Quick summary: Neck pain can come from muscle strain, disc problems, joint irritation, trauma, or degeneration, and the right treatment depends on which of these is actually driving your symptoms. Most neck pain responds well to conservative, non-surgical care, though a smaller set of symptoms deserve prompt medical evaluation. At Advanced Spine Health Center, we evaluate the structural and functional factors behind your neck pain — including cervical curvature and posture — using Chiropractic BioPhysics® (CBP) alongside other conservative treatment approaches, individualized to what your exam actually shows.

Table of Contents

What Causes Neck Pain?  |  Neck Pain Symptoms — And What They Might Mean  |  When Neck Pain Needs Prompt Medical Attention  |  How We Evaluate Neck Pain  |  Neck Pain Treatment Options  |  Cervical Curvature, Forward Head Posture, and the CBP Approach  |  How We Approach Neck Pain  |  FAQ

Key Takeaways

• Neck pain has many possible causes, from simple muscle strain to disc and joint problems, and treatment should match the actual cause rather than follow a generic protocol.
• Most neck pain improves with conservative care. A smaller group of symptoms — progressive weakness, balance changes, or loss of fine motor control — warrant prompt medical evaluation.
• Clinical practice guidelines support manual therapy and chiropractic care, combined with exercise, for several categories of neck pain, including neck pain with headache.
• Cervical curvature, forward head posture, and thoracic alignment are a specific area where Chiropractic BioPhysics® (CBP) research has produced real, if still limited, clinical trial data — and CBP traction isn't a single technique; it's matched to the specific structural finding.
• We combine structural assessment with individualized treatment planning rather than putting every patient through the same sequence of care.

What Causes Neck Pain?

The neck, or cervical spine, supports the full weight of your head — roughly 10 to 12 pounds — while allowing more motion than any other part of the spine. That combination of load and mobility is exactly what makes it vulnerable to a wide range of problems, from minor strains to more significant structural issues.

Neck pain is also extremely common. Globally, it ranks among the leading causes of disability, affects women somewhat more often than men, and has become more prevalent over the past decade rather than less, a trend researchers link partly to sedentary work and increased screen time.¹

Common causes include:

• Muscle strain and postural fatigue — from desk work, driving, sleeping in an awkward position, or repetitive movement.
• Cervical disc problems — a bulging or herniated disc can irritate a nearby nerve root and cause pain that radiates into the shoulder, arm, or hand. See our page on disc injury for more detail.
• Facet joint irritation or osteoarthritis — wear-and-tear changes in the small joints of the cervical spine that can cause localized pain and stiffness, especially with age.
• Ligament sprain, laxity, and whiplash-type trauma — the term whiplash describes a sudden acceleration-deceleration mechanism, most often from a car accident, rather than a specific injury in itself. The actual injury it produces can involve muscle strain, disc injury, facet joint irritation, or stretching and laxity of the ligaments that help stabilize the cervical spine. Cadaveric biomechanical testing has shown that capsular ligaments exposed to simulated whiplash develop measurably greater laxity than uninjured ligaments.² Some researchers have proposed that this kind of ligament laxity, when it doesn't fully resolve, may contribute to chronic, harder-to-pin-down neck pain and a sense of instability — though this remains a developing area of research rather than a routinely diagnosed condition, and evidence on how best to address it is still limited.³ See our whiplash page for more on this specific mechanism of injury.
• Cervical spinal stenosis — narrowing of the spinal canal that can put pressure on the spinal cord or nerve roots, more common in older adults.
• Referred pain — pain that originates in the shoulder or upper back but is felt in the neck, or vice versa. See our page on shoulder pain if your symptoms overlap both areas.

Less commonly, neck pain can stem from inflammatory conditions, infection, or other systemic causes, which is part of why a proper evaluation matters before assuming the cause.

Neck Pain Symptoms — And What They Might Mean

Not all neck pain feels the same, and the type of symptom often points toward the underlying cause.

Aching, stiffness, and reduced range of motion are the most common presentation and typically point toward a muscular or joint-related cause rather than a nerve problem.

Sharp or radiating pain into the shoulder, arm, or hand, especially when paired with numbness or tingling, suggests nerve root involvement — often from a disc issue or narrowing around the nerve as it exits the spine. This pattern is worth mentioning specifically to your provider rather than describing simply as "neck pain." Our pages on arm and leg pain and carpal tunnel cover related symptom patterns that can sometimes originate in the neck rather than the wrist.

Headaches that seem to start at the base of the skull or upper neck — sometimes called cervicogenic headaches — are a recognized category of headache tied to the cervical spine rather than a primary headache disorder. See our page on headaches and migraines for more on how these are distinguished.

Dizziness or balance changes are sometimes reported alongside neck pain, occasionally referred to as cervicogenic dizziness. This is a less-studied area of neck pain than the pain-focused outcomes discussed elsewhere on this page, and it's not something every patient with neck pain and dizziness has — a broader evaluation is usually needed to sort out the actual source. Our vertigo page has more information.

When Neck Pain Needs Prompt Medical Attention

Most neck pain is mechanical — meaning it comes from muscles, joints, discs, or ligaments — and responds well to conservative care. A smaller set of symptoms points toward pressure on the spinal cord itself (cervical myelopathy) or another problem that needs prompt medical evaluation rather than conservative treatment alone.⁴

If any of these apply to you, the right next step is medical evaluation, not chiropractic care. We'll tell you this directly if we see it during an exam — conservative care is not appropriate for every presentation of neck pain, and part of a thorough evaluation is recognizing when it isn't.

How We Evaluate Neck Pain

Evaluation starts with a detailed history — how the pain started, what makes it better or worse, whether it radiates, and whether any of the red-flag symptoms above are present — followed by a physical and neurological exam to assess strength, sensation, reflexes, and range of motion.

When appropriate, we use weight-bearing X-rays to assess spinal alignment and structure as part of that evaluation. Not every patient needs imaging. X-rays are most useful when they help clarify a structural finding relevant to the treatment plan, rather than as a routine step for every neck complaint. MRI or other advanced imaging is reserved for cases involving red-flag symptoms, significant neurological findings, or when conservative care hasn't produced the expected improvement after a reasonable trial — and in those cases, we'll refer you for it or to the appropriate specialist.

Neck Pain Treatment Options

Clinical practice guidelines from the American Physical Therapy Association's Orthopaedic Section group neck pain into a few broad categories — neck pain with limited motion, neck pain related to whiplash, neck pain with headache, and neck pain with nerve-related symptoms radiating into the arm — and recommend somewhat different first-line approaches for each.⁵ In general terms:

• Education and activity modification — understanding what's driving the pain and staying appropriately active, rather than prolonged rest, is a consistent recommendation across categories.
• Exercise — range-of-motion work, and strengthening of the neck and upper back, is recommended for most categories of neck pain.
• Manual therapy and chiropractic care — a 2024 review of clinical practice guidelines found that spinal manipulation for neck pain is favored across essentially all current guidelines, whether used alone or as part of a broader care plan, and that recommendations now extend to cervicogenic and tension-type headache as well.⁶ The same review notes evidence gaps for certain populations, including adults over 65 and children, where the research base is thinner.
• Decompression traction — aims to reduce pressure on a disc or nerve root and may be considered for neck pain with radiating arm symptoms, typically alongside other care rather than as a standalone treatment.
• Structural / curvature-correction traction — a different tool with a different goal. Rather than relieving pressure on a disc, this type of traction, used in Chiropractic BioPhysics® care, works toward a more favorable spinal alignment over a course of treatment. It isn't one single technique — depending on what the evaluation shows, it may target the cervical spine's forward curve, a side-to-side head lean, or excess rounding in the thoracic spine that contributes to forward head posture. More on this distinction in the section below.
• Medication — over-the-counter or prescription medication for pain and inflammation is managed by your physician and isn't something we prescribe, but it's a legitimate part of many patients' overall care.

For a smaller group of patients — typically those with chronic, nerve-related neck or arm symptoms that haven't responded adequately to conservative care — biologic injections such as PRP may be considered as part of a broader treatment plan. This isn't a starting point for most neck pain, and candidacy depends on the specific condition; see our regenerative medicine page for more detail. In rarer cases involving significant structural compromise or progressive neurological symptoms, referral for surgical consultation is the appropriate next step, and we'll make that referral when it's warranted.

Cervical Curvature, Forward Head Posture, and the CBP Approach

A healthy neck has a gentle forward curve, known as cervical lordosis, that helps distribute the load of the head across the spine. Chiropractic BioPhysics® (CBP) is built around the idea that this curve — and posture more broadly — is clinically relevant, not just a cosmetic detail, and that restoring a more favorable structural alignment can be a meaningful part of care for some patients.

That said, the relationship between posture and pain is more nuanced than the popular "text neck" narrative suggests. A 2018 study of young adults specifically testing whether "text neck" posture during phone use was associated with neck pain found no significant association between the two, using both self-reported and physiotherapist-assessed posture.⁷ That doesn't mean posture is irrelevant to neck health — it means the simple claim that everyday phone posture, by itself, causes neck pain isn't well supported by the evidence we currently have. It's a different question from whether correcting cervical curvature helps patients who already have chronic neck pain, which is where CBP-specific research has actually focused.

How CBP Addresses Cervical Curvature — and Why Traction Isn't Just One Thing

CBP care for the cervical spine typically combines several elements: structural assessment of cervical and thoracic alignment, mirror-image corrective exercises designed to work the spine in the direction opposite the identified misalignment, corrective traction, and chiropractic adjustments. These are generally used together rather than as a single isolated technique.

It's worth being specific about the traction piece, since patients (and plenty of articles) tend to treat "traction" as one thing. CBP structural traction is matched to the specific misalignment found on evaluation, not applied the same way to every neck. A reduced cervical curve is typically addressed with extension-based cervical traction. A side-to-side head lean — what's called lateral head translation — calls for traction in that plane rather than a straight extension pull. And because the thoracic spine and cervical posture are mechanically linked, excess rounding in the upper back, or thoracic hyperkyphosis, is sometimes addressed with traction directed at the thoracic spine as part of a forward-head-posture treatment plan, rather than working on the neck alone. This is a different tool, aimed at a different goal, than decompression traction used to relieve pressure on a disc or nerve — both can be genuinely useful, but they're not interchangeable, and conflating them tends to create confusion about what a given treatment is actually meant to do.

What the Research Shows

Three randomized controlled trials, all involving CBP-affiliated researchers, have looked at structural correction in the neck and upper back:

A 2022 trial of 30 patients with chronic cervical radiculopathy and a measurably reduced cervical curve compared cervical extension traction plus neck stretches against neck stretches alone. The traction group showed a significant improvement in cervical curvature that was maintained at two-year follow-up, along with sustained pain reduction and improved nerve conduction measures — while the comparison group's curvature didn't change and their pain outcomes worsened over the same period.⁸

A 2023 trial of 66 older adults with chronic, non-specific neck pain and forward head posture compared a CBP approach — mirror-image exercises plus cervical traction — against a standard stretching and strengthening program. Both groups improved similarly on pain and balance measures at six weeks. At three-month follow-up, though, only the CBP group maintained its posture correction and its gains across all outcome measures; the standard-exercise group had regressed back toward baseline.⁹

A third 2022 trial looked specifically at the thoracic side of this picture. Eighty patients with chronic, non-specific neck pain were split between a standard multimodal program — heat, soft tissue work, thoracic manipulation, and exercise — and the same program with added thoracic traction targeting hyperkyphosis. At ten weeks, only the group that received the added thoracic traction showed a significant reduction in thoracic kyphosis, along with significantly better pain, disability, and sensorimotor control scores. At one-year follow-up, the standard-care group had regressed toward baseline, while the thoracic-traction group maintained its improvements across every measure.¹⁰ This supports the idea that forward-head-posture-related neck pain isn't always best addressed by working on the neck in isolation — for some patients, the thoracic spine is part of the picture.

These are real, randomized findings, and they're worth taking seriously — but they're also small-to-moderate trials, with methodological limitations the authors themselves note (including non-random sampling in one study and relatively short follow-up in two of the three), and all three were conducted by researchers affiliated with CBP. They support a structural approach — addressing the cervical spine, lateral alignment, or thoracic posture depending on what's found on exam — as a reasonable option for appropriate patients, not proof that structural correction is necessary or effective for everyone with neck pain. We think that's an honest way to describe where this evidence currently stands.

Advanced Spine Health Center is the only Chiropractic BioPhysics®-certified practice in the Des Moines area, and structural evaluation has been part of our approach since the practice opened in 2016. Learn more on our CBP Technique page.

How We Approach Neck Pain

We don't start every neck pain evaluation assuming the answer is the same treatment. Your exam findings — not a standard protocol — determine what we recommend.

For most patients, that starts with a history and physical exam, including screening for the red-flag symptoms described above. When structural or postural factors appear relevant, we may use X-rays to evaluate cervical alignment as part of that picture. From there, care is typically multimodal: it may combine chiropractic adjustments, CBP mirror-image rehabilitation exercises, and corrective cervical traction, along with supportive therapies like red light therapy or targeted strengthening when appropriate to the case. Not every patient receives every component — the combination depends on what we find and how you respond.

Our general clinical philosophy is that pain relief matters, but it isn't necessarily where care should stop. When structural, postural, or functional factors are contributing to your neck pain, addressing those alongside your symptoms — rather than symptoms alone — is often part of a more complete plan. We combine CBP-based structural care with other conservative approaches because, in our clinical experience, addressing both the symptom and the underlying contributing factors tends to produce a more durable result than either alone. That's a reflection of our clinical perspective built over years of practice, and it should be weighed alongside the research discussed above, not in place of it.

We serve patients throughout Urbandale and the greater Des Moines metro area, including West Des Moines, Clive, Johnston, and Grimes. Learn more about our practice and Dr. Ruehle's background on our About Us page.

FAQ

What is cervical lordosis, and why does it matter?

Cervical lordosis is the natural forward curve of the neck. It helps distribute the weight of the head across the spine. A reduced, straightened, or reversed curve is one structural factor some clinicians, including CBP practitioners, evaluate as part of understanding chronic neck pain — though it's one piece of a larger clinical picture, not the whole story.

Does poor posture or "text neck" actually cause neck pain?

The evidence is more limited than commonly assumed. At least one study looking specifically at phone-use posture in young adults found no significant link to neck pain. That doesn't mean posture and alignment don't matter for anyone — it means the simple, popular claim that everyday phone posture directly causes neck pain isn't well established by current research.

Can chiropractic care actually change the curve in my neck?

Small randomized trials using CBP-style cervical traction and corrective exercise have shown measurable improvement in cervical curvature that held up at follow-up, in patients who started with a reduced curve. This is a developing area of research rather than a settled one, and results vary by patient and condition.

What's the difference between decompression traction and the traction used in CBP care?

They're often lumped together as "traction," but they're aimed at different problems. Decompression traction is used to reduce pressure on a disc or nerve root, most often for radiating arm pain. Structural traction, used in Chiropractic BioPhysics® care, works over a course of treatment toward a more favorable spinal alignment — and it isn't limited to a single direction of pull. Depending on what your evaluation shows, it may address the cervical curve, a side-to-side head lean, or thoracic posture contributing to forward head posture. Both types of traction can be useful; they're just not the same tool for the same job.

Can a whiplash injury cause chronic neck problems even without a fracture?

It can. Biomechanical testing has shown that the ligaments stabilizing the cervical spine can develop measurable laxity after a whiplash-type injury, even when imaging doesn't show a fracture. Some researchers have proposed this laxity as a contributor to ongoing, harder-to-pin-down neck pain in a subset of patients. This is still a developing area of research rather than a routinely diagnosed condition, and how best to address it isn't yet well defined.

Can neck problems cause headaches or dizziness?

Headaches that originate from the cervical spine (cervicogenic headache) are a recognized category, and current guidelines support manual therapy for this type of headache. Neck-related dizziness is a less-studied area, and if you're experiencing both dizziness and neck pain, a broader evaluation is usually needed to sort out the actual cause.

Is it normal for neck pain to radiate into my arm or hand?

Radiating pain, numbness, or tingling into the arm or hand often points toward a nerve being irritated, commonly from a disc issue in the neck. It's worth describing this pattern specifically to your provider, since it can change what evaluation and treatment make sense.

How long should I try conservative care before seeing a specialist?

This varies by presentation, but if you're not seeing meaningful improvement after a reasonable trial of conservative care, or if new neurological symptoms develop, that's a reasonable point to pursue advanced imaging or specialist referral. If red-flag symptoms are present from the start, skip conservative care and seek medical evaluation directly.

Do I need an X-ray or MRI for neck pain?

Not always. Many cases of neck pain are evaluated and treated based on history and physical exam alone. Imaging becomes more useful when red-flag symptoms are present, significant neurological findings show up on exam, or conservative care hasn't produced the expected improvement.

Ready to Have Your Neck Pain Evaluated?

If you're dealing with neck pain in Urbandale or the surrounding Des Moines metro area, we can help you understand what's actually driving it and what a reasonable, individualized treatment plan looks like. Contact Advanced Spine Health Center to schedule an evaluation.

About the Author

Dr. Kyle Ruehle, DC is the owner and practicing chiropractor at Advanced Spine Health Center in Urbandale, Iowa. A graduate of Simpson College and Palmer College of Chiropractic, he has practiced since 2016 with a clinical focus on Chiropractic BioPhysics® and structural approaches to spine health.

References

1. Xu F, et al. Magnitude, temporal trend and inequality in burden of neck pain: an analysis of the Global Burden of Disease Study 2019. BMC Musculoskeletal Disorders. 2025;26:202. View source
2. Cleveland Clinic. Cervical Myelopathy: Symptoms, Causes & Treatment. View source
3. Neck Pain: Revision 2017. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health, Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(7). View source
4. Trager RJ, Bejarano G, Perfecto RPT, et al. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. Journal of Clinical Medicine. 2024;13(19):5668. View source
5. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. European Spine Journal. 2018;27(6):1249-1254. View source
6. Moustafa IM, Diab AA, Harrison DE. The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial with 2-Year Follow-Up. Journal of Clinical Medicine. 2022;11(21):6515. View source
7. Suwaidi AS, Moustafa IM, Kim M, Oakley PA, Harrison DE. A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study. Journal of Clinical Medicine. 2023;12(2):542. View source

This article is for educational purposes and does not replace an individualized evaluation by a qualified healthcare provider. If you're experiencing any of the warning signs described above, seek prompt medical evaluation.