For patients with one-sided neck pain, the large majority of patients have a diagnosis (joint derangement) that warrants movements that go backward (retraction and/or extension) or movements toward (not away from) the side of pain. It is rare that the answer is moving forward (protrusion and/or flexion) or moving away from the side of pain.
This is unfortunately not how most orthopedic clinicians think. Most clinicians (and non-clinicians) tell patients to stretch away from the pain, with neck pain and other pains as well. If you really understand how joints, muscles, and nerves work, however, you would realize stretching away makes no sense in most cases. While this may be commonly disseminated, it is by no means intuitive.
If you have left neck pain, moving into retraction, extension, or left side bend, for example, may initially hurt when performed. My job is to assess the overall response. Does the pain reduce with repetition? Does the pain move? Does movement increase? Does the pain only exist at the end of the movement and then disappear? And so on. To find the correct movement (directional preference exercise), we closely gauge the response.
As always, it boils down to being specific, to diagnosis. But having done this for years and taken time to work with several mentors, we can appreciate patterns and percentages regarding diagnoses. While a small minority of patients with left neck pain will indeed need to move right to get better, the majority will not. With competent use of the MDT system, we quickly deduce the specific movement you need for your specific pain. -- Laura
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