Physiotherapy for Neck Pain: Effective Approaches and Treatments

Physical therapy offers exercises, advice, and sometimes manual therapy to reduce cervical pain—that is, neck pain—and make it easier for you to carry out your daily activities. A 2021 review of European guidelines—documents that summarize recommended care—supports these options. The evidence supporting these recommendations is weak or moderate; they must be tailored to your situation¹. A 2017 Danish guideline recommends supervised exercises and manual techniques—performed by hand—over medication for recent neck pain lasting less than twelve weeks. Its recommendations are based on weak evidence or expert opinion².

At Physioactif, our physical therapists treat patients with neck pain every day. Your physical therapist will explain the recommended treatment, the potential benefits, and any limitations based on your evaluation. To understand the causes and symptoms of neck pain, check out our comprehensive guide to neck pain.

Neck pain can interfere with sleep, work, or movement. Exercises have been studied, in particular, among adults whose pain persists without a specific identifiable cause³. A 2024 study surveyed 609 nurses and paramedics in northeastern Poland⁴. Recurrent pain was reported by 29.5% of paramedics and 9.3% of nurses. This cross-sectional study assesses each person at a single point in time. It shows associations with certain work and health characteristics, without proving that they cause the pain. These prevalence rates do not represent the entire population.

Why Consider Physical Therapy to Treat Neck Pain?

Physical therapy can reduce neck pain and improve daily functioning through a tailored program, without resorting to surgery right away. The choice depends on the symptoms and the evaluation.

Among adults with nonspecific chronic pain—pain that persists without a specific identified cause—certain exercises reduced pain and daily difficulties more than no treatment. The certainty of the evidence was very low: further studies could change these estimates³. Medications, physical therapy, and other options should be discussed based on your needs, their benefits, and their risks.

Non-surgical treatments and situations in which surgery should be considered

Non-surgical treatment may combine exercises, advice, manual techniques, and medications selected based on your specific situation. Surgery may be discussed if certain neurological symptoms are severe or worsening, or if treatment does not result in sufficient improvement. The spinal cord is the bundle of nerves in the spine that transmits messages between the brain and the body. A nerve root is the portion of a nerve that emerges from the spinal cord.

Two 2025 trials compared surgery with non-surgical care in 180 people with radiculopathy, a condition affecting a nerve root that causes symptoms in the arm, among other things. One focused on a herniated disc, in which part of the cushion between the vertebrae protrudes. The other focused on spondylosis, age-related changes in the discs and joints. At 12 months, surgery led to greater improvement in functional ability in the herniated disc group: the average difference was 7.4 points out of 100, which was below the 15-point threshold defined by the trial as significant. The spondylosis trial did not show a clear difference⁵.

A 2024 review included two other trials, involving a total of 117 people. It generally found no clear difference in arm pain or daily functioning, except for certain specific or long-term outcomes. Surgery resulted in greater improvement in neck pain, loss of sensation, and perceived recovery, but the evidence for these findings was uncertain⁶. The decision should therefore be based on your diagnosis, symptoms, and goals—not on an image alone.

How is a physiotherapy assessment for the neck conducted?

The initial evaluation includes a discussion of your symptoms, an assessment of your range of motion and strength, and nerve tests if necessary. The physical therapist will explain the findings and the proposed treatment plan to you. Please confirm the duration of the appointment with the clinic.

What happens during the first visit

Your first appointment begins with questions about your health. The physical therapist wants to understand when the pain started, how it has progressed, and what makes it worse or better. They are also interested in your daily activities, your job, your past health issues, and your treatment goals.

The physical examination follows this discussion. The physical therapist observes how you move your neck in all directions. They test your muscle strength, assess your posture, and check the mobility of your cervical joints. Neurological tests evaluate whether your nerves are involved, especially if you have pain or numbness in your arms. The tests focus on strength, sensation, and reflexes—automatic muscle responses. A review published in 2025, based on research completed in February 2024, reports that the content and accuracy of the neurological examination vary greatly from one study to another⁷. A 2018 review concludes that data on the accuracy of physical tests of the neck remain limited⁸. Certain tests may support the hypothesis of a compromised nerve root, but a single test result is not sufficient to reach a definitive conclusion. The results must be interpreted in conjunction with the person’s medical history, multiple tests, and, if necessary, imaging.

Tests and Measurements Used

The evaluation is used to identify movements, symptoms, and limitations that guide the treatment plan.

What are the main physiotherapy techniques for the neck?

Patient education, therapeutic exercises, and manual therapy are the most commonly recommended approaches for neck pain. A review of European guidelines—the documents that list recommended treatments—shows that these approaches are frequently mentioned¹. The same guidelines also mention medications, psychological support, and care provided by a team of professionals. The choice depends on the individual’s profile and assessment. These approaches are combined based on your specific needs. Each treatment plan is tailored to your assessment results.

Manual therapy

Manual therapy encompasses techniques applied by hand to the neck and surrounding areas. It can complement exercises to reduce pain and facilitate daily activities. A 2025 Cochrane review, which systematically evaluates trials, included nine trials and 694 participants, most of whom had persistent pain. At around four weeks, the combination improved pain by about 2.4 points out of 10 and functional ability compared with no treatment. Compared with a sham treatment, improvement in functional ability was still possible, though no clear difference in pain was demonstrated. The evidence was uncertain. Read the review on manual therapy and exercises.

Joint mobilization is a guided movement of the neck. It can be tried for a specific movement or symptom and then reevaluated based on the observed effect.

Manual muscle work may be used to relieve discomfort in a sensitive area. The physical therapist will assess its effect on your pain or on a specific movement before continuing.

Cervical traction applies a pulling force to the neck, either by hand or using a device.

Dry needling involves inserting thin needles into muscles without administering an injection, particularly in sensitive areas⁹. A 2020 review compiled twenty-eight trials on this technique; the results depend on the comparison, measurement, and time frame studied¹⁰. A trial involving 77 adults compared the needles to a sham injection, both of which were used in conjunction with exercises and manual therapy. It found no additional benefit from the needles regarding pain or functional ability up to one year. Both groups showed improvement over the course of follow-up.

Therapeutic Exercises

Exercises are the part of treatment that you do on your own, between sessions and after treatment is complete. The exercises can be continued or adjusted based on your symptoms, your abilities, and your goals.

In adults with chronic nonspecific neck pain, several types of exercises improved pain and functional ability compared with no treatment³. The 2020 review included 40 randomized trials, in which participants were randomly assigned. It combined direct and indirect comparisons between treatments. The favorable results pertained to strengthening, movement control, and programs such as yoga, Pilates, tai chi, or qi gong. No single type stood out as clearly superior to the others. The very low certainty suggests choosing based on your goals and how you respond.

Strength-training exercises can be selected and adjusted based on your symptoms, your abilities, and the activities you want to do.

Understanding the Problem and Participating in Care

Information about pain helps people discuss their symptoms, activities, and care options. A review published in December 2023 compiled eleven studies of programs in which people learn to manage their symptoms. These programs improved pain levels, activity levels, and certain pain-related concerns¹¹. They often combined information, exercises, or manual techniques: the results cannot be attributed to information alone. Another review reports that structured information alone does not yield significant benefits compared to other forms of care¹². Small, short-term benefits were still possible when it supplemented physical therapy, particularly after whiplash—a sudden movement of the neck during an impact.

Concerns and context can be part of the assessment; their importance and how they are addressed vary from person to person.

What is the McKenzie approach and how does it work?

The McKenzie approach assesses how your symptoms respond to repeated movements and certain positions to guide tailored exercises. The physical therapist also takes your medical history and other exam findings into account.

The basic idea is simple: some movements make your pain worse, while others make it better. The therapist has you perform repeated movements in different directions. Some movements may alter your symptoms during the exam; however, the interpretation of these movements alone does not determine the treatment.

When pain that was radiating down the arm moves closer to the neck during the examination, the physical therapist notes this change. The ability to predict the course of the condition has been studied primarily in the lower back; data for the neck remain limited¹³. The 2018 review does not establish that this sign can determine which treatment will work best. It can supplement the evaluation but should not dictate the treatment plan on its own.

The McKenzie approach includes exercises that you learn to do on your own between sessions. A 2023 review included 11 trials, involving a total of 677 adults. It found an additional average reduction in pain of 1.14 points out of 10 compared with the control treatments, with no clear benefit regarding daily functioning¹⁴. In five trials where the average baseline pain was at least 5 out of 10, the favorable difference reached 2.06 points. This result compares study groups; it does not predict your individual response. Follow-up periods were mostly short, and the comparators varied. A 2004 review found only one trial on the neck, in which the McKenzie method showed benefits similar to those of another exercise program¹⁵.

How many physiotherapy sessions are needed?

There is no set number of physical therapy sessions for neck pain. The treatment plan is tailored to your symptoms, activities, and goals. Chronic cases may require ongoing care that is reassessed based on your progress.

You’ll work with the physical therapist to determine which changes to monitor and when to schedule a follow-up evaluation. If your symptoms or activities aren’t progressing as expected, the therapist will revise the program, identify any obstacles, and discuss other options. A worsening of symptoms or the appearance of new neurological signs requires a more prompt evaluation.

Is physiotherapy covered by insurance in Quebec?

Physical therapy may be covered in Quebec depending on the type of care setting, your insurance, and the rules of the relevant plan. Care provided in the public system is covered by the government; access depends on the facility. In private clinics, the terms vary depending on your contract or an eligible public plan. Read the terms of access and reimbursement.

In Quebec, direct access to a physical therapist has been recognized since 1990. You can see a physical therapist in a private clinic without a referral, although your insurer may require one for reimbursement. Read the historical overview from the Quebec Professional Order of Physical Therapy. Also review the rules of the SAAQ and the CNESST before incurring any expenses.

When should you request a reevaluation or seek medical care?

A reevaluation is necessary if the pain worsens, if your activities are limited, or if new neurological symptoms appear. Severe pain that persists despite the treatment plan may also warrant a medical consultation. Some conditions require a combination of treatments or a different intervention.

Signs That Require Urgent Medical Attention

Seek urgent medical attention if you experience any of the following symptoms:

• Sudden, severe neck pain or pain that worsens rapidly
• Heaviness or weakness in the arms or legs
• Tingling accompanied by pain in the neck or arm
• Pain between the shoulder blades in this context

Signs That Call for 911

Call 911 if you notice any of the following signs:

• New difficulty walking
• Incontinence of urine or stool
• Sudden loss of coordination, such as a new difficulty buttoning a shirt
• One side of the face is sagging
• Inability to keep both arms raised
• Difficulty speaking

Even just one of these signs may be enough. Don't wait to schedule an appointment. Learn to recognize the signs that indicate urgent care is needed.

Options are discussed with the relevant professionals based on the diagnosis, symptoms, functional abilities, and goals. For more information on nerve compression, see our guide.

The doctor and physical therapist can discuss medications, tests, or a surgical referral together when they are indicated. Your preference and the expected benefits are taken into account in the decision.

What results can I expect from physiotherapy?

Physical therapy can reduce pain, improve mobility, and help you resume your activities. The results depend on the specific problem and the treatment plan. Some types of pain go away; for others, the first sign of progress is being able to sleep better or move more easily, even if some pain remains.

Many cases of neck pain improve within a few weeks, but some persist or recur. This general guideline does not predict how many sessions you will need. If the pain does not subside after a few weeks, if medication is not helping, or if you are concerned about your condition, seek medical advice. Read the tips on how neck pain progresses.

How can you reduce the risk of future episodes of neck pain?

Exercise can reduce the risk of another episode of neck pain, though it does not guarantee that it will never happen again. A review of five trials examined participants who were pain-free at the start. Two trials on exercise, involving a total of 500 people, showed a reduced risk, with moderate certainty; one combined exercise with other measures. Three trials on task and workplace adjustments did not show a clear reduction¹⁶. Postural habits can be adjusted for comfort without requiring a “perfect” posture. A review of 21 articles found insufficient evidence that leaning the neck forward while looking at a screen alone causes pain¹⁷. The exercises studied for pain that is already persistent address a different question: treating current symptoms³.

Maintenance Exercises

After your sessions, maintain an exercise routine that’s tailored to your activities and how your body responds. Also, adjust your breaks based on the tasks and positions your neck can handle.

Daily Habits

Workstation setup can be adjusted based on comfort, tasks, and symptoms; the impact of these changes is then reassessed.

Stress Management

If stress is interfering with your sleep, your daily activities, or your exercise routine, talk to your physical therapist. You can discuss relaxation techniques or a tailored treatment plan. Stress alone does not account for all cases of neck pain.

How does physical therapy address specific neck problems?

Physical therapy tailors movements, exercises, and their progression to the symptoms in the neck, any nerve damage, and medical recommendations. The goals may include regaining range of motion, reducing pain in the arm, or resuming an activity. Our guides explainwhiplash and torticollis.

After a car accident, the resumption of movement is determined following an evaluation and reassessed based on symptoms and the instructions received. See our guide on whiplash.

When neck pain radiates down the arm, the evaluation may include guided neck and arm movements, followed by a reassessment based on your symptoms and abilities. For more information, read our guide on cervicobrachialgia.

Osteoarthritis—joint changes associated primarily with aging—may be visible on an imaging study without fully explaining all the symptoms. Twelve follow-up studies found no consistent link between neck imaging findings and future pain; however, some isolated results showed associations¹⁸. Another review estimated that asymptomatic spinal cord compression was visible on imaging in about one in four healthy adults. The prevalence increased with age and varied across populations¹⁹. These imaging findings must be interpreted in conjunction with symptoms and physical examination. See our guide on cervical osteoarthritis.

What are some frequently asked questions about cervical physical therapy?

Frequently asked questions about cervical physical therapy include discomfort, manual therapy, choosing a practitioner, access without a prescription, wait times, and how the body responds to exercises.

Is it painful to see a physiotherapist for your neck?

Some techniques may cause temporary discomfort. If you experience significant pain, let your physical therapist know so they can adjust or stop the technique.

Can a physiotherapist crack my neck?

Some physical therapists use manipulation techniques that can produce a cracking sound. A critical review of the literature examined the joint noise heard during manipulation—that is, a brief, rapid thrust applied to a joint. A cracking sound may accompany the technique, but this review highlighted the lack of research on this noise²⁰. This 1996 review focuses on methods for recording and analyzing the sound, without assessing its relationship to pain relief. You have the right to refuse a manipulation. The practitioner must explain the potential benefits, risks, and other options. Neck manipulations carry a rare risk of serious complications; studies do not fully document these events. Read the review on mobilizations and manipulations. Gentle mobilizations and exercises can also be discussed based on your preferences.

Should I see a physiotherapist or a chiropractor?

Physical therapists and chiropractors can treat neck pain. In a 2014 international survey of 360 clinicians, exercises and manual therapy were among the two practices²¹. Physical therapists reported using certain exercises, pain education, and other strategies more frequently. Chiropractors reported performing rapid joint manipulations more often. These are practices reported by the respondents; they do not constitute evidence of the superiority of one profession over another. Approaches vary: ask what treatments are offered, why, and what other options are available.

Can I see a physiotherapist without a medical prescription?

Yes. In Quebec, you have been able to see a physical therapist directly at a private clinic since 1990. However, an insurance company or public health care provider may require a prescription, depending on its policies. Be sure to confirm the reimbursement requirements before receiving treatment. See our guide on physical therapy.

How long before you see improvement?

Some types of pain improve within a few weeks, but the timeframe varies depending on the issue. The physical therapist will monitor your pain and activities with you. A lack of progress will lead to a review of the treatment plan; a new neurological symptom or worsening of symptoms requires prompt consultation.

Can neck exercises make my pain worse?

Exercise may cause temporary discomfort. Reduce the intensity or stop the exercise if the pain increases significantly or remains more severe afterward. Seek advice before continuing. If a new nerve-related symptom appears, follow the medical instructions provided above.

References

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2. Kjaer P, Kongsted A, Hartvigsen J, Isenberg-Jørgensen A, Schiøttz-Christensen B, Søborg B, et al. National clinical guidelines for the non-surgical treatment of patients with recent-onset neck pain or cervical radiculopathy. Eur Spine J. 2017;26(9):2242-2257. (Back to section: 1)
3. de Zoete RM, Armfield NR, McAuley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic nonspecific neck pain: a systematic review with network meta-analysis of 40 randomized controlled trials. Br J Sports Med. 2020. (Back to sections: 1, 2, 3, 4)
4. Citko A, Górski S, Marcinowicz L, Mateusz C, Matylda S. Nonspecific cervical spine pain/neck pain among medical personnel in northeastern Poland—A cross-sectional study. Front Med (Lausanne). 2024;11:1466370. (Back to section: 1)
5. Taso M, Sommernes JH, Sundseth J, Pripp AH, Bjorland S, Engebretsen KB, et al. Surgical versus Nonsurgical Treatment for Cervical Radiculopathy. NEJM Evid. 2025;4(4):EVIDoa2400404. (Back to section: 1)
6. Klein Heerenbrink S, Coenen P, Coppieters MW, van Dongen JM, Vleggeert-Lankamp CLA, Rooker S, et al. (Cost-)effectiveness of personalized multimodal physical therapy compared to surgery in patients with cervical radiculopathy: A systematic review. J Eval Clin Pract. 2024;30(7):1227-1238. (Back to section: 1)
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19. Smith SS, Stewart ME, Davies BM, Kotter MRN. The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis. Global Spine J. 2021;11(4):597-607. (Back to section: 1)
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