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.
A major feature of my tutorials is that I actively update them as new science and information becomes available. Unlike regular books, and even ebooks — which can be obsolete by the time they are published, and can go years between editions — this tutorial 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 51 major and minor updates worth logging since I started logging carefully in late 2009, and countless more minor tweaks and touch-ups.
Science update (Nov 11 '15, section #5.6) — Added a humility citation, conceding the absence of scientific evidence that massage helps neck pain. Also, modernization summary of trigger point therapy. See section #5.6, Introduction to treating your own neck trigger points.
Science update (Nov 2 '15, section #3.1) — Added a little more information about the nature of uncovertebral joints. See section #3.1, Why does a crick feel the way it does?
Upgraded (Oct 29 '15, section #2.2) — More and clearer red flag details, especially about spinal cord trouble (myelopathy). See section #2.2, “What if there’s something really wrong with my neck?” Safety information!
Major update (Jun 17 '15, section #5.17) — Completely rewritten and greatly expanded, with much more science, emphasizing strength as a worthwhile treatment option. See section #5.17, Build your neck muscle strength and endurance.
Revised (Jun 16 '15, section #5.18) — Editing and some new science about changing head posture. See section #5.18, Will strength improve neck posture/curvature?
Minor update (Jun 15 '15, section #2) — More data on neck pain recovery rates See section #2, Prognosis: What’s the worst case scenario for neck pain?
Minor addition (Jun 10 '15, section #3.10) — Added a patient anecdote about a strange muscle spasm experience…which I know all too well. See section #3.10, Is it a spasm? Nope, probably not a spasm either: the muscle spasm myths (plural).
Minor update (Jun 10 '15, section #3.8) — Added an expert quote. See section #3.8, Does abnormal curvature hurt? Not much! The neck posture myth.
Science update (Mar 3 '15, section #4.1) — Added brief example of nerve pinch by vertebral artery twistiness. See section #4.1, How can I tell if there’s a pinched nerve?
Science update (Feb 28 '15, section #3.7) — Added three good references and a diagram about how much “wiggle” room nerve roots have. See section #3.7, Is it a pinched nerve? I doubt it! The nerve pinch myth.
Expanded (Feb 24 '15, section #5.13) — Added about 350 words about neck circle safety. See section #5.13, Mobilizations or “wiggle therapy”.
Science update (Nov 23 '14, section #3.12) — Added a new good news study about massage for neck pain. See section #3.12, The case for myofascial trigger points as a major neck pain villain.
Minor update (Oct 22 '14, section #2) — Upgraded references on neck pain recovery rates. See section #2, Prognosis: What’s the worst case scenario for neck pain?
Science update (Jul 11 '14, section #3.12) — 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. See section #3.12, The case for myofascial trigger points as a major neck pain villain.
More content (Jul 11 '14, section #3.2) — Explanation of the difference between a subluxation and an MID. See section #3.2, Subluxation: can your neck be “out”?
Science update (Jul 1 '14, section #5.23) — Added citation to a key 2012 study of the effectiveness of adjustment for neck pain. See section #5.23, Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.
New (Jul 1 '14, section #4.10) — A new section, but also a summary of an existing free article. See section #4.10, Digital Motion X-Ray.
Minor update (Dec 21 '13, section #5.26) — Added a (fascinating) footnote about the myth of anaesthetic paralysis. See section #5.26, Reality checks: some popular treatments that don’t work at all (or not nearly as well as you would hope).
Minor yoga update (Dec 14 '13, section #5.14) — Added a reference and paragraph about the risks of yoga, which are minor but real, especially for neck pain. See section #5.14, Will stretching help neck pain? Much?
Minor science update (Jul 20 '13, section #5.14) — Added a tiny, flawed study about yoga for neck pain (for what little it’s worth). See section #5.14, Will stretching help neck pain? Much?
New evidence (May 29 '13, section #5.16) — 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. See section #5.16, Relaxation and the confidence cure.
New section (May 29 '13, section #5.8) — No notes. Just a new section. See section #5.8, A massage success story.
Science update (Oct 26 '12, section #1.1) — Added evidence that the stakes are high with chronic pain: it may even shorten lives. See section #1.1, Neck pain myths busted here!
Science update (Oct 24 '12, section #3.12) — 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. See section #3.12, The case for myofascial trigger points as a major neck pain villain.
Science update (Jul 4 '12, section #3.10) — 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. See section #3.10, Is it a spasm? Nope, probably not a spasm either: the muscle spasm myths (plural).
Minor update (Mar 8 '12, section #5.12) — Added some creative problem-solving for hot climates. See section #5.12, Avoid drafts at night.
Minor update (Dec 14 '11, section #5.20) — Added a minor but odd note about “sensory annoyances” like hats and collars. See section #5.20, Ergonomics are probably more important than posture.
Minor update (Dec 1 '11, section #3.9) — Added some unusual research about the risks heavy metal “head-banging” — a fun example, for perspective. See section #3.9, Is it a strain? Probably not! The muscle strain myth.
More content (Dec 1 '11, section #3.2) — 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. See section #3.2, Subluxation: can your neck be “out”?
trivial update (Nov 25 '11, section #1.2) — Trivial but fun. Added an amusing quote about neck pain diagnosis from the TV series, House. See section #1.2, How can you trust this information about neck pain?
Minor science update (Nov 4 '11, section #5.14) — Cited a study about yoga and stretching for back pain. See section #5.14, Will stretching help neck pain? Much?
New section (Aug 26 '11, section #3.13) — 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 finally is. See section #3.13, From the frying pan of injury pain to the fire of trigger point pain.
Minor update (Jul 29 '11, section #1.1) — Added a reference about the poor overall quality of online information about common injuries. See Starman et al. See section #1.1, Neck pain myths busted here!
Added a fun thing (Jul 15 '11, section #5.15) — I can’t believe I didn’t know about inflatable neck extenders until now! See section #5.15, Pull my neck! The potential of traction.
New section (Jul 13 '11, section #4.5) — More information about an important characteristic of muscle-dominated neck pain. See section #4.5, “Out of nowhere”: seemingly random episodes of neck pain.
Major update (Jul 12 '11, section #4.4) — 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. See section #4.4, Estimating the importance of trigger points in your own case.
Major update (Jun 21 '11) — 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.
Upgraded (Feb 17 '11, section #5.23) — New artwork from PainScience.com artist Gary Lyons, plus some important new references. See section #5.23, Spinal manipulative therapy (SMT): Adjustment, manipulation and cracking of the spinal joints.
Updated (Oct 6 '10, section #5.14) — 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. See section #5.14, Will stretching help neck pain? Much?
Minor update (Oct 5 '10, section #1.1) — Some good new science cited in the introduction, about the overall effectiveness of manual therapies. See D'Sylva et al. See section #1.1, Neck pain myths busted here!
Major Update (Oct 1 '10, section #3.2) — Rewriting and expansion of the Special Supplement on spinal manipulative therapy. See section #3.2, Subluxation: can your neck be “out”?
Update (Sep 29 '10, section #3.9) — New science confirms that helmets do not cause neck injuries — they just keep your head safe. However, minor injury remains likely and problematic. See section #3.9, Is it a strain? Probably not! The muscle strain myth.
New cover (Aug 6 '10) — At last! This e-book finally has a “cover.”
Science update (Jul 7 '10, section #5.26) — Updated with a summary of a bizarre experiment with muscle relaxants that had quite surprising results. See section #5.26, Reality checks: some popular treatments that don’t work at all (or not nearly as well as you would hope).
Minor update (May 24 '10, section #5.18) — Update with another recent study showing that strength training doesn’t work. See section #5.18, Will strength improve neck posture/curvature?
Major update (Apr 20 '10, section #5.18) — Completely overhauled and substantially expanded, and polished several relevant bibliographic records. See section #5.18, Will strength improve neck posture/curvature?
Rewritten (Apr 20 '10, section #3.8) — Completely overhauled and substantially expanded, and polished several relevant bibliographic records. See section #3.8, Does abnormal curvature hurt? Not much! The neck posture myth.
Science update (Feb 13 '10, section #5.26) — Added an interesting reference about how muscle relaxants are surprisingly ineffective. See section #5.26, Reality checks: some popular treatments that don’t work at all (or not nearly as well as you would hope).
Minor update (Dec 31 '09, section #3.12) — 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. See section #3.12, The case for myofascial trigger points as a major neck pain villain.
New section (Dec 16 '09, section #4.3) — First new section since the huge update in the fall, a short-but-useful section. See section #4.3, A poke in the disc! Cervical provocation discography as a method of diagnosis.
Huge upgrade (Sep 23 '09) — 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 (not including two substantive customer-only special supplements). 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.