How to ease neck pain

CONTENTS

Why Neck Exercises Don’t Always Work | Good Posture and Mindful Motion
Moving with Awareness | Understanding Spinal Mechanics
Understanding Head and Neck Mechanics | The Impact of Stress
Guided Techniques for Relief | Manual Therapy
Breathing | Strengthening Exercises
Broader Lifestyle Changes | Complementary and Alternative Medicine
Medications and Medical Procedures | Conclusion

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Neck pain can be completely debilitating. I know this firsthand after 12 years of neck pain, headaches and barely being able to move my head. The common approaches to neck pain are strengthening, mobilisation and stretching. It took me years to figure out exactly what works best for me and others - and it wasn’t what you’d expect.

Here's what I've learned through working with clients and addressing my own pain.

Why Neck Exercises Don't Always Work

When my physio said all you have to do is just keep doing neck strengthening exercises I was suspicious. After six months I had a neck like a racing driver yet I was still in pain.

Studies¹ show no high-quality evidence and uncertainty about the effectiveness of exercises for neck pain. They may have their place as part of a wider pain relief strategy but done incorrectly, they may actually make things worse.

So what does doing exercises incorrectly look like?

Imagine yourself doing one of the exercises recommended by your physio. How do you feel in your body? Are you concentrating or frowning? Are you tightening your neck, jaw, or face muscles? Are you tensing your stomach muscles? Are you gritting your teeth - just enduring the movement? Is the movement jerky and uncomfortable?

Most people I work with don’t even realise they’re doing these things until I point them out. All of this behaviour sends a warning signal to your nervous system, keeping you in pain.

Good posture and mindful motion- the key to unlocking neck pain relief

Most of us have a “grin and bear it” approach to exercise. We think of it as something we have to get through to get the results we need. But all this way of approaching exercise does is create more connections in our brain between movement and pain.

When recovering from neck pain, strength and mobility are often essential, but they typically come later in the process. The early steps are about calming pain and soothing an overactive nervous system. The good news is that it’s completely possible to train yourself out of these habits and reduce your body’s ‘worry’ about movement.

By approaching movement mindfully, you can soothe your brain and nervous system, persuading yourself that movement is safe. You create a solid foundation for the next stages of recovery. At the right time, these relaxation and awareness exercises done a few minutes before strengthening can allow you to find ease and less pain in the movement.The Alexander Technique is an evidence-based way to do this.

One large study² found that the Alexander Technique resulted in a 31% reduction in neck pain, similar improvement in self-efficacy and a reduction in the dependence on pain medication. Further research³ into the Alexander Technique suggests that combining this effort reduction with the right strengthening exercises can further enhance pain relief.

This holistic approach not only alleviates current discomfort, including neck-related headaches, but also prevents future issues by going beyond posture to improve poise, a calm and composed state ready for coordinated, confident movement in everyday activities. When I use the word posture below, I’m referring to this state.

Moving with awareness - the key to unlocking neck pain relief

Awareness is the starting point for good posture, and free and easy movement.

Being aware of what is happening in your body. Developing an understanding of how you relate to gravity. Cultivating a sense of what it feels like to sit and stand efficiently, with less effort and more ease.

So how to do your neck exercises with less effort, and more ease?

My clients are often amazed by what a difference simple awareness techniques can make to classic neck mobilisations, such as turning to the left and right and looking up and down.

Physiotherapists often refer to these movements as cervical extension mobilisation, cervical flexion mobilisation, cervical rotation mobilisation, and cervical lateral flexion mobilisation. When mobilisations such as this become overly self-conscious, body-focussed and robotic-like the movements in the diagram above encourage, we create more tension and pain. We forget how natural it is to look out, really see and let the movement follow.

As Chris Worsfold, one of the leading physiotherapists specialising in neck rehabilitation, emphasises, the neck is designed to function in everyday activities like turning from side to side whilst crossing the road. Instead of solely focusing on impairment-level exercises like the ones above, rehabilitation should incorporate functional, goal-oriented movements. For example, Worsfold suggests focusing attention on external cues like "looking over your left shoulder" rather than simply "turning your head." This approach better mirrors everyday tasks and can be more effective in reducing neck pain. Try both of those cues out for yourself and see if you notice any difference.

We can take this further as well with spatial awareness.

Exercise - Spatial Awareness

It’s the practice of going from over-focus mode on , say, the screen you’re looking at, to being spatially aware. As soon as you shift your awareness your body can float upwards to find effortless good posture. This is posture training reimagined. It reactivates brain pathways for balance, connecting with whole-body systems of proprioception.

Try this exercise adapted from Loch Kelly and Penelope Easten. You will guide your attention beginning at the front of your body, then include the sides, and finally direct it behind you, creating a sense of 360-degree panoramic awareness in order to move smoothly and effortlessly. In order to do this, you're going to open your peripheral vision. Opening your peripheral vision is not moving your eyes at all. Your eyes will remain relaxed and comfortable in front of you.

You can also try an audio version of this exercise below.

Let's begin by just sitting comfortably. Now, without moving your head, bring your gaze slightly upwards to see what is behind the screen to something in front of you that is a comfortable distance away to look at.

1. Take an interest in the space between what you're looking at behind the screen and the screen, still looking slightly upwards.

2. From that space, begin to gently expand your vision on each side at the same time, beginning to feel a sense of a panoramic awareness in front and to the sides, expanding the space to the sides at a pace that is comfortable.

3. Before turning to one side, refresh this sense of the space around you and then trace a path with your eyes to one side of you resting your eyes on all of the objects and space in between, inviting the eyes not to narrow focus on objects losing the sense of space around, or jump to the next object or to glaze over. It can help to imagine a long feather or a paintbrush from your nose to what you’re looking at, brushing these as you explore what you’re seeing.

4. Are you able to smoothly move from left to right without losing the sense of space? Or glaze over and stop seeing? Or do you jump from object to object? What would it be like if you could invite more curiosity about what you’re seeing in the shapes, colours and textures of the things around you? It all gets easier if you can be curious about the objects around you, observing them with a fresh perspective and a beginner's mind.

5. An alternative is to move your index finger around the room from left to right and for your eyes to look at your finger as you turn. Let your eyes track your finger's movement, and notice how your neck follows effortlessly. Alternatively, you can use a laser pen, tracking the beam.

This exercise encourages a more natural and less forced way of moving, reducing tension and enhancing your range of motion by enhancing spatial awareness and fostering a more intuitive understanding of how to move your body through space.

So far we’ve looked at how to approach the various neck pain treatments and strategies out there and ensure they are not doing more harm than good. But what does an effective treatment plan for neck pain actually look like?

Understanding Spinal Mechanics

First of all, let’s take a look at what is happening on an anatomical level.

Your neck is part of your spine. The spine does not function as a collection of separate, independent parts but as a whole unit, with each part affecting the others. Our spine contains over a hundred joints, including those in the ribs, and these are all synovial joints that get their nutrition and lubrication through movement.

Unfortunately, very few people move their spine through its full range of motion daily. Some, but not enough, physio exercises recognise the importance of finding good posture and poise before performing exercises, and spinal mobility is often overlooked in neck pain treatment.

Understanding Head and Neck Mechanics

Your head acts as a keystone for your body. It pivots atop the neck at the uppermost spinal joint, located at earlobe level in the middle of your head. The head's centre of gravity lies both in front of and above this point, causing it to naturally nod forward. This delicate balance is maintained by tiny muscles. When this balance is disrupted, these small muscles can't support the weight, forcing the larger neck muscles, like the trapezius, to overwork, leading to tension and stiffness.

The head weighs between five and six kg, yet before we got into neck pain when we were moving well, it felt like it weighed nothing at all. We lose the sense of lightness and freedom of our head so often because we get caught up in our thoughts while sitting or standing for too long. When we become rigid under pressure or feel down and collapsed, our head and neck lose balance. Some of us pull our head forward, slump, look down, or twist to one side, often due to repetitive activities like using a computer mouse.

Try sitting or standing up straight, holding yourself up. Feel the effort and push that comes with this, notice what happens to your head and neck, and then let that go. Now try collapsing forward, then pushing up, and notice what happens to your head and neck.

Early Steps: The Impact of Stress and Calming the Nervous System

In various studies with neck pain that Woolsford cites show that “people were found to be getting less quality and quantity of sleep and were working in jobs with high strain. They were also less physically active and had depressed mood. Their bodies are essentially experiencing greater stress and they notice more “muscle tension” in their neck.”

All of this compounds your structural misalignments further. Stress doesn’t just weigh on your mind—it impacts your body, too. It’s so common for stress to manifest as physical pain that we even have an expression for it—“(s)'he’s a pain in the neck.”

Under stress, those five to six kilos of your head can scrunch down onto your neck. The constant strain of feeling overwhelmed, overthinking, and overscheduling can send your body into a cycle of collapse and rigidity as you hold yourself up. This misalignment often comes with habits like pulling your shoulders up, squeezing them together, or slumping forward.

But here’s the reality: a few minutes of exercises each day won’t resolve these deeply ingrained postural patterns linked to stress. There are rarely quick fixes or magic cures. True change happens when you tackle both the emotional and physical aspects together. By addressing the psychological stresses and the physical habits they create, you can make lasting improvements and find genuine relief from neck pain. I’ll talk more about lifestyle changes towards the end of this piece.

Although there are so many ways to destress, here’s the best way I know to move towards ease quickly wherever you are. On your next inhalation of breath, breathe in through your nose. When you've comfortably filled your lungs, take a second, deeper sip of air to expand your lungs as much as possible. Then, make a sigh as if all of your work is finished for the day and you can relax.

When you’ve done that, then do the same two-part inhale, then very slowly, exhale through your mouth as if you’re breathing through a straw. After one or two of these deep breaths, you may already feel a little calmer.

Being more calm can help us feel more grounded, centred and present, so it’s great to do before and at the start of an important meeting or presentation, or before you do any neck exercises that we’re coming onto.

Guided Techniques for Relief

Verbal, manual, and self-touch guidance can make all the difference to be able to move more naturally again. With the right cues, many people experience their neck becoming free, moving forward and up away from their spine, lengthening and widening, supported by grounded feet allowing movement through the legs. It’s inspiring to see people realise the rapid changes they can make when they say, “Wow, that took five minutes. I feel pretty good right now.”

When it comes to choosing exercises, finding exercises personalised to someone’s unique alignment that they can practice in day-to-day activities is the most effective approach.

A regime of neck exercises that are just something else to get done on your to-do list can be the cause of more stress, tension, and pain. Instead, approaching how your body works as a whole and incorporating neck strengthening and mobilisation exercises into your daily movement means you can better feel the benefits of these exercises, whilst ensuring your nervous system remains calm. This next one is adapted from Penelope Easten.

EXERCISE - Unlock your neck by “unscrunching” your head, balance it atop your spine

1. To locate the point where your skull rests on top of your spine, put your middle finger on the bony outcrop under your ears and your thumb resting on your shoulders below.

2. Move your middle fingers up while your thumb stays where it is.

3. Next, imagine there is a feather attached to your nose gently brushing what’s in front of you like we did before or perhaps a paintbrush if you prefer, or imagine a raindrop on the top of your nose slowly rolling down.

4. As it does so, let the head very gently roll forward in sync with this raindrop. Notice the movement coming from somewhere between your hands. Notice the neck lengthening up and the front of the body lifting. Perhaps you can notice the whole spine lengthening, feeling more balanced.

5. Bring your head back up with the use of whatever image you are using and try that a few more times. Can you make it more subtle? Can you be more sensitive to the movement?

6. Then allow your eyes to see the room and turn from side to side, noticing how that feels now.

EXERCISE - Achieving softness and your full natural height

This is an exercise from my teacher Judith Kleinman. First, get back your sense of spatial awareness we practiced above.

Now, think "up and easy," allowing your body to be soft on the support of the chair or ground, and tall.

If you’re slumped forward, gently release upwards to your full height with your head leading your torso. If you’re over-lifted and puffing your chest out in a military-style posture, allow your sit bones to re-anchor downwards to let go of the pushing forward and rigid holding up. You’re looking for that fine balance between being tall whilst being soft on your support in order to create a poised body ready for movement or stillness.

Can you notice any difference in ease and a sense of being in balance?

Now turn from side to side in the same way as before, tracking with your eyes. Do you notice a difference?

EXERCISE - Incorporate Mewing, from Dr. John Mew and his son, Dr. Mike Mew:

• Tongue Position: While performing the above exercise again, place the entire surface of your tongue against the roof of your mouth, just behind your front teeth. Ensure that the back of your tongue is also gently resting on the palate. Avoid pressing too hard, and instead focus on a light, consistent contact that supports the natural shape of your upper jaw.

• Swallowing: As you go through the gentle head and neck movements, practice a slow, deliberate swallow. Ensure that your tongue maintains contact with the roof of your mouth throughout the swallow. This action will help activate the muscles that support your neck alignment.

EXERCISE - Using your hands for relief

When you place your hands on your neck, they can assist too. Neuroscience tells us that the hands have a large representation in the brain's motor cortex, making them highly sensitive and capable of fine control. This connection allows your hands to act as a catalyst for smooth and easy motion, using their intelligence to guide and support your neck movements.

Try this exercise:

1. It's comforting to first place your non-dominant hand on the place of pain on your neck and send some love to that area (this is not soft and pointless, but a scientifically sound strategy to reduce pain).

2. Play around with where you place your hands to allow this to happen. It can help to cradle that part of your neck as if you were supporting a baby or patting a loved animal. For some people, imagining the eyes of a kind person, be it someone you know well or not, can really help this on. Can you notice a difference? Has your neck softened?

3. Now, without losing that quality of care in the touch, allow your hands to lead the turn to one side like you were doing earlier. The trick is to let your hands move and adapt to where they can help the movement most.

4. Turn your head from left to right, letting your hands lead and asking, "How can this be easier?" Your hands will naturally figure out how to make the movement as easy and comfortable as possible.

5. Experiment with where to place your hands, how many fingers to use, and whether more or less pressure helps.

6. Adjust the height of your fingers and change the angles. Is it better to have two hands turning at the same time?

7. Now, try the same looking up and down. Place your fingertips below the base of your skull to initiate this movement. You can also place your hand at the back of your skull and imagine the space between your nose and the back of your skull.

8. Imagine this space as fully as you can and, without losing this, look up and down. Do you notice any difference in the movement? Is it smoother, easier, more balanced?

Approaching Manual Therapy With More Ease

If you’re not seeing much benefit from these exercises, then it probably means that our spine including our neck is too tangled up and knotted to allow these movements. Manual techniques such as myofascial release, High-Velocity Low Amplitude (HVLA), joint manipulation, massage, joint articulation and traction, visceral and Craniosacral techniques, along with self-care techniques, can provide immediate relief and free you up to do them much more effectively⁴.

These techniques work on a mechanical level, by relaxing tight and overactive muscles that may be causing pain. However, this relief will usually only continue if you can reproduce some of the effects yourself, alongside addressing the underlying neuromuscular patterns that are at the root cause.

A skilled manual therapist can help you identify the areas that are not moving so well and help you understand how to mobilise your neck effectively. You can then replicate some of these techniques, but again, they will only be effective if you can approach them with a sense of relaxation and ease. Often the best way to achieve this is to first find a lying down position that truly brings you ease. Here are some ideas.

With a bit of creativity, you can then transition to and from these positions to doing manual therapy from a place of relaxation and ease. Then you have to find the right position and tools to find release.

Ensure you maintain a heightened awareness during these movements to stay attuned to what feels beneficial, avoiding overexertion or strain.

Breathing is Movement: How to Breathe With Less Tension

You can get the most rest and pain relief when you use these lying-down positions combined with breathing.

Breathing naturally acts as a gentle massage for our bodies, all provided naturally. The ribs connect to the spine at the back, creating an expansive, widening movement when we breathe freely. Often, we only think of breathing as happening in the front of the body, but our lungs are three-dimensional, and the breathing movement occurs in all directions, including our armpits and sides. Try to tune into the sensation of your back widening and releasing as you breathe in.

In the presence of neck pain, we tend to breathe using our neck muscles or upper chest instead of our diaphragm. Like neck strengthening exercises, specific exercises such as belly breathing often add tension on top of tension as we try to get it right and in the process get in the way of natural movement.

Rather than focusing on more exercises and techniques we have to get right, creating further tension and pressure in the body, instead, we find indirect ways to breathe with less tension and more ease, starting with where we are right now.

EXERCISE - Hands-on connection with the breath

This is another exercise from my teacher Judith Kleinman. Hands-on connection is an incredibly comforting way of reconnecting with natural breathing.

Try this with exercise with your eyes closed if you feel present and comfortable doing so.

1. Place your hands on your belly and just below the breastbone to feel the connection to breathing and movement in the front of your body.

2. Next place the front or back of your hands on your sides and enjoy feeling the movement expanding outward.

3. Return to a quiet sense of your breath expanding gently in all directions, allowing yourself to be soft in your support and tall as you breathe out.

4. If this is uncomfortable at all for you then you can do this lying down.
   

EXERCISE - The wave of breath

Another easy way to start reconnecting with natural breathing mechanics is to use metaphors and images such as synchronising your breath with the rhythm of waves.

Here’s how it works:

1. Get comfortable, close your eyes and imagine the movement of your breath as ocean waves lapping onto the shore.

2. Inhaling is like a wave rising up the beach, while exhaling is like the wave receding.

3. Synchronise your breath with the image of ocean waves. Breathe in and out through your nose if possible.

4. Let the wave of movement begin low around your belly and release up through your body.

5. Allow this easy breathing to happen naturally, tuning into the rhythm of your body, helping you feel restored and at ease.

EXERCISE - Rolling over in a chair to reset your spine

Getting some space from your workstation and rolling over in a chair is a great way to reset your spine.

1. First, look at the image to know where we are heading in the movement

2. Sit in a chair with your legs hip-width apart, ensuring you are grounded through your contact points with the seat. Take a moment to notice this grounding.

3. Look at the diagram of the head in the image above leading the movement down, which is what you will be doing now. Look above your computer screen into the distance and then track with your eyes what you can see in front of you, moving downward. Let your eyes lead your head until you are hanging over your legs. Only go as far as feels easy and come back up whenever you want if it’s not comfortable. Sense the length and ease of your spine.

4. Notice your belly releasing forward into your legs and your back widening as you breathe. Become aware of the weight of your head and let it release further.

5. Before coming back up, don't rush the process. When ready, look at your tailbone at the bottom of your spine. Keep looking down as you roll gently back up to sitting with some help from your legs, pushing through your feet into the ground, as though slowly stacking your vertebrae. Don't rush.

Strengthening exercises leading to functional movement

Research shows that for some people, especially those working long hours at a desk, specific exercises targeting neck and shoulder strength and motor control can help. In my experience, these are especially effective when combined with posture and functional activities, such as how to move your arms at a desk. it’s often highly personalised what needs to be strengthened and worked more and what needs to be worked less.

The most common pattern I see is office workers with overworked muscles like the scalenes and upper trapezius that need a break. To address this, specific exercises aimed at controlling the neck flexor and extensor muscles, as well as those in the shoulder region, are particularly effective when integrated into posture and functional activities that connect your arms to your back, including activating the lower trapezius, whilst using the mouse and typing.

As Chris Worsfold emphasises, the neck plays a key role in everyday activities like "smelling the coffee" or "observing traffic," and rehabilitation should reflect these natural movements. Instead of focusing solely on impairment-level exercises, incorporating goal-oriented, functional activities early in the process can better restore normal movement patterns and alleviate pain.

Exercises from practices like Anatomy in Motion and Qigong⁴ can be helpful when combined with verbal and manual guidance tailored to the specific exercises like we did above to allow fluid movement. 

Broader lifestyle changes

Lifestyle changes, like destressing, incorporating more exercise—such as walking—and sleeping more can protect against neck pain. These improvements are enhanced when paired with greater comfort through awareness and movement exercises.

For example, one of my clients, Kate, experienced neck pain while walking. After observing her, I saw she walked with a forward-head posture. By first taking a step back to break the habit and then orientating towards a spatial awareness like we did earlier, she was able to maintain awareness of her posture and reduce pain while walking.  Additionally, improving her sleep through better sleep positions and aids allowed for better rest and recovery, further reducing her neck pain.

Complementary / Alternative Medicine Approaches

These approaches combine the best of nutritional, complementary and lifestyle treatments with the above approach to provide care for the whole person: mind and body. 

Acupuncture is an ancient Chinese practice backed by a robust evidence base. Dietary supplements often contain vitamins, minerals, herbs, or other natural substances that are believed to support overall wellness and alleviate symptoms. While the effectiveness of these approaches may vary from person to person, they're often worth a try if you can afford the extra spend. It's important to ensure safe and effective integration with conventional therapies.

Medications and medical procedures

When you're uncertain about the cause of your neck pain, consulting a doctor is essential to rule out any underlying pathologies. 

The following have some evidence to support them include:

• Medications: NSAIDs and muscle relaxants can help manage pain and inflammation. Opioids should be used cautiously.
  
• Trigger Point Injections and Nerve Blocks: Target specific pain sources and are effective for chronic pain.
• Epidural Steroid Injections: Reduce inflammation around spinal nerves, particularly useful for radiating pain.
• Radiofrequency Ablation (RFA): Disrupts nerve signals to alleviate chronic neck pain.

When used well, these medical approaches serve by taking the edge off the pain, reducing bracing, and enhancing your freedom to move offered by these approaches above. These medical approaches can complement non-medical strategies like the Alexander Technique for a comprehensive treatment plan.

Making Neck Pain Relief Simple

Hopefully, some of the exercises and ideas above have already helped you release some tension and find some relief from neck pains, aches, and strains.

If you’d like to know more about how to use mind-body approaches like the Alexander Technique to move with more ease, awareness, and without pain don’t hesitate to get in touch, or take a look at how my Pain Treatment Plans could help you.

REFERENCES

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2. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med. 2015 Nov 3;163(9):653-62. doi: 10.7326/M15-0667. Erratum in: Ann Intern Med. 2016 Feb 2;164(3):204. doi: 10.7326/L15-0020. PMID: 26524571.
3. Tim Cacciatore, “Beyond Posture Correction: Exploring How Alexander Technique Reduces Chronic Neck Pain,” Alexander Technique Science: Peer-reviewed Research on Mind, Movement, and Posture, 29 July 2024, accessed 13 August 2024, https://alexandertechniquescience.com/biomechanics/beyond-posture-correction-exploring-how-alexander-technique-reduces-chronic-neck-pain/
4. Walker M, Boyles R, Young B, Strunce J, Garber M, Whitman J, Deyle G, Wainner R. The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain. SPINE. 2008;33(22):2371-2378
5. Wiedemann AM, von Trott P, Lüdtke R, Reisszlihauer A, Willich SN, Witt CM. Developing a qigong intervention and an exercise therapy for elderly patients with chronic neck pain and the study protocol. Forsch Komplementmed. 2008 Aug;15(4):195-202. doi: 10.1159/000148211. Epub 2008 Aug 15. PMID: 18787328.