Article by Jamie Van Beek
What Causes Neck Pain Without Injury?
Neck Pain without injury is a common complaint in the clinic. It can be frustrating to wake up without any triggering event and be stuck with neck pain.
The driver of this pain may be a muscle strain, a sprained facet joint or a bulging disc. These structures become injured due to repetitive microtrauma instead of a single event associated with injury. The microtrauma may be caused by poor posture, poor sleeping positioning or repeated movements throughout the day, which place a high load on the neck.
How Do I Fix My Posture?
The spine is made up of three curves. A concave curve in your lower back, a convex curve in your mid-back and another concave curve in the neck. Research has shown that people with neck pain have a flattening of the curve in their neck, resulting in a forward head posture. 1
An injury to any part of the spine can cause changes to spinal alignment, which can often flow onto the neck. A flattened lower back curve is a common postural adaptation from lower back pain. This increases the postural demand of the muscles which keep the head upright. Over time, these muscles may spasm and produce pain or fail and allow the head to float forward.
This is just one possible mechanism out of many. Your physiotherapist can identify which previous injuries may be contributing to your neck pain and the influence it’s having on your neck.
Forward head postures may also result from sustained positions such as looking down at a phone and looking down at laptops and gaming. Text neck is becoming more prevalent in our community.
What Is The Consequence of a Forward Head Posture?
Each vertebral level in the neck is made up of three joints. At the front, the vertebral bodies and discs make up the joints of the spinal column. At the back, facet joints sit on either side of the spinal cord.
A forward head posture shifts the weight of the head forward, stressing the vertebral bodies and discs in the neck. A loss of this natural curve has been linked to conditions such as cervical spondylosis, bulging discs and chronic neck pain 
This condition has become known as Nerd Neck.
How Should I Sleep With Neck Pain?
Sleep positioning should focus on reducing strain on the front joints of the neck (the vertebral body and disc). In side-lying, this means sleeping as upright as possible in order to avoid curling up into the foetal position and encouraging a forward head posture. To achieve this, try moving your pillow a couple of inches upwards and stretching your neck up to meet it.
When sleeping on your back, it’s important to find a pillow that fully supports your neck to prevent it from rotating. The pillow also shouldn’t be too thick, to prevent encouraging a forward head posture.
Sleeping on your back is not recommended due to the sustained positions the neck has to maintain all night.
Solving Your Neck Pain
Whether your neck pain is caused by sleep positioning, poor posture or repetitive movements involving the neck, your Physiotherapist is trained to identify and treat the cause. Contact your Physiotherapist for an individualised assessment.
 Alpayci M, İlter S. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):621-626. doi: 10.1097/PHM.0000000000000698. PMID: 28118272.