Neck pain presentations we commonly see

Cervical physiotherapy at our Mooloolaba clinic addresses a range of presentations that are often grouped together despite being mechanically distinct:

  • Mechanical neck pain — stiffness and localised pain without referral, usually driven by facet joint or disc irritation at one or more cervical levels
  • Cervicogenic headache — headache that originates from the upper cervical spine (C0–C3), typically one-sided and provoked or altered by neck movement or sustained postures
  • Whiplash-associated disorder — post-MVA neck pain with associated features that may include headache, jaw pain, dizziness and upper limb symptoms
  • Cervical radiculopathy — arm pain, numbness or weakness caused by nerve root compression in the cervical spine. Often misidentified as a shoulder problem
  • Upper crossed syndrome — a postural imbalance pattern with overactive upper trapezius and pectorals, underactive deep neck flexors and lower stabilisers — very common in desk workers and commonly linked to chronic neck pain and tension headaches

Cervicogenic headache vs other headache types

Cervicogenic headache is one of the most commonly missed diagnoses in primary care. It accounts for approximately 15–20% of all headache presentations, yet many patients presenting with it have been told they have tension headache or migraine and treated accordingly — without addressing the cervical source.

Key features that distinguish cervicogenic headache from other types include: pain that starts in the neck and radiates forward, provocation by neck movement or sustained posture, restricted cervical range of motion (particularly rotation at C1/C2), and tenderness at the upper cervical joints. The flexion-rotation test — where restriction of more than 10 degrees compared to the unaffected side is a positive finding — is a reliable clinical indicator.

We use Motion IQ testing to objectively measure cervical range of motion at baseline and track it through treatment. Improvement in C1/C2 rotation is one of the clearest measurable markers of recovery in cervicogenic headache.

Physiotherapy for neck pain and cervicogenic headache

Treatment depends on the specific presentation but typically includes a combination of:

  • Cervical joint mobilisation or manipulation — targeted at the restricted or irritated segments identified on assessment
  • Soft tissue therapy — addressing the suboccipital muscles, upper trapezius and cervical extensors that are typically overloaded in both neck pain and cervicogenic headache
  • Dry needling — particularly effective for the suboccipital and upper trapezius trigger points that refer pain into the head
  • Deep neck flexor rehabilitation — progressive strengthening of the longus colli and longus capitis, the deep stabilisers of the cervical spine that are consistently inhibited in chronic neck pain
  • Postural correction — addressing the sustained postures that load the cervical spine throughout the day, particularly in screen-based workers

Whiplash rehabilitation

Post-whiplash physiotherapy requires a graded approach. In the acute phase, the priority is pain management and maintaining gentle movement without provocation. As the acute phase settles, active rehabilitation of the cervical and thoracic spine takes over. Motion IQ testing is particularly useful in whiplash cases — cervical range of motion deficits are well documented and providing objective measurement of the deficit (and its resolution) is valuable both clinically and for any medico-legal documentation required.

We also screen for vestibular involvement post-whiplash — post-concussion and post-whiplash dizziness is a separate but related presentation that our physiotherapists can assess and manage. Read about our vestibular physiotherapy service.