TMJ, jaw & headaches
Headaches that start in your jaw, or in your neck.
Read more about TMJ, jaw & headachesPhysiotherapy in Parktown North
Neck and back pain that won’t settle
Most people put up with it for far too long — and by the time they book, they have stopped expecting it to change. It usually can. The first job is finding out what is actually driving it.
Does this sound familiar
This is the sort of thing patients come in with
- A neck that has locked up overnight and will not turn
- Low back pain that flares every time you sit too long, drive too far, or lift badly
- “Tech neck” — stiffness and headaches that build through a week at a desk
- Pain, pins and needles or numbness travelling into an arm or down a leg
- A recurring niggle that settles for a month and then comes straight back
More on specific problems
What happens
How this is treated
Every patient is different, but the shape of the work is consistent — and you will always be told what is happening and why.
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Step 1
A proper history
What you do all day, how you sleep, when it started, what makes it worse. Most of the answer is in here, and it is the part that gets rushed everywhere else.
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Step 2
Assessment
Movement, joint mechanics, muscle length and strength, and a neurological screen where the symptoms warrant one.
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Step 3
Hands-on treatment
Joint mobilisation, soft-tissue work, dry needling and taping — whatever the assessment points to, to bring the pain down quickly.
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Step 4
Retraining, so it holds
A short, specific home programme, and Clinical Pilates where it helps. Relief that outlasts the appointment is the whole point.
Worth knowing
Why a neck problem so often arrives as a headache
The joints and muscles of the upper neck share their nerve supply with the parts of the head where you feel a headache. That overlap is why pain arising in the neck is experienced above the eye or behind the temple, and it is why a great many headaches that have been managed with tablets for years are actually a neck problem that nobody has examined.
The pattern is fairly recognisable once you know it. The headache is usually one-sided and stays on that side. It starts at the base of the skull and travels forward. It gets worse after a long stretch at a screen or in a car, and it eases when the neck moves freely. Turning the head is often stiffer on the painful side, and the patient has usually stopped noticing that.
This is what people mean by “tech neck”, and the mechanism is unremarkable: the same joints held in the same position for eight hours, with the deep muscles that should be sharing that load gradually opting out. Nothing is damaged. Something has become very good at one position and very poor at every other one, which is a problem that responds well to being addressed and not at all to being tolerated.
Worth knowing
Lower back pain, and the scan you probably do not need
International guidance has moved a long way on back pain in the past decade, and it has not filtered through to the general public. The short version: for most episodes of low back pain, imaging is not recommended as a first step, because what it finds usually does not change what should be done, and can make matters worse by giving a frightening name to a change that is present in plenty of people with no pain at all.
The same guidance is emphatic that staying active is better than resting. Not training through severe pain — staying in motion, keeping walking, returning to normal loading early rather than waiting to feel ready. Beds have a poor record with backs.
That is the general case, and it is genuinely most cases. It is not all of them, which is why the assessment exists. Pain radiating below the knee, weakness, numbness or pins and needles in a specific distribution, or a history that does not fit a mechanical pattern all change the approach, and a neurological examination forms part of the first appointment where the symptoms call for one.
Worth knowing
When it is not a physiotherapy problem
A small number of back and neck presentations need a doctor rather than a physiotherapist, and need one quickly. Numbness around the saddle area, a new problem controlling your bladder or bowel, weakness or numbness in both legs, or new sexual dysfunction alongside back pain should be assessed as an emergency, not booked in for next week.
So should back pain with fever, back pain with unexplained weight loss, back pain after a significant fall or accident, or a first episode of severe back pain in someone over the age of about fifty-five with no obvious cause.
None of this is common. It is here because the honest version of “book a physio” includes the short list of times you should not, and because a practice that only ever tells you it can help is not much use in working out whether it can.
Worth knowing
How long will it take?
An acute locked neck often eases substantially within two or three sessions. Long-standing back pain that has been building for years takes longer and needs your input between visits. You will get an honest estimate at the first appointment, not an open-ended course of treatment.
Before you book
Questions patients ask about this
Almost never, and it is worth not rushing into one. Current international guidance recommends against routine imaging for back and neck pain, because scans very often show age-related changes that are also present in people with no symptoms at all — and being told you have a “degenerated disc” tends to make people move less, which makes the pain worse.
If your history or examination suggests imaging would actually change the plan, Rikki will say so and tell you who to see. If you already have scans, bring them or photograph the report on your phone.
Keep moving, within reason. The evidence on this is consistent and it runs against the instinct: extended rest slows recovery from most back pain rather than speeding it. That does not mean pushing through severe pain or carrying on with whatever caused it — it means staying upright, walking, and returning to normal activity earlier than feels natural.
What you should do in the specific first few days depends on what is wrong, and that is one of the things you will leave the first appointment knowing.
Usually not, and the phrase itself is misleading — discs do not slip. A genuine disc problem pressing on a nerve produces a fairly specific picture: pain travelling down the leg in a defined band, often below the knee, sometimes with pins and needles, numbness or weakness in a matching pattern. That is examined for directly.
Far more often the pain is coming from joints, muscles and the way the area is being loaded, and it behaves quite differently.
An acute locked neck often eases substantially inside two or three sessions. Long-standing back pain that has been building for years takes longer, and how much longer depends partly on what you do between appointments — the home programme is not optional decoration.
You will get an honest estimate at the first appointment. If it is not improving roughly as expected, that is a reason to reassess rather than to keep booking.
Because the treatment settled the symptom and nothing changed the load. Recurring pain in the same place is usually a capacity problem: the tissue is being asked for more than it can currently give, whether that is eight hours at a laptop, a garden, or a sport.
That is what the retraining half of the treatment is for, and it is why Clinical Pilates is so often part of the answer for people on their third or fourth episode.
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Next step
Book an appointment
Book online at any hour, or send a WhatsApp if you would rather describe the problem first and be told honestly whether physiotherapy is the right call.
071 491 6759
12 7th Ave, Parktown North