When do you have significant pain?
Even if your pain is very acute, you may be able to get out of bed, although probably with difficulty. But certain movements will be impossible and often you will not be able to find a comfortable position in which to sit or work. Even though you are in acute pain, you should always attempt to begin with Exercise 1. Many people find that this exercise gives substantial relief from pain and that they do not have to start with the exercises that involve lying on a bed (Exercises 3 and 4).
As soon as possible, even on the first day, you should add Exercise 2. You should continue Exercises 1 and 2 until you feel considerably better. Once you no longer have acute pain, you should follow the exercise program as outlined in this chapter under the heading When Acute Pain Has Subsided.
If you have done three or four sessions of Exercise 1, spread over a period of 15 minutes, and the pain remains too acute to tolerate that exercise, you should stop it and replace it with Exercise 3. Your symptoms should gradually decrease and centralize so that there is some improvement by the time you have completed a few sessions. Exercise 4 should be added as soon as you have become well practiced in Exercise 3 and your symptoms have improved to some extent, or when Exercise 3 is no longer bringing you any improvement.
When the person with neck pain should introduce Exercise 4 varies from person to person, but the sooner you can do this, the better. It is important that you carefully watch the pain pattern. You are exercising correctly if in a few days the pain moves toward the base or the center of the neck and decreases. In time the pain should disappear entirely and be replaced by a feeling of strain or stiffness, a feeling that is more tolerable.
