The first version of this document was created in 2002. It was upgraded and expanded several times before I started keeping track of updates put it up for sale in September of 2007. It was revised and expanded to book-length in the summer 2009, and continues to be updated as new scientific information becomes available, and in response to reader requests and suggestions.

Regular updates are a key feature of PainScience.com tutorials. As new science and information becomes available, I upgrade them, and the most recent version is always automatically available to customers. Unlike regular books, and even e-books (which can be obsolete by the time they are published, and can go years between editions) this document is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 108 major and minor updates since I started logging carefully in late 2009 (plus countless minor tweaks and touch-ups).

AugustComplete book edit: Top-to-bottom edit of the book, the first ever. Described in more detail in a blog post.

AugustMinor update: Added the revelation that literally all of the very weak studies supporting DCF training are probably fraudulent. [Section: “Core” neck strength: training the deep cervical flexors.]

JulyNew section: A new standard chapter for most PainScience.com tutorials summarizing several key concepts about placebo. [Section: Some important things to keep in mind about placebos.]

JuneNew section: No notes. Just a new section. [Section: “Core” neck strength: training the deep cervical flexors.]

JuneRevised: Substantial miscellaneous modernization. In particular, much more useful information on the critical distinction between “poor posture” and “postural stress.” [Section: Ergonomics are probably more important than posture.]

JuneScience update: Added several references about the long term risks of joint popping, a paragraph about the short-term risks, and a citation about what causes joint popping. [Section: Popping your neck joints: bad habit, or self-treatment?]

JuneRevision: Clarified the important distinction between hazard and risk. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

MayScience update: Added information about dry needling, a cousin of acupuncture, and a neglected sub-topic. Note that information about dry needling has always been available in the companion book about trigger points, but its presence here in the neck pain book is long overdue. [Section: The fascinating case of acupuncture.]

MayRevision: Substantial improvements, harmonizing with the ergonomics revision. Much stronger focus on the scientific case for microbreaking despite the lack of evidence that stagnacy is a problem in the first place. Added a practical tip, and a comic. [Section: Microbreaking.]

AprilUpgrade: Added much more detail about the crisis in orthopedic surgeries — very important context — and more detail to the descriptions of surgical options. [Section: Surgical options.]

FebruaryMajor improvements: Extensive new material about the relationship between neuropathy and neck pain, focused on clues that neuropathy is a factor in a case of chronic neck pain. [Section: How can I tell if there’s a pinched nerve?]

FebruaryMinor improvement: Added a footnote about the long-term risks of poor neck posture and text neck. [Section: Does abnormal curvature hurt? Not much! The neck posture myth.]

FebruaryRe-write: I threw 90% of this section away and started over with a much stronger focus on the interesting question of whether or not “cervicogenic headache” is even a thing. It’s a like-new section, now with much more useful diagnostic clues. [Section: Connections between neck pain, headaches, and migraines.]

JanuaryMinor science update: Added some references about the reliability of subluxation diagnosis. [Section: Subluxation: can your neck be “out”?]

2017Science update: Cited Chumbley et al on traction for neck pain in… fighter jet pilots! [Section: Pull my neck! The potential of traction.]

2017New section: No notes. Just a new section. [Section: Kill it with fire! Treatment by nerve destruction.]

2017Change of position: After reviewing the same scientific papers previously cited more carefully, I decided that they were much less promising than I originally thought. The section has flip-flopped from optimism to pessimism about nerve blocks without a single change in what’s actually cited, just a change in the level of diligence in interpreting the science. I’ve also added more detail and references. [Section: Diagnostic numbing of facet joints.]

2017Science update: Brought some more science to this discussion, especially Sandler et al on a link between stretching and back pain, and Tunwattanapong et al with modestly good news. Plus a bunch of editing. [Section: Will stretching help neck pain?]

2017Upgraded: Added much more information about massage “endangerment sites,” discussion of the potential relevance of neuritis, extensive clarifications and editing. [Section: Can you damage neck nerves by self-massaging?]

2017Science update: Finally added some basic information about “text neck” — mostly that it’s not actually a thing, and a good example of bogus information about neck pain. [Section: Neck pain myths busted here!]

2017Science update: Finally brought a little science to support the claim that trigger points complicate injury. More needed, but it’s a start. [Section: From the frying pan of injury pain to the fire of trigger point pain.]

2017Revision: This section was aging poorly. Reviewing it recently, it seemed too much like I was defensively explaining a pet theory (and I suppose I was). So I’ve done some thorough revision to bring it up to my current standards: less overconfidence, more science. [Section: The case for myofascial trigger points as a major neck pain villain.]

2017Upgraded: Added some more detailed safety advice and discussion of vibrating massage tools. Removed and de-emphasized a couple tools. Better images. Thorough editing the whole section. [Section: The role of massage tools in neck massage.]

2017New tip: Added a weird bonus strengthening tip based on Smith et al, which showed that clenching leg muscles reduced pain everywhere in patients with chronic neck pain. [Section: Build your neck muscle strength and endurance.]

2017Science upgrade: More evidence on how much (or little) pain is caused by cervical disc herniations, plus other miscellaneous citations and clarifications. Removed the claim that herniations actually decrease with age — the reference for that was no longer persuasive. [Section: Is it a herniated disc? Does it matter? The herniation myth.]

2017Revision: Added an example of SMT injury and a footnote about fearmongering, and then found myself editing the whole section. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

2017Minor update: Widespread minor improvements to complete the integration of central sensitization into the book. The neck pain book is now fully sensitive about sensitization!

2017Minor update: Integrated discussion of central sensitization, reframing the “confidence cure” as treatment for central sensitization. [Section: Relaxation and the confidence cure.]

2017Science update: Light editing, plus a new paragraph and citation to Morikawa et al, an odd little study showing that neck massage is relaxing, or possibly more. [Section: Introduction to treating your own neck trigger points.]

2017Edited: Several minor miscellaneous clarifications and elaborations, and some additional references. [Section: Pain killers and muscle relaxants.]

2017Revised: Thoroughly revised section and, unfortunately, a reversal from optimism to pessimism about the efficacy of nerve blocks. [Section: Needles for neck pain: nerve blocks for facet joints and related treatments.]

2017Expanded: Added important red flag information about artery tears with pain as the only symptom. [Section: “What if there’s something really wrong with my neck?” Safety information!]

2017Revision: Modernization and expansion; added more information about surgical options in particular. [Section: Surgical options.]

2017New section: Tips and a checklist for trying to estimate how much your neck pain might be about sensitization. [Section: How can you tell if you’re sensitized?]

2017Correction: An evidence-based correction regarding computer display position. [Section: Ergonomics are probably more important than posture.]

2017Big upgrade: Continued to beef up the science of psychological risk factors, and also added much more about other kinds of risk factors. The section almost doubled in size. [Section: A recipe for persistent neck pain — what are the risk factors?]

2017Science update: Two key new citations to support the idea that the state of muscle tissue is a big factor in neck pain. [Section: The most important tissue issue in most neck pain: muscle.]

2017Science update: A paragraph about genetic vulnerability to persistent neuropathic pain. [Section: Is it a pinched nerve? Rarely! The nerve pinch myth.]

2017New section: Substantial new section about sensitization, an important perspective on chronic neck pain. [Section: Neck pain as the tip of the sensitization iceberg.]

2017Science update: Solid little science update based on Nakashima et al, showing huge numbers of intervertebral disc bulges in healthy people. [Section: Is it a herniated disc? Does it matter? The herniation myth.]

2017Upgraded: Several good red flag clarifications and a couple interesting new references about spinal cord compression. [Section: “What if there’s something really wrong with my neck?” Safety information!]

2016Science update: Significant revision and some important new citations more firmly establishing the link between psychological and lifestyle factors and poor recovery from neck pain. Previously this section relied too much on similar evidence about other problems: it is now more neck-centric. [Section: A recipe for persistent neck pain — what are the risk factors?]

2016Science update: Added some useful new indirect evidence about SMT for migraine (Chaibi et al). [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

2016Edited: Added some important footnotes and clarifications. [Section: The most important tissue issue in most neck pain: muscle.]

2016Edited: Thorough revision and modernization. Although I revised this section a mere five years ago, it needed it again! [Section: Estimating the importance of trigger points in your own case.]

2016New section: More than a thousand new words on the topic of neck cracking. [Section: Popping your neck joints: bad habit, or self-treatment?]

2016Science update: Revised the introduction to treatments for clarity and completeness, added new references, and a new short paragraph about risks and harms. [Section: Treatment: What can you do for a crick in the neck?]

2016Major update: Broadened scope of section to include all pain killers. Added a summary of opioids, and a guide to experimenting with the over-the-counter ones; added more science; merged and edited previously separate sections on rebound pain and muscle relaxants. [Section: Pain killers and muscle relaxants.]

2016Correction: Removed overconfident statements about the clinical significance of the effects of psychoactive drugs, plus related minor updates. [Section: Estimating the importance of trigger points in your own case.]

2016Minor update: Some editing and new caveats. [Section: Diagnostic numbing of facet joints.]

2016Update: Added new intro to section about distorted body image. [Section: Subluxation: can your neck be “out”?]

2016Science update: Added citation about the efficacy of ibuprofen for headache. [Section: Pain killers and muscle relaxants.]

2016Science update: Added some particularly good science to shore up the personal anecdote added in January. [Section: Could it be arthritis? Is your spine degenerating? Probably not, no.]

2016Improved: Added a new key point about how to recognize the pain of a nerve root pinch. [Section: How can I tell if there’s a pinched nerve?]

2016Science update: New footnote supporting the use of education (like this tutorial!) to treat chronic pain. [Section: Introduction.]

2016Minor update: Added a good personal ancedote…because my spine is degenerating! Also, a footnote about surprisingly painless joint damage. [Section: Could it be arthritis? Is your spine degenerating? Probably not, no.]

2015Science update: Added some hard evidence on the minor (non-lethal) risks of SMT from Carlesso 2010. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

2015Science update: Added an interesting reference to Carlesso 2013 with some discussion of the implications. [Section: Neck pain versus back pain: some similarities and differences.]

2015Science update: Added a humility citation, conceding the absence of scientific evidence that massage helps neck pain. Also, modernization summary of trigger point therapy. [Section: Introduction to treating your own neck trigger points.]

2015Science update: Added a little more information about the nature of uncovertebral joints. [Section: Why does a crick feel the way it does?]

2015Upgraded: More and clearer red flag details, especially about spinal cord trouble (myelopathy). [Section: “What if there’s something really wrong with my neck?” Safety information!]

2015Major update: Completely rewritten and greatly expanded, with much more science, emphasizing strength as a worthwhile treatment option. [Section: Build your neck muscle strength and endurance.]

2015Revised: Editing and some new science about changing head posture. [Section: Will strength improve neck posture/curvature?]

2015Minor update: More data on neck pain recovery rates [Section: Prognosis: What’s the worst case scenario for neck pain?]

2015Minor addition: Added a patient anecdote about a strange muscle spasm experience…which I know all too well. [Section: Is it a spasm? Nope, probably not that either: the muscle spasm myths (plural).]

2015Minor update: Added an expert quote. [Section: Does abnormal curvature hurt? Not much! The neck posture myth.]

2015Science update: Added brief example of nerve pinch by vertebral artery twistiness. [Section: How can I tell if there’s a pinched nerve?]

2015Science update: Added three good references and a diagram about how much “wiggle” room nerve roots have. [Section: Is it a pinched nerve? Rarely! The nerve pinch myth.]

2015Expanded: Added about 350 words about neck circle safety. [Section: Mobilizations or “wiggle therapy”.]

2014Science update: Added a new good-news study about massage for neck pain. [Section: The case for myofascial trigger points as a major neck pain villain.]

2014Minor update: Upgraded references on neck pain recovery rates. [Section: Prognosis: What’s the worst case scenario for neck pain?]

2014Science update: Added some important acknowledgements that the science of trigger points is a bit half-baked, and linked out to much more information for the curious. [Section: The case for myofascial trigger points as a major neck pain villain.]

2014More content: Explanation of the difference between a subluxation and an MID. [Section: Subluxation: can your neck be “out”?]

2014Science update: Added citation to a key 2012 study of the effectiveness of adjustment for neck pain. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

2014New: A new section, but also a summary of an existing free article. [Section: Digital Motion X-Ray.]

2013Minor update: Added a (fascinating) footnote about the myth of anaesthetic paralysis. [Section: Reality checks: some popular treatments that are particularly silly.]

2013Minor yoga update: Added a reference and paragraph about the risks of yoga, which are minor but real, especially for neck pain. [Section: Will stretching help neck pain?]

2013Minor science update: Added a tiny, flawed study about yoga for neck pain (for what little it’s worth). [Section: Will stretching help neck pain?]

2013New evidence: Rare good news: the first good quality scientific test showing that reducing fear is actually good medicine. The section got a decent editing as well. [Section: Relaxation and the confidence cure.]

2013New section: No notes. Just a new section. [Section: A massage success story.]

2012Science update: Added evidence that the stakes are high with chronic pain: it may even shorten lives. [Section: Neck pain myths busted here!]

2012Science update: Added a key reference about the effectiveness of massage for back pain, with the (safe) assumption that it probably applies to neck pain as well. [Section: The case for myofascial trigger points as a major neck pain villain.]

2012Science update: A new study shows that massage therapists cannot reliably find the side of pain by feel — good evidence that no gross spasm (or other structural factor) is usually involved. [Section: Is it a spasm? Nope, probably not that either: the muscle spasm myths (plural).]

2012Minor update: Added some creative problem-solving for hot climates. [Section: Accidental icing: avoid drafts at night.]

2011Minor update: Added a minor but odd note about “sensory annoyances” like hats and collars. [Section: Ergonomics are probably more important than posture.]

2011Minor update: Added some unusual research about the risks heavy metal “head-banging” — a fun example, for perspective. [Section: Is it a strain? Probably not! The muscle strain myth.]

2011More content: Added scientific cases studies, examples, pictures and video of true dislocation and abnormal anatomy to help drive home the point that even significant spinal joint dysfunction can be surprisingly harmless … never mind subtle joint problems. [Section: Subluxation: can your neck be “out”?]

2011Minor science update: Cited a study about yoga and stretching for back pain. [Section: Will stretching help neck pain?]

2011New section: This section is a summary of an important concept that’s been available in a free article since late 2008, but also needed to be emphasized here. Now it is. [Section: From the frying pan of injury pain to the fire of trigger point pain.]

2011Minor update: Added a reference about the poor overall quality of online information about common injuries. See Starman et al. [Section: Neck pain myths busted here!]

2011Added a fun thing: I can’t believe I didn’t know about inflatable neck extenders until now! [Section: Pull my neck! The potential of traction.]

2011New section: More information about an important characteristic of muscle-dominated neck pain. [Section: “Out of nowhere”: seemingly random episodes of neck pain.]

2011Major update: Totally renovated section: re-written, reformatted, expanded, upgraded. A few new checklist items were added, most were expanded, and all were clarified. A separate and handier “quick” checklist was added to the existing “slow” checklist. [Section: Estimating the importance of trigger points in your own case.]

2011Major update: Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.

2011Upgraded: New artwork from PainScience.com artist Gary Lyons, plus some important new references. [Section: Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.]

2010Updated: Updated with an important story about a disastrous example of neck stretching that backfired. Not just for customers: this particular section is a short version of a new free article. [Section: Will stretching help neck pain?]

2010Minor update: Some good new science cited in the introduction, about the overall effectiveness of manual therapies. See D’Sylva et al. [Section: Neck pain myths busted here!]

2010Major Update: Rewriting and expansion of the Special Supplement on spinal manipulative therapy. [Section: Subluxation: can your neck be “out”?]

2010Update: New science confirms that helmets do not cause neck injuries — they just keep your head safe. However, minor injury remains likely and problematic. [Section: Is it a strain? Probably not! The muscle strain myth.]

2010New cover: At last! E-book finally has a “cover.”

2010Science update: Updated with a summary of a bizarre experiment with muscle relaxants that had quite surprising results. [Section: Reality checks: some popular treatments that are particularly silly.]

2010Minor update: Update with another recent study showing that strength training doesn’t work. [Section: Will strength improve neck posture/curvature?]

2010Major update: Completely overhauled and substantially expanded, and polished several relevant bibliographic records. [Section: Will strength improve neck posture/curvature?]

2010Rewritten: Completely overhauled and substantially expanded, and polished several relevant bibliographic records. [Section: Does abnormal curvature hurt? Not much! The neck posture myth.]

2010Science update: Added an interesting reference about how muscle relaxants are surprisingly ineffective. [Section: Reality checks: some popular treatments that are particularly silly.]

2009Minor update: Shored up substantiation of the relationship between migraines and trigger points. See Fernández-de-Las-Peñas et al, and another paper by Fernández-de-Las-Peñas et al, and also Calandre et al. [Section: The case for myofascial trigger points as a major neck pain villain.]

2009New section: First new section since the huge update in the fall, a short-but-useful section. [Section: A poke in the disc! Cervical provocation discography as a method of diagnosis.]

2009Huge upgrade: Over the past several months, the neck pain tutorial has more than quadrupled the amount of information it offers, and it is now book-length at more than 40,000 words. Almost every single section was overhauled, and many new sections were added. Dozens of references to more recent scientific research were integrated and their significance explained, including several good new studies less than six months old.