail in the coffin comes with the lack of exercise that inevitably happens whilst studying for exams. This is usually the thing that keeps people supple and avoids headaches, back and neck pain, but during exams is restricted due to time.


  • Regular study breaks not only help concentration, but also help avoid back and neck pain.
  • Stretching and mobility exercises during study breaks will help to get the circulation going, as well as take the pressure off joints and muscles that are strained hunching over desks.
  • Regular physical exercise and activity help concentration and memory retention, but also assist in avoiding headaches, back and neck pain.


The last thing you want is a headache, back pain, or neck pain whilst going through some of the most important exams of your life. Your Physiotherapist from Physiotherapy4u will be able to accurately assess and treat any these problems and quickly get you back on track.



Can Driving Be A Pain In The Neck?

What’s the worse job for back and neck pain; LONG DRIVING.

This may surprise many people who thought that jobs involving lifting or hard labour would be the worse. The problems with truck driving, in particular long distance truck driving are a combination of the worse things for your back. The worst of all is prolonged sitting.

Studies show that sitting puts at least 50% more pressure onto the discs in your lower back then standing does.  This by itself is not a problem as the spine is magnificently designed to withstand these pressures and significantly more. However, the problem comes from being stuck sitting for prolonged periods of time, without changing position. It is this constant increase in pressure, which causes the damage.

Discs, joints, and all the tissues in your back need regular movement to stay healthy and painfree.  Movement stimulates circulation, which is vital for the wellbeing of all of the body’s tissues.

Combining increased pressure with lack of movement is a deadly combination. Add to this the heavy lifting usually required at the end of a long run when unloading, the very long hard hours, and the lack of time to exercise, and its little wonder that back pain is so common in truck drivers.

But you don’t even have to be driving a truck for these problems to exist.  Driving for even half and hour without movement or even sitting at a desk for half and hour without movement can gradually lead to problems and possibly pain.





This in combination with regular exercise is the best way you can avoid back pain and you can avoid driving your back pain.

For more information, contact us


Headaches Can Be A Pain In The Neck

Headaches are one of the most difficult conditions in general practice. They are often the most disabling and limiting of conditions most people experience.

Recent research released at an international conference in Perth offers answers for at least some of the many headache sufferers. Professor Gwen Jull of the University of Queensland released the findings of an Australia wide multi centre study carried out over two years. This trial compared a number of common treatments for headaches and the resulting improvements in the patient’s condition.

Two hundred subjects suffering from headaches for longer than six weeks were randomly assigned to four different groups.  The control group received no specific treatment, and the other three groups received either

Specific physiotherapy mobilisation to the neck. A new form of specific low load exercises for the deep neck flexors. A combination of physiotherapy and low load exercises.

The results of this study showed that those clients receiving specific physiotherapy mobilisations, the low load exercise, or a combination of these two managements, all showed significant improvements in comparison to the control group. The combination of the two therapies was shown to be better than either of the treatments individually.

Not only this, but the improvements were shown to be lasting over a 12 month period.

In comparison it was found that the medication levels of clients undergoing these form of treatments dropped significantly, whereas the control group increased their medication intake over time.

The other interesting finding was that the majority of patients with cervicogenic headache reported that the headache pain was worse than the pain in their neck.

Significant benefits were still derived even if the symptoms have existed for many years prior to receiving this form of treatment.

This research is the first of its type in the world, and gives guidance to practitioners in dealing with this very difficult and disabling problem.  It offers hope for those suffering from headaches no matter how long the problem has existed.



Headaches: Research Into Treatment

Evidence Based Management of Cervicogenic Headaches shows that

Manual Therapy and Specific Exercises are beneficial for Cervicogenic Headaches

In 2009 noted Researchers Bogduk and Govind, found that the treatment of cervicogenic headaches with;

  • Manual therapy,
  • Specific exercises, or
  • Manual therapy plus exercises


Are “significantly more effective at reducing headache frequency and intensity than was no specific care”.

At 12 month follow up, about 76% of the patients treated with these approaches achieved more than a 50% decrease in their headache frequency.

Combination of Exercises and Manual therapy is Especially Beneficial for Cervicogenic Headaches.

Jull et al (2002) found that in treating patients with cervicogenic headaches, both manipulative therapy and specific exercise significantly reduced headache frequency and intensity.

With the combination of the manual therapy and the exercises, 10% more of the patients gained relief.

It was shown when using manipulative therapy alone, muscle performance of craniocervical flexion failed to improve.

Thus there is a need for a specific exercise intervention to target muscle control of the cervical region.

Too late? Too chronic?

Interestingly, Jull et al (2002) identified that the length of headache history was not a determinant of treatment effectiveness.

The subjects in the study had symptoms that were chronic in nature, with average length of symptoms 6.1 years. As identified above they still gained significant benefit from the treatment.

Physiotherapists at LifeCare would be happy to discuss any aspects of managing patients with cervicogenic headaches.


  • N. Bogduk, J. Govind. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. The Lancet Neurology, 2009;8:959-968.
  • Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., Emberson, J., Marschner, I.C., Richardson, C. A randomised controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 2002; 27:1835-1843.


Cervicogenic Headache

There is widespread support in the literature that headaches are often multifactorial in their origins. If your assessment reveals poor posture, limited range of cervical spine movement, palpatory tightness or a reproduction of symptoms on cervical palpation you may consider referring to physiotherapy. Even a short trial period of treatment is often useful to help with differential diagnosis provided medical review is arranged if symptoms remain unchanged.


Treatment is guided by signs and symptoms but the literature supports a 2 phase programme:

  • Mobilization of the upper cervical spine

Improvement in symptoms of cervicogenic headache have been shown with attention to pain provoking structures (Edeling 1994, Jull 1994b, Schoensee 1995). However, whilst improvements were gained in the short term there was a plateau after mobilization.

  • Muscle Re-Training

Specific exercises isolating the deep flexors and addressing postural dysfunction. In a study by Beeton and Jull(1994) it was found by incorporating these into a more comprehensive programme that improvements were maintained six weeks after treatment had ceased.


Edeling J (1994): Manual Therapy for Chronic Headache (2nd ed.) Oxford: Butterworth- Heinemann.*Jull GA(1994b): Headaches of cervical origin. In Grant R(Ed.): Physical Therapy of the Cervical and Thoracic Spine (2nd ed.) New York: Churchill Livingstone).

Schoensee SK, Jensen G, Nicholson G, Gossman M and Katholi C (1995): The effect of mobilization on cervical headaches. Journal of Orthopaedic and Sports Physical Therapy 21(4): 184-196.

Physiotherapy4u Physiotherapists are involved in a comprehensive ongoing education programme including the management of acute and chronic headaches.



Cervical Headaches


Cervical headaches are one of the types of headaches people experience and between 15-20% of all headaches are thought be cervical in origin.


Nerves that supply much of the scalp, forehead and base of the skull also supply the joints and tissues of the upper neck Therefore: a problem in the upper neck = a headache


  • Limitations in neck movement.
  • Tenderness and stiffness around the neck.
  • Headache in the base of the neck, base of the skull or frontal head region.



  • Muscle tension in the neck head and jaw region.
  • Poor posture especially when working at a desk.
  • Trauma such as a car accident.
  • Poor sleeping position.



Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.