Neck pain (cervicalgia): clinical framing and integrative perspective

Neck pain, also known as cervicalgia, refers to pain located in the neck region. It is part of the broader group of spinal pains and can coexist with back or lower back complaints. It is one of the most frequent musculoskeletal complaints in the adult population, with a significant impact on daily functionality, professional performance, and general well-being.

According to data widely reported by the World Health Organisation, a significant proportion of the population will experience back pain throughout their lives. In many cases, cervical episodes are acute and evolve favourably over days or weeks. Even so, the intensity of the symptoms and the associated functional limitations justify a careful clinical assessment and an approach tailored to the individual context.

Currently, neck pain is understood as a complex and multifactorial phenomenon, influenced by physical, neurological, emotional, social, and contextual components, a framework that underpins contemporary person-centred intervention models.

What is understood by neck pain

Neck pain can appear suddenly or progressively and have different characteristics, such as a feeling of heaviness, stiffness, burning or stabbing. It can be localised or radiate to the shoulders, interscapular region or upper limbs, manifest intermittently or persistently and be associated with limited movement, headaches or sensory changes.

From a clinical perspective, a significant portion of neck pain is classified as non-specific, meaning there is no single, clearly identifiable structural cause on imaging. These cases often involve multiple simultaneous mechanisms, including alterations in joint mobility, increased muscle tone, changes in movement control, and nervous system sensitisation phenomena, where stimuli that are usually neutral begin to be perceived as uncomfortable.

This understanding moves away from an exclusively mechanistic view of pain and reinforces the importance of approaches that integrate multiple dimensions of the clinical experience.

Factors such as high stress levels, irregular sleep patterns, fear of movement, prolonged posture in front of screens, or previous negative experiences associated with pain can influence the progression of neck pain. These aspects are now recognised as an integral part of clinical assessment.

Common types of neck pain and associated mechanisms

Neck pain can be related to different structures and systems, and it is common for several mechanisms to coexist:

- Cervical disc changesThe cervical intervertebral discs play a central role in impact absorption and neck mobility. In cases of disc degeneration or protrusion, local inflammatory phenomena and chemical sensitisation can occur, contributing to neck pain and sometimes radiating pain down the arm.

- Cervical root painCharacterised by pain radiating to the upper limb, which may be associated with tingling, numbness, or loss of strength. It generally results from a combination of mechanical compression and inflammatory irritation of the nerve roots. It is important to note that imaging findings do not always correspond to the intensity of the symptoms.

- Cervical facet arthropathyThe facet joints contribute to the fine control of cervical spine movement. With disc aging or postural overload, these joints can develop degenerative changes, manifesting as local pain or pain referred to the shoulders and the interscapular region.

- Myofascial painMuscles and fasciae, such as the scalenes, levator scapulae, trapezius, suboccipitals, and deep cervical musculature, play a significant role in stability and proprioception. Spasm, overload, or altered activation patterns can generate local pain and referred tension points.

- Cervicogenic headachesChanges in the mobility of the upper cervical segments or increased suboccipital muscle tone can contribute to cervicogenic headaches.

- The relationship between visceral dysfunction and neck painVisceral stimuli can influence the cervical region via neurological pathways and fascial continuities, causing increased muscle tone or referred pain in segments with the same innervation.

The evolution of neck pain varies widely among individuals. Some episodes resolve spontaneously, while others tend to become recurrent, particularly when mechanical, emotional, and contextual factors coexist.

The relationship between visceral dysfunction and neck pain

Internal organs possess physiological mobility necessary for their function. Restrictions in this mobility can influence the cervical region through fascial connections and neurological pathways. The viscerosomatic reflex describes how stimuli originating from internal structures can lead to increased muscle tone or pain in areas with the same segmental innervation, with this interaction being considered in osteopathic evaluation, particularly in persistent conditions.

Beyond neurosegmental mechanisms, there is also a mechanical continuity between the pleura, cervical spine and superior mediastinum through fascial thickenings often described as vertebro-pleural ligaments. These structures connect the pleural apex to the lower cervical vertebral bodies and the prevertebral fascia, contributing to the stability of the pleural dome during respiration.

In contexts of restricted pleural mobility or increased upper thoracic fascial tension, as occurs in altered breathing patterns, inflammatory processes or mechanical overload, tension can be transmitted to the lower cervical segments. This link should not be understood as a direct cause of neck pain, but as a possible additional mechanical contribution which, associated with viscero-somatic convergence and adaptation of respiratory motor control, may play a role in maintaining persistent neck pain.

The osteopathic view of neck pain

Osteopathy is a manual clinical practice based on the assessment of the relationships between the musculoskeletal system, fascial structures, the nervous system, and internal organs, recognising the functional interdependence between these components.

In neck pain, the process begins with a detailed assessment, which includes:

– Full clinical history (onset of symptoms, aggravating or relieving factors, functional impact)

- Postural observation and movement analysis

– Palpation of tissues, joints and musculature

– Alarm signal tracking, with forwarding when indicated

From this assessment, clinical hypotheses are formulated, guiding the approach, always adapted to the specific needs of each person.

The cervical region, due to its high mobility and integration with the visual, vestibular, and respiratory systems, is particularly sensitive to factors such as sustained posture, stress, and altered breathing patterns. It is common to observe increased stiffness in this area in contexts of prolonged tension.

How osteopathy works on neck pain

Osteopathic treatment uses manual techniques selected based on clinical findings, integrated into an individualised plan that considers the person’s overall functioning.

Depending on the clinical context, strategies such as:

– Cervical and thoracic joint mobilisations

– Soft tissue techniques targeting superficial and deep musculature

- Fascial normalisation of the cervico-scapular chains

– Muscle energy techniques

Gentle neurodynamic approaches

Low-amplitude joint techniques, adapted to individual tolerance

– Visceral integration in specific contexts

– Respiratory work, enhancing diaphragm function and autonomic nervous system regulation

These interventions are part of a broader plan which may include pain education, guidance for progressive physical activity, simple mobility and motor control exercises, as well as respiratory and self-regulation strategies.

The clinical objective is to support mobility improvement, modulate the nervous system's response and promote more efficient movement patterns, while simultaneously encouraging the individual's active participation in the therapeutic process.

Some common myths about neck pain

Ideas persist that prolonged rest is necessary or that changes observed in imaging scans always explain the pain. In clinical practice, gradual mobilisation adapted to individual tolerance tends to be associated with better outcomes, and functional assessment is central to understanding non-specific neck pain.

The clarification of these aspects is part of the health education process, contributing to more realistic expectations throughout the follow-up.

When to consider osteopathic assessment

If neck pain is persistent, recurring, or limits your movement and daily activities, it is advisable to have a proper clinical evaluation.

Osteopathic assessment can integrate frameworks for acute, subacute or persistent cervical pain, particularly when there is functional limitation or recurrence of episodes. It can be integrated with Physiotherapy, therapeutic exercise or other clinical areas, always in a coordinated manner and based on individual progress.

Understanding Osteopathy in Neck Pain from an Integrative Perspective

Osteopathy fits into current neck pain care models by combining rigorous clinical assessment, manual intervention, and health education. Embedded within a person-centred practice, it constitutes a valid approach to support the management of this common condition, respecting the complexity of its mechanisms and the uniqueness of each clinical journey.

In an Integrative Osteopathy consultation, neck pain is assessed by considering the interactions between the musculoskeletal, visceral, and cranial systems, as well as factors such as breathing patterns, sleep quality, stress levels, and movement habits. This holistic view allows for the definition of strategies tailored to individual needs, promoting not only pain relief but also functional recovery and the prevention of recurrence.