Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be

The physio will ask about the location and nature of the pain. Neck problems often involve other areas and the presence of shoulder and arm pains will tell the physiotherapist what kind of pain they are dealing with. Sharp, localized pain on movement could be joint sprain, generalized neck ache a postural or segmental problem and severe arm pain could be a nerve root compression from a disc prolapse.

Many illnesses and conditions can be associated with cervical problems so the physios review the past medical history, general health, loss of weight, normal control of the bowel and bladder, normal appetite, drugs use and quality of sleep. The physio will then ask the patient to disrobe and examine the posture of the thoracic spine, cervical spine, arms and shoulders. Poor posture is very common, with a rounded trunk, rounded shoulders and a poking chin being the most common combination.

Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physio understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.

Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough t