The Best Exercise For Neck Pain Or Back Pain

Dr. Stephen Fose, PT, CSCS | Owner, Physical Therapist at Retrieve Physical Therapy | Orthopedic Telehealth Physical Therapy for Neck & Back Pain

Short Answer: It depends! (Sorry)

Long Answer: 75% of low back pain and neck/upper back pain has a direction of preference, MDT physical therapists have been tracking these numbers for a long time. This is a DIRECTION OF MOVEMENT vs. a group of multiple exercises which will show a reduction of your pain, improve function, and improve mechanics of your body. When your condition has a direction of preference, progress is quicker, you have full resolution and relief in minutes - weeks, not months - years. You also know exactly what to do for your neck or back and detect problems before they get too bad, and you can quickly prevent it by taking action. Usually the direction of movement is opposite of the one that causes your pain.

The big problem we see is that in the United States only 1-2% of physical therapists, less than 1% of chiropractors, primary care doctors, surgeons, massage therapists understand this principle, have full training in it, and are able to fully assess it. This is why patients end up in physical therapy or chiropractors for months, and even YEARS trying to improve their pain or "maintenance of symptoms that aren't going to improve". No wonder back pain is the largest total cost of any disease in the world, and it's getting worse.

Think of it like this: If you cut your hand with a knife and its bleeding, would you treat that differently than if you got a lodged splinter/sliver/hunk of wood stuck in your hand? Those two painful conditions would be treated very differently. These two things are examples of how specific painful conditions that physical therapists and chiropractors see are sometimes treated differently based on their classification or sub-group. If you have a splinter/sliver/hunk of wood, does it make sense to

  1. Stretch your finger/hand/wrist muscles to get the wood out? NO

  2. Strengthen your finger/hand/wrist/arm muscles? NO

  3. Hot Pack/Ice Pack, TENS, Cupping, ART, Massage Gun, to the sliver and all areas that are sore around the hand? NO

The way to get your pain to go away and your problem to go away if you have a splinter/sliver/hunk of wood in your hand is figure out which way to PUSH IT OUT, and KEEP DOING IT UNTIL ITS GONE!

So if we regroup to really tie everything together...

  • Only 1-2% of PT's, <1% of chiropractors understand that the splinter/sliver/hunk of wood condition even exists and know how to "push it out" correctly. That means 98% of PT's and 99% of chiropractors all treat injuries the same way, like a wound/cut. (Let it heal, do techniques to break up scar tissue, stretch what was injured, strengthen what got weak, and work on your goals)

  • 75% of neck pain and back pain conditions present like a splinter/sliver/hunk of wood

  • 40% of humans have back pain and neck pain every year

No wonder insurance companies continue to cut reimbursement for PT's and chiropractors. As a whole, we're not saving them any money! (That's for another blog post...) No wonder surgeries that show no long-term success continue to see people lining up hour after hour, day after day.

Lets Talk About The Good News: What this does all mean is neck pain and back pain is actually very treatable, does not take long (most of the time), and is able to be done from home remotely. No missed time from work or family, no increasing your health care plan because you have to go to massage or chiropractors 3x/week for years. Use your HSA account for tax purposes again. Get that promotion or go back to that job you thought was "bad for your back" that you really enjoyed. Since 75% of the time all that needs to be done is an evaluation and movement testing using repeated motions to identify a direction of preference by using response-based assessment and education on how to "push it out", most back pain and neck pain (75% of them) can get better via telehealth, from home, on your own, with long term results.

So this means if you have low back pain, neck pain, arthritis, bone spurs, a pinched nerve, sciatica, sacroiliac joint pain, your leg length is causing pain, SIJ, your back goes out, you woke up with a "crick in your neck", muscle spasms, trigger points in your levator scapulae or upper trapezius, spondylolisthesis, disc herniations, disc bulges, spondylosis, stenosis, degenerative joint disease, quadratus lumborum pain, radiculopathy, hip flexor problem causing lower crossed syndrome, degenerative disc disease, or you just have a "bad back" because you have all of these, you can actually get better quickly, IF SEEN BY THE RIGHT CLINICIAN.

This technique of understanding direction of preference using response-based assessment is the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). Your likelihood of your back pain or neck pain getting better will depend more on your ability to see a clinician that understands these concepts than how bad your back or neck is and what MRI/X-Ray shows. These PT's and chiropractors should be fully trained with certifications of proof of taking Part A,B,C,D and/or have "Cert. MDT" in their name. At Retrieve Physical Therapy, we will only have healthcare professionals that are fully trained and have years of experience using MDT, and/or certified in MDT.

If you're still not sure if Retrieve PT is right for you, or this sounds like some experiences you have gone through and have more questions, feel free to email us at, or schedule a "Free Consult" to talk with a therapist who is trained in MDT.


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