Why your neck can hurt more when you already have more range and more strength

Almost every piece of advice about neck pain assumes one of two things. Either you are too tight and should stretch, or you are too weak and should strengthen. A study published last week describes a group of people for whom neither explanation holds, and who reported more neck pain anyway.

Researchers set up at a large state fair and assessed 555 adults for generalized joint hypermobility, the trait of having joints that move further than most, measured with the Beighton Score and the Five Part Questionnaire. Everyone also completed a neck pain survey. Hypermobility turned out to be far more common in the women than the men, 23.5 percent against 6.8 percent, and among the women, neck pain was more common in the hypermobile group than in the rest, 24.1 percent against 16.0 percent (Abbott et al., 2026). Only 15 men were hypermobile, too few to analyze, so the findings below are about women.

Then comes the part that cuts against the usual advice. A subset of 182 women went on to have their necks actually tested for range of motion and strength. After the researchers controlled for age, body mass index, and how much neck pain and disability each person carried, hypermobility was associated with greater range of motion in multiple directions and greater strength. The group reporting more neck pain was not the stiffer group. It was not the weaker group either.

The authors also found that the relationship between disability and function ran differently depending on whether someone was hypermobile, which led them to suggest that hypermobility may represent a distinct neck pain phenotype, a version that behaves by its own rules. Two caveats belong here. This was a snapshot taken at a single moment, so it can show associations but cannot establish what causes what. And it was a relatively healthy crowd wandering a state fair, not a clinic population, which the authors note themselves.

Alongside that study, the August issue of the Journal of Orthopaedic & Sports Physical Therapy ran an editorial with a pointed title: "They've Seen You, but Have You Seen Them?" Its argument is that a preparation gap exists in musculoskeletal physical therapy. People with hypermobility often arrive after years of recurrent sprains, joint subluxations, widespread pain, and fatigue, carrying normal imaging and inconsistent explanations, and their care can become fragmented, overly passive, or stopped early when pain persists. The authors set out five principles, among them treating hypermobility as a multisystem condition, prioritizing education and validation, favoring active stabilization over passive strategies, and accounting for altered pain processing and fatigue (Mintken et al., 2026).

Put the two together and something practical falls out. If you have a mobile body and a sore neck, the standard script may not fit you, and the person treating you may not have been trained in why.

Three questions worth raising

"Has anyone actually checked whether I am hypermobile?" This is the question I would start with, because it is quick and it is often skipped. The Beighton Score takes a couple of minutes in an office. In this sample nearly a quarter of the women met the threshold, so it is not a rare finding. Knowing the answer changes how the rest of the conversation should go.

"My range and strength test well. So what are we measuring instead?" This moves the appointment off the two variables that dominate neck care and onto the one this research points toward, which is control. It also matches the editorial's principle of favoring active stabilization over passive treatment, and it is fair to ask if stretching or strengthening has already been tried without much changing.

"How do fatigue and pain sensitivity fit into my plan?" Hypermobility is described in the editorial as a multisystem condition, and fatigue and altered pain processing are named as part of the clinical picture rather than as side issues. Raising them invites a plan that accounts for the whole pattern instead of treating the neck as an isolated part.

What this means for moving

This is familiar territory from my own work. When someone with a very mobile neck turns their head, the range is rarely the problem. They get there easily, often too easily. What tends to be missing is the finer sense of where the head is along the way, so the movement arrives at its edge without much notice of the middle. That gap in proprioception and joint sense is not something more range would help. These women already had more range.

The instinct, when a neck feels uncomfortable, is usually to stretch it further. For a hypermobile neck that instinct points the wrong way, and our guide there walks through movements that build steadiness inside a comfortable range instead.

The Feldenkrais Method®, which I teach, works on exactly the channel this research keeps implicating. An Awareness Through Movement® lesson is not a stretching routine and not a strength drill. It is a series of small, slow movements whose purpose is to notice the difference between one position and the next, which is how the sense of where a joint sits gets sharper. For a mobile body, two details matter. You only go where it feels easy, pleasant, and comfortable, which keeps you away from the dramatic end range that already comes too readily. And attention, rather than effort, is what is asked of you. This kind of work sits alongside what a physiotherapist has given you rather than replacing it. Pilates and yoga offer a different way of working with the body, each with its own strengths.

None of this makes the underlying trait go away, and one snapshot study does not settle a question. But it suggests a useful shift in emphasis. If your neck hurts and your tests keep coming back fine, the question worth asking may not be how far your neck can go. It may be how well you know where it is. That is a skill, and skills can be practiced.