Back Pain Doctor
Neck Pain
Neck pain can be acute after a strain or develop gradually with sustained posture, training load, sleep position or recurrent guarding. Pain may remain local to the neck or spread into the upper back, shoulder blade region or head.
Most neck pain is managed without surgery. The first step is to identify whether there are any concerning features, then work out which movements, positions and loads are contributing. A clear plan often includes mobility, strengthening, ergonomic changes and sensible return to normal activity.
Where pain is persistent or recurrent, further assessment may consider whether joints, discs, muscles or nerve irritation are contributing. Treatment should be matched to the clinical pattern rather than based only on a scan result.
Neck pain that began with a head knock during sport needs a different first step. Concussion is assessed and cleared on its own pathway rather than as a neck problem, and the two commonly occur together after the same impact — see the concussion section for what that involves.
Where neck pain is accompanied by headache, and the headache is reproduced by particular neck movements or positions, cervicogenic headache is worth considering — although migraine and tension-type headache can also involve neck pain, so the pattern has to support a causal link.
Common symptoms
- Pain or stiffness through the neck, upper back or shoulder girdle
- Reduced range of movement, especially turning or looking up
- Headache associated with neck movement or sustained posture
- Symptoms aggravated by desk work, driving, lifting or sleep position
Commonly seen in
Evidence for twelve treatment options in neck pain
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation — diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Every high-quality guideline says the same thing. The American College of Physicians makes a strong recommendation that chronic low back pain be treated first with exercise and multidisciplinary rehabilitation rather than drugs or procedures (Qaseem, Ann Intern Med 2017). An overview of 15 primary-care guidelines found consistent agreement on education, staying active, exercise and reassurance, and on discouraging routine imaging (Oliveira, Eur Spine J 2018). For neck pain the strongest effects also belong to exercise, with strengthening of the neck and upper quadrant showing a moderate short-term effect (Sterling, J Clin Med 2019). Adding pain-science education to exercise improves pain, disability and fear of movement over exercise alone (Bonatesta, J Pain 2021).
Pairing reviewed 2026-09-02.
Where it fits for you
Understanding why the back hurts, and moving well, does more than anything injected. Imaging is used to answer a specific question, not as a starting point — degenerative findings are near universal and frequently unrelated to the pain.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Worth discussing
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling — the same technique with nothing injected — is not offered here.
What the evidence shows
For myofascial pain, trigger point injection performed as well as shockwave in head-to-head comparison — a meta-analysis of 10 trials found shockwave better than sham and ultrasound but NO better than trigger point injection, dry needling or laser (Zhang, Arch Phys Med Rehabil 2020). Trials of needling in myofascial pain are small and generally low quality.
Pairing reviewed 2026-08-30.
Where it fits for you
Directed at a tender muscle band that reproduces part of your pain, alongside the loading work. Not a treatment for the joint, disc or nerve itself.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Only for a specific target
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Few trials exist for any neck pain treatment, and none supports injection as a general answer. A review of the field found exercise beneficial, the evidence for epidural corticosteroid in radiculopathy conflicting, and only weak positive evidence for radiofrequency denervation of the cervical facet joints (Cohen, Mayo Clin Proc 2015). Where one facet joint is the target, ultrasound can reach it: in 60 joints in 36 people, a lateral ultrasound-guided approach was confirmed intra-articular on contrast arthrography 92% to 98% of the time (Bodor, Spine J 2022). That is an accuracy study rather than an efficacy trial — but it is the opposite of what the same question returns in the lumbar spine, where ultrasound misses the target roughly one time in eight (Ashmore, Pain Rep 2022).
Pairing reviewed 2026-09-17.
Where it fits for you
Considered only where examination points to one identifiable structure and pain is blocking rehabilitation. For neck pain in general the evidence sits with exercise, education and reassurance, and degenerative changes on a scan are near universal and often unrelated to the pain. See the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible — no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits for you
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Worth discussing
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
For myofascial pain, a meta-analysis of 8 controlled studies (571 patients, mostly neck and upper back) found shockwave reduced pain and improved pain threshold and neck disability compared with other methods (Wu, Ann Transl Med 2021). A second meta-analysis of 10 trials found it better than sham and ultrasound, but NO better than dry needling, trigger point injection or laser (Zhang, Arch Phys Med Rehabil 2020).
Pairing reviewed 2026-08-30.
Where it fits for you
Directed at a tender muscle contributing to the pain, not at the disc, joint or nerve. No better than needling in head-to-head trials, so the choice is about what suits you.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Only if relevant
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Focused shockwave is not aimed at a disc, a facet joint or a nerve root, and there is no trial evidence for it in these conditions.
Pairing reviewed 2026-08-30.
Where it fits for you
Considered only where examination finds a separate tender muscle or tendon contributing to the pain.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Plausible — no studies
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that we can point to. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative — a randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits for you
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why we describe it this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Worth discussing
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
The published work sits in one narrow group — chronic whiplash-associated neck pain in which facet joints were confirmed as the pain source by diagnostic medial branch block. Two prospective case series from the same clinic report that twelve months after cervical facet platelet-rich plasma, 53% had exceeded the smallest worthwhile improvement in pain and 37% had more than half their pain relieved (Smith, Interv Pain Med 2023; Smith, Clin Pract 2025). Neither had a control group, physiotherapy was given alongside, and the authors themselves state that a controlled trial is needed.
Pairing reviewed 2026-09-03.
Where it fits for you
Not done in this clinic — a cervical facet injection should be performed under CT guidance by a radiologist, and the facet joints have to be confirmed as the source by diagnostic blocks first, so this is a referral rather than something we provide. For neck pain generally, exercise and understanding the problem carry the evidence and are where we start; this becomes a conversation only where pain has persisted for months and points clearly at the facet joints.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Plausible — no studies
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No randomised trial of prolotherapy in this condition. The evidence base sits in lateral epicondylitis, rotator cuff tendinopathy, plantar fasciitis and knee osteoarthritis (Capotosto, Orthop J Sports Med 2024). A network meta-analysis of 87 trials across chronic soft-tissue injury found prolotherapy had no statistically significant pain advantage over other therapies overall, though its effect size was consistently better than non-injection treatment and corticosteroid (Goh, PLoS One 2021).
Pairing reviewed 2026-08-30.
Where it fits for you
Can be discussed on the same rationale as the studied tendon and ligament problems, with the absence of direct trials stated plainly.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used here
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Searching hyaluronic acid, hyaluronate and viscosupplementation against the cervical spine, cervical facet joints, neck pain, cervical spondylosis, cervicogenic headache, whiplash and the atlantoaxial joint returns thirteen records, and not one of them is an injection into the neck. The closest is 49 people with jaw joint osteoarthritis and neck pain whose neck disability and movement improved and held for six months after five weekly viscosupplementation injections — given into the jaw joint, not the neck, and with no comparison group (Guarda-Nardini, Cranio 2016).
Pairing reviewed 2026-09-20.
Where it fits for you
Not offered for this problem. Nothing has been injected into a neck joint and measured, so there is no basis for offering it here.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. No controlled trials
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
Uncontrolled evidence only, but consistent. Sixteen people with chronic periscapular myofascial pain that had failed conservative care received ultrasound-guided dextrose to the trapezius, rhomboid minor and levator scapulae together with hydrodissection of the spinal accessory and dorsal scapular nerves; pain fell from 7.1 to 3.3 out of 10 at three months (mean reduction 3.8, 95% CI 2.6 to 5.0) with no major complications (Yadav, Cureus 2025). Two case reports describe 5% dextrose into the superficial fascia of the neck and shoulder girdle: a professional kickboxer with persistent cervicobrachial pain whose Neck Disability Index fell from 77 to 33 over five sessions and held at one year (Lam, Cureus 2025), and a two-year history of neck and arm pain settling over six weeks (Lam, Cureus 2024). No randomised trial has tested it in neck pain.
Pairing reviewed 2026-09-09.
Where it fits for you
Considered for neck and shoulder-girdle pain that has not settled with loading, mobility and work-setup changes, particularly where the skin over the upper trapezius and scapula is tender to a light pinch rather than only deep to it. Discussed as unproven, because every published report so far is uncontrolled.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Worth discussing
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Two small randomised trials support it in myofascial neck and shoulder pain. In 41 people with upper trapezius myofascial pain syndrome, ultrasound-guided myofascial hydrodissection matched lidocaine trigger point injection for pain and neck disability across 12 weeks, with a large within-group effect (r = 0.72) and no adverse events (Chen, Sci Rep 2025). In a double-blind trial of 35 people with chronic neck and shoulder myofascial pain, interfascial hydrodissection with 10% dextrose beat a sham subcutaneous injection for pain at 12 weeks, though not for range of movement or function (Hsu, Am J Phys Med Rehabil 2024). Both trials are small and neither has been replicated.
Pairing reviewed 2026-09-06.
Where it fits for you
Considered for persistent myofascial neck pain that has not responded to exercise and manual therapy, particularly where a tender fascial plane or a cutaneous nerve is identified on ultrasound. Expect pain relief rather than a change in movement.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other neck conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
Do I need imaging for neck pain?
Can neck pain cause headaches?
What is the main treatment?
Ready for a clearer plan for your back or musculoskeletal pain?
Book an assessment with Dr Joshua Hatch.
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
Book an appointment