Avin Patel

Neck Pain

As with lower back pain, there are a number of causes for neck pain that your osteopath can help with.

Neck pain: muscles, joints, discs, and ligaments commonly involved

Muscle pain

One major cause of neck pain is tight or strained muscles. Any prolonged position will be uncomfortable for muscles in the short term. If this position becomes a usual position over days and weeks, the muscles will adapt for efficiency. This means shortening, or tightening the muscles that are rarely stretched.

There is an increased demand on muscles when the head is not held in a neutral position. Looking down at a phone or low computer screen puts as much of a requirement through the neck as if your head was twice as heavy- or more.

Muscles will also react to other causes of pain as the body tries to protect itself. Most people with neck pain will also have some tightness in the neck, regardless of the original cause. This can lead to headaches.

Joint pain

Off to the side of each vertebra is a joint that connects it to the one above, and another that connects it below. These joints are small but they can be quite painful if irritated. Sometimes they might lock up in response to a problem with another structure in the neck, which can cause muscle tightness that perpetuates the cycle. The tight muscle keeps the joint stiff, so the discomfort causes the muscle to stay tight. We have a range of techniques from gentle cranial techniques and acupuncture to quick manipulations.

Neck pain from arthritis

Osteoarthritis and rheumatoid arthritis can both affect the small joints of the neck. Even when it’s uncomfortable, one of the best things you can do to manage this is keep it moving. It can be really helpful to see your osteopath for guidance with this. When we are in pain, we might worry about causing damage if we push through the pain. Osteopaths can help you find a good balance of movement and discomfort to manage the symptoms of your arthritis.

Intervertebral discs

Like back pain can be caused by a problem with a disc, the same is true in the neck. If the fibrous outer layer of a disc is weakened (which is not unusual), the soft layer inside can push against it and cause a small bulge. Discs themselves are not as sensitive as things like muscles. It is possible to have a disc bulge without any symptoms at all.

If the bulge pushes on a nerve, it can cause pins and needles, numbness, weakness, or pain. The lower nerves leaving the neck actually supply the arms, so a “trapped nerve” in the neck could be the cause of symptoms in the hand. Only the first few nerves in the neck supply the head, and when they’re irritated they can cause headaches.

Disc problems sound worse than they are. We work to find the original cause of a bulge, which may be something further afield like stiffness in the upper back. By addressing issues that have caused the disc to overwork in the first place, we give the disc space to heal and reduce the chance of it happening again.

Ligament sprains

This can be as simple as a cricked neck, or the cause may have been more traumatic. Mild ligament sprains are classified as an injury where under 10% of the ligament’s fibres have been damaged. They tend to resolve within a month, but you’re welcome to make an appointment to try and speed up recovery or work out why it happened in the first place.

More significant ligament sprains can take a few months to heal. Blood supply to ligaments is poor, which limits their capacity to recover quickly. However your osteopath can work around the whole area to help keep fluids moving and give the injury the best environment possible to heal.

It is important to keep moving your neck even after an injury. Neck braces and collars are not recommended for the vast majority of neck sprains. Loading the tissue within a safe limit will encourage the fibres to knit back together stronger.

Managing neck pain

All four of these structures are within your osteopath’s remit. We have a range of techniques to suit any patient with any problem: we don’t just “click necks”! If you prefer a more gentle approach, we can provide that too.

An important part of your treatment plan will include self management. Alongside your diagnosis and prognosis, we can advise you on how to manage between appointments with an exercise plan and other advice.

See how we can help with your neck pain, book in now.


How do stress and tension affect the musculoskeletal system? Some people are aware of tightness in their shoulders before they even register that they are stressed. Others say they hold their stress in their hips. Whatever the case, there are some muscular effects of of tension that we see frequently in clinic.

Examples of tension manifesting in the MSk system

Breathing under Stress

A common change to breathing in times of stress is to “upper rib breathe”. This means the abdomen is no longer moving as it should, and the so called “accessory muscles” of breathing (AMoB) in the shoulders are over-recruited. The body copes quite well with this in the short term, but if it goes on for too long it can cause all sorts of aches and pains.

People often don’t notice when they’re upper rib breathing, so this can go on for quite some time undetected.

The diaphragm

It’s easy to forget that the diaphragm is just another muscle. It attaches to the bottom of the rib cage, all the way around, and its role is to move to inflate and deflate the lungs. But just like any other muscle, it can become tight and restricted. Of course, you still need to breathe, so other muscles take over. These muscles are not cut out for this kind of work, so they get sore. This can manifest as transient or recurrent aches around the upper back and shoulders. For anxious people, these strange aches and pains can cause more stress, and the cycle continues.

Breathing exercises and hands on treatment can make a start to improvement to the flexibility of the diaphragm and provide some reassurance. We can look at the relationships between all of these areas and get everything moving again, but the stress management is up to you!

Tension and the Jaw

Along with changes to breathing, another common response to stress is teeth grinding. This can happen without you realising at all, or you might start noticing a tight feeling around the jaw. Both an osteopath and a dentist can help you here.

In times of tension, you may also subconsciously change your posture, adopting a more hunched position. This can be directly related to stressful computer work or more of a change in body language. Either way, they can both affect the jaw as shown in the diagram below.

The effects of tension on head position and the jaw

That change of posture makes the jaw want to open, but most of us won’t walk around with an open mouth. This means those same muscles that overwork with tooth grinding have to overwork to keep the mouth shut.

(Not just Tension) Headaches

Combined changes in head position and tightness through those accessory muscles of breathing means a lot of change around the neck.

All these changes in the neck can cause another problem! Cervicogenic headaches (CHGs) are headaches that originate in the neck, from irritated nerves or tight muscles. Alongside the tightness caused by stress itself, changes in breathing can cause overuse of smaller muscles in the neck and shoulders. Either of these causes could lead to a CGH.

Tension-type headaches (TTH) are different, but often confused with cervicogenic headaches. One key difference in their symptoms is that TTH are typically a generalised ache on both sides of the head, whereas CGHs tend to stay on one side.

If you feel that tension is causing your aches and pains, make an appointment to address it.


Poor circulation can cause pins and needles, numbness, and pain in the affected tissues. Localised issues with circulation can be due to mild problems with muscles causing compression. If the causes are more serious, your osteopath can refer you on to somewhere more appropriate.

More widespread symptoms can be a sign of something more systemic going on.

Problems with circulation due to injury or lymphoedema

Post injury swelling

After a sprain or similar injury, we tend to try and minimise inflammation and swelling, but it is there for a reason. In the early stages, inflammation brings in nutrients to help heal the area. However, this swelling is not helpful when it’s static for long periods. As nutrients enter the injured tissue, waste products leave- but if they stay nearby and aren’t flushed out, they prevent the flow of new nutrients in.

Some areas of the body are easier to encourage circulation than others. The calf works as a pump when we walk to push blood back up towards the heart, so walking or calf exercises can be useful to clear swelling in the ankle and knee. Other areas respond best to hands on techniques.

Heat and ice can be advised by your osteopath where appropriate. Cold compresses encourage blood vessels to constrict, whereas warmth encourages them to dilate. Repeating one after the other simulates a pumping mechanism.

Poor circulation due to Lymphoedema

When blood enters a cell, it leaves in two parts. Some makes its way back to the veins, and some ends up as lymph. Lymph is fluid that bathes cells, allowing for nutrient and waste exchange. It flows through the lymphatic system, through lymph nodes (what we know colloquially as “glands”) before re-entering the venous system at the top of the chest.

Lymphoedema literally means “lymph swelling”. A common cause of this is after cancer, when lymph nodes have been removed through surgery or damaged by radiotherapy. For patients who have had lymph nodes around the armpit removed due to breast cancer, lymphoedema can affect the arm.

Managing lymphoedema is an important task. If the cause is surgical, you should be managed with Decongestive Lymphatic Therapy in the early stages. Once this is under control, you can be left to manage the symptoms yourself. Self massage is a big part of this, and your osteopath can help.

Vascular Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome can affect vascular circulation

The thoracic outlet is the space around the front of the shoulder where nerves and blood vessels pass between the ribcage and arm. A number of muscles and other structures in this area can compress the nerves or blood vessels and cause pain, numbness, or pins and needles into the arm.

The most common form of TOS is neurological, but in 3-10% of cases it can be blood vessels that are compromised. Although most vascular TOS cases require referral back to the GP, your osteopath will be able to differentiate between the two types and support you in getting the right care.

You should seek urgent care from your GP or hospital if your arm symptoms include:

  • white or blue skin
  • swelling
  • cold skin

For more mild cases of vascular TOS, and for neurological TOS, your osteopath can work to reduce the compression around the area. This may mean working to strengthen the upper back muscles, relaxing off the chest muscles, or identifying other causes of your symptoms.

If you have problems with your circulation, book an appointment to see how we can help.

Tennis Elbow

Tennis elbow is the common name for lateral epicondylitis. Although it can start as a simple muscle injury, the word “epicondylitis” tells us it’s become a bit more complicated. This means there’s inflammation where the end of the muscle meets the bone at the elbow.

Typical symptoms include pain and tenderness in the forearm and side of the elbow, especially during activity. This pain can also lead to a feeling of reduced strength. The inflammation can cause some swelling around the side of the elbow which is tender to touch. The body may also start compensating subconsciously. This might mean causing strains elsewhere in the arm or wrist as you move differently to avoid discomfort.

Tennis Elbow and Golfers Elbow

As the name suggests, tennis elbow can be a form of sports injury, but it doesn’t come on suddenly. Repetitive aggravation of the wrist extensor muscles irritates the junction between bone and muscle and causes localised pain and tenderness.

However, you don’t have to play tennis to develop this injury. Other sports can cause it in the same way, or even more innocuous things like carrying heavy shopping bags can bring it on. If left unmanaged it can develop beyond the usual muscle strain.

How your osteopath can help

Diagnosing tennis elbow is easily done, and although it can be a slow condition to rehabilitate, your osteopath can work with you to resolve it.

Relaxing off the muscles will reduce the pull on the bone and begin to let the whole area calm down. Your osteopath might also want to work more generally around the elbow, wrist, and shoulder to keep everything working well together. Advice for reducing or managing inflammation may also be appropriate.

Understanding the cause of the episode is important, especially if this is something that keeps coming back.

Tennis elbow vs golfer’s elbow

You may have heard of golfer’s elbow, another form of epicondylitis. Golfers elbow affects the medial epicondyle in the same way as tennis elbow affects the lateral epicondyle. Tight muscles or injury lead to inflammation around the muscular-bony junction. As before, you don’t have to play golf to develop it.

Repetitive overuse of the wrist flexor muscles predispose a person to developing golfer’s elbow. Playing a sport with a thin handle that requires you to grasp tighter can sometimes be enough to irritate the area, and prevention might be as simple as wrapping it with a thicker grip. Your osteopath can advise you on this.

The sooner you can address your tennis elbow, the better the prognosis. Book an appointment today.