What causes neck pain?
Neck pain originates from a surprisingly compact area. Seven cervical vertebrae, eight pairs of spinal nerves, multiple layers of muscle, and a network of ligaments all occupy the small space between skull and shoulders. Pain can arise from any of these structures, and the cause determines the treatment.
The most common presentation Sarah Monaghan, BSc DC with over 20 years of clinical experience and GCC-registered chiropractor, sees at Costa Health is mechanical neck pain. This involves restricted, painful movement in one or more cervical segments, often with associated muscle spasm. It typically develops gradually from sustained postures, repetitive strain, or poor sleeping positions, and it responds well to manual treatment.
Cervical disc herniation is less common but more disruptive. It produces sharp pain that radiates into the shoulder, arm, or hand, sometimes with numbness or tingling in specific fingers. A disc bulge at C5/6, for example, characteristically causes pain and weakness in the bicep and numbness along the thumb side of the forearm. These patterns help identify the affected level before any imaging is considered.
How are neck pain and headaches connected?
One of the most under-recognised causes of persistent headache is the neck itself. Cervicogenic headaches originate from dysfunction in the upper cervical spine, particularly the C1-C3 segments, and refer pain into the base of the skull, behind the eye, or across the temple. A landmark RCT by Jull et al. (2002, Spine), confirmed by a 2019 Cochrane review, demonstrated that spinal manipulation combined with exercise produced significant improvement in cervicogenic headache frequency and intensity.
Patients often don’t connect their headaches to their neck. They’ve been managing with painkillers for months or years, sometimes receiving a diagnosis of tension headache or migraine, when the primary driver is a stiff, irritable upper cervical segment. The distinguishing feature is usually reproduction of the headache pattern through manual palpation or movement testing of the neck. If pressing on the C2/3 facet joint reproduces the familiar headache, the diagnosis becomes clear.
At Costa Health, chiropractic adjustment of the upper cervical spine is the primary approach for cervicogenic headaches. Osteopathy offers an alternative for patients who prefer gentler mobilisation techniques, using articulation and cranial approaches to address the same segments. Both disciplines are effective, and the choice often comes down to patient preference and response.
Why does phone and laptop use cause neck problems?
The average human head weighs approximately 5 kg. When the neck is in neutral alignment, the cervical spine supports this load efficiently. But for every 15 degrees of forward head tilt, the effective load on the cervical spine roughly doubles. At 45 degrees, the typical angle when looking at a phone, the neck muscles are working to support the equivalent of 22 kg (Hansraj, 2014).
Remote workers along the Costa del Sol are particularly prone to this. Laptop screens sit below eye level, forcing sustained cervical flexion. Phone use adds further strain. The pattern is predictable: suboccipital muscles shorten and tighten, deep neck flexors weaken, the upper thoracic spine stiffens into flexion, and the shoulders round forward.
This doesn’t happen overnight. It develops over months, sometimes years, of accumulated postural strain. By the time pain appears, the movement pattern is well established. Treatment needs to address both the painful structures and the postural habits maintaining them.
Sports massage targeting the suboccipital muscles, upper trapezius, and levator scapulae provides immediate relief from the muscular component. Chiropractic or osteopathic treatment restores mobility to restricted cervical and upper thoracic segments. Rehabilitation then focuses on retraining the deep neck flexors and scapular stabilisers, the muscles that hold the correction between appointments.
Does pillow choice really matter for neck pain?
More than most people realise. The cervical spine has a natural lordotic curve, a gentle forward arc, that needs support during sleep. A pillow that’s too high pushes the neck into sustained lateral flexion (for side sleepers) or forward flexion (for back sleepers). Too low, and the neck falls into the opposite position. Either way, six to eight hours in a poor position produces stiffness and pain by morning.
A common misconception is that the most expensive pillow is the best one. In practice, the right pillow depends on sleeping position. Side sleepers need enough height to fill the gap between the shoulder and the side of the head, keeping the cervical spine level. Back sleepers need a thinner pillow that supports the lordosis without pushing the head forward. Stomach sleeping places the neck in sustained rotation and is best avoided entirely if neck pain is an issue.
Sarah Monaghan advises patients to test pillow height simply: when lying on your side, your nose should be roughly in line with your sternum. If you’re looking down at the mattress, the pillow is too high. If you’re looking towards the ceiling, it’s too low. Memory foam or latex pillows hold their shape better through the night than feather or hollow fibre alternatives, though personal comfort matters too.
How does Costa Health treat neck pain?
Assessment always comes first. Sarah Monaghan uses a combination of orthopaedic testing, neurological screening, and manual palpation to identify which structures are involved and whether the problem is mechanical, discogenic, or referred from elsewhere.
For mechanical neck pain, chiropractic adjustment of the restricted segments is typically the fastest route to improvement. Specific, controlled manipulation restores joint play and reduces muscle guarding. Most patients notice improved range of motion within the first one to two treatments. According to a 2012 Annals of Internal Medicine trial, spinal manipulation was more effective than medication for both acute and subacute neck pain at 8, 12, 26, and 52 weeks.
Osteopathic treatment approaches neck pain through articulation, soft tissue work, and muscle energy techniques. These methods suit patients who prefer lower-force treatment or who have conditions that make high-velocity manipulation less appropriate, such as osteoporosis or inflammatory arthritis.
Manual therapy and dry needling address the muscular component directly. Trigger points in the upper trapezius, levator scapulae, and sternocleidomastoid muscles are common contributors to neck pain and headache patterns. Releasing these alongside joint-focused treatment produces more complete and lasting results.
When should neck pain prompt urgent assessment?
Most neck pain is mechanical and resolves with appropriate treatment. But certain presentations require prompt medical review. Pain following trauma, particularly a road traffic accident or fall, should be assessed for cervical fracture or ligamentous instability before any manual treatment begins.
Progressive weakness in one or both arms, changes in coordination or balance, or difficulty with fine motor tasks (buttoning a shirt, writing) may indicate cervical myelopathy, compression of the spinal cord itself. This is distinct from a nerve root problem and requires specialist referral rather than manual therapy.
Neck pain accompanied by severe headache, high fever, and neck stiffness that prevents the chin from touching the chest warrants emergency assessment to rule out meningitis. This combination is rare, but recognising it quickly is critical.
For the vast majority of neck pain presentations, Costa Health’s multidisciplinary approach, combining chiropractic, osteopathy, sports massage, and targeted rehabilitation, resolves the problem efficiently and equips patients with the knowledge and exercises to prevent recurrence.