Have you ever woken up with a stiff or “kinked” neck? From personal experience, nothing derails your day like a sudden unexpected inability to turn your neck or find a comfortable position to sit or stand upright.

 

Up to 70% of people will experience bout of neck pain in their life.  And bad news for those of you 35-50; neck pain seems to target you folks the most.

 

Trauma to the neck, such as a car accident, workplace or sports injury can certainly be a cause of neck pain, but more frequently we get “I’m not exactly sure what caused this”. There are a lot of contributing variables and it’s not always clear what was the straw that broke the camel’s back.

 

Pain that can be localized and aggravated by certain movements is called mechanical neck pain in medical terminology. Often times sudden loss of neck mobility may be part of this clinical picture. Mechanical neck pain can be simply thought of as pain coming from the muscles or joints of your neck that is triggered by (to use Dr. Stu McGill’s terminology) postures, positions and loads affecting your neck.

 

What is the best treatment strategy for mechanical neck pain?

 

We know several things for sure about managing these bouts of neck pain.

1. Staying active is important. Bed rest or use of neck collars do not help your recovery.

2. Exercises for range of motion and strength of the neck, upper back and shoulder blade are helpful. A Cochrane review from 2016 concluded that specific strengthening exercises of the neck, scapulothoracic and shoulder region are beneficial.

3. Recovery is faster and more effective when exercise is combined with manual therapy.

The combination of manual therapy and exercise, is recommended by both the American Physical Therapy Association Clinical Practice Guidelines and the Canadian Chiropractic Guideline Initiative

 

There is some conflicting evidence that dry needling (acupuncture without electrical stimulation) into myofascial trigger points can be helpful in managing neck pain.

 

So authors of a recent study published in the Journal of Orthopaedic and Sports Physical Therapy in March 2024 set out to compare dry needling and manual therapy to determine which is more effective.

 

This was a well designed and adequately powered (78 participants) randomized controlled trial that gave everyone the same 5 commonly used exercises for neck pain and then randomized them to either a dry needling or manual therapy group.

 

The exercises used in this study were: 1) upper trap stretch 2) deep neck flexor stabilization exercise 3) rotation range of motion 4) mid trapezius (“T”) exercise and 5) lower trapezius (“I” exercise).

 

7 sessions were conducted over 6 weeks for people who on average had their neck pain episode for 21 weeks. 15 minutes of the treatment was allocated for the exercises and 15 minutes was allocated for either the dry needle acupuncture or the manual therapy.

 

I love these types of pragmatic study designs as they closely reflect the clinical use of these treatments and thus give us a better real world answer to the question.

 

Results were measured with several outcome measures, but the primary outcome measure was a functional scale we commonly employ in the clinic called the NDI (Neck Disability Index). The NDI (among other outcome measures) was given at baseline, 2 weeks into treatment, at the end of the 7 sessions and a 3 month follow up.

 

To the authors surprise (according to their hypothesis!), there was a clear benefit at all measured time points for the use of manual therapy over dry needling.

 

 

 

Graph A shows the functional improvement using the neck disability index (NDI) and Graph B shows the improvement on pain levels using the Numeric Pain Rating Scale (NPRS).

 

Both groups improved in the first two weeks. However, the manual therapy group improved faster and to a greater extent with respect to functional improvement and pain reduction. But more importantly, the manual therapy group demonstrated longer term sustained improvements. Whereas the dry needling group regressed to poorer levels of functional ability and higher levels of pain at the 3 month follow up.

 

This is a no brainer. Manual therapy combined with some basic exercises is more effective than dry needling and the same basic exercises.

 

To see some of the manual therapy considerations utilized in this study, check out the following you tube video.

 

The results of this well designed, clinically relevant study demonstrate that hands on care, manual therapy, needs to be prioritized over dry needling acupuncture.

 

For quicker, more sustained results for your neck pain, you need to find yourself some good hands on help. In our opinion it matters less what discipline they’ve been trained and lisenced in: massage therapy, Physiotherapy, Chiropractic or Osteopathy and more that they know what to do (up to date on the latest evidence) and how to do it well (have the experience and skillset).