Conditions · Neck
Neck pain,
and what's driving it.
Most necks that come through the door are not injured. They are stiff, guarded, and doing too much of somebody else's job — usually after weeks of desk work, poor sleep, or a shoulder that stopped pulling its weight months ago.
That matters, because a neck that hurts because it is overworking needs something different from a neck that hurts because it is damaged. Working out which one you have is the first appointment.
01 · The differential
What's usually behind it.
Mechanical neck pain — the everyday kind, not the kind that follows an accident — tends to come from a handful of places. They overlap, and most people arrive with more than one.
Joints that have stopped moving well
The neck has small joints at every level, and when a few of them stiffen the rest have to compensate. Often felt as a specific spot that catches on turning, or a range of movement you've quietly stopped using.
Muscles guarding something else
A muscle that has gone tight and protective is usually working around a problem rather than being the problem. That's why I go looking for what it is protecting before I try to release it.
The load your day puts on it
Desk height, screen position, how long you hold a phone, how you sleep. Rarely the whole story, frequently the reason it keeps coming back after it settles.
The shoulder girdle below it
The neck and the shoulder blade share muscles and workload. A shoulder that isn't moving properly hands its work upward — and the neck is where you feel it.
02 · The wider picture
The neck is rarely just the neck.
The neck is unusually dense with the receptors that tell your brain where your head and body are in space, which is why I treat it as a hub rather than a part. When it isn't moving well, the effects tend to show up outside it — most commonly in the shoulder girdle and down the arm.
It runs the other way too. A shoulder problem that keeps returning after local treatment is one of the more common reasons I end up examining a neck that the patient never mentioned, because it wasn't hurting.
Headaches that start in the neck are a related presentation and a common reason people come in. They are their own subject and I'll cover them separately.
03 · The appointment
What actually happens.
A new patient appointment is 45 minutes. History first — when it started, what you do all day, how you sleep, what you've stopped being able to do, and whether anything else has been grumbling. Then the examination: how far the neck moves in each direction and what stops it, joint-by-joint assessment, orthopaedic and neurological testing where warranted, and an examination of the shoulder girdle and upper back.
I'll also test how muscles are firing, because a neck that is tight on one side and weak on the other tells a different story from one that is simply stiff. Then I explain what I've found, and we agree what to do about it.
04 · The honest answer
Chiropractor or physiotherapist?
It is the question people actually want answered, and most sites avoid it because they sell both. I don't, so here is a straight answer.
There is more overlap than either profession usually admits, and the individual practitioner matters more than the letters after their name. Broadly: physiotherapy tends to lead with graded exercise and loading, and is often the better fit after surgery, after significant injury, or where a structured strengthening programme is the main thing you need. My work leads with hands-on joint and soft-tissue assessment, and suits a neck that is stiff, guarded and not responding to stretching or exercise alone.
If what you need is a rehabilitation programme rather than hands-on work, I'll say so and point you to someone good. That isn't modesty — sending you to the right place is the fastest route to you getting better, and it's how I'd want to be treated.
05 · The limits
When it isn't one for me.
Necks warrant more caution than most areas, and there are presentations where the right answer is not a chiropractic appointment. I screen for these at the first visit, and I'd rather turn you away than work around uncertainty.
Go to A&E today
Neck pain after a significant impact or fall; sudden severe headache unlike any you've had; weakness, numbness or clumsiness in the arms or legs; problems with balance, speech or swallowing; or neck stiffness with fever. These need emergency assessment, not an appointment next week.
Following an accident
Neck pain that began with a road traffic accident or similar trauma sits outside what I'd take on from a standing start — it needs medical assessment first, and I'll say so.
When imaging should come first
Progressive weakness, symptoms that keep spreading, or a history that raises questions the examination can't settle. I refer for imaging rather than treating around the gap.
Patients who came in with this
Good session today with Richard my neck is feeling far more comfortable than when I went in.
I’ve been seeing Rich for a couple of years now with various back, neck and knee issues. Rich manages to translate my description of the issues into appropriate treatment, which usually does the trick in one or two sessions. Totally recommend Rich, he’s a great guy.
…Richard took the correct approach by looking at the bigger picture, neurologically, and we realised that my neck had a profound impact on the rest of my kinetic functions.
Often connected
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.