For mild pain without warning signs, staying gently active, adjusting posture, and using short-term comfort measures are often reasonable first steps. If symptoms continue, interfere with work or sleep, or travel into the arm, Neck pain treatment should begin with an assessment rather than repeated self-adjustment or guesswork.

A clinician evaluates the pain’s location, duration, triggers, range of motion, and associated symptoms before recommending care. At True Health Chiropractic and Acupuncture, the first appointment typically takes about 45 minutes to an hour and includes a history, examination, and explanation of findings.

Start by identifying the pattern

Neck pain is commonly divided into two broad patterns:

• Axial pain stays mainly in the neck and may feel sore, tight, or stiff.
• Radicular pain follows an irritated nerve and may shoot toward the shoulder, arm, or hand.

Pain may be acute, lasting days to several weeks, or persistent and recurrent. Muscle strain and prolonged posture often improve with conservative care. Nerve symptoms, significant injury, or progressive loss of function require a more careful evaluation.

Common causes include:

• Muscle strain or spasm after sleeping awkwardly, lifting, or repetitive activity.
• Forward-head posture associated with prolonged computer or phone use.
• Joint irritation or restricted movement in the cervical spine.
• Disc degeneration or a disc injury.
• Whiplash and other vehicle, sports, or workplace injuries.
• Nerve compression causing pain, tingling, numbness, or weakness in an arm.
• Tension-related headaches that begin in the neck or upper shoulders.

A physical examination is often enough to guide the initial plan. Imaging is not automatically necessary for every episode, but a healthcare professional may consider X-rays, MRI, CT, or other testing when trauma, neurological changes, infection, cancer, or spinal-cord involvement is a concern.

What to do during the first few days

Complete bed rest is rarely helpful for ordinary neck strain. Gentle movement supports circulation and helps prevent stiffness, provided it does not sharply increase symptoms.

Practical measures include:

• Continue normal light activity as tolerated, but pause heavy lifting and movements that provoke pain.
• Apply a wrapped cold pack during the early phase of an injury if swelling or inflammation is present.
• Use gentle heat later or for muscle tightness. A warm shower or heating pad may relax tense muscles.
• Take regular breaks from screens. Raise the monitor, bring the phone closer to eye level, and avoid holding the head bent forward for long periods.
• Sleep in a position that keeps the neck reasonably neutral. Avoid stacking pillows so high that the head is pushed forward.
• Try slow, pain-free neck turns or shoulder movements rather than forceful stretching.

Over-the-counter medicines such as acetaminophen or anti-inflammatory drugs may help, but they are not appropriate for everyone. NSAIDs can be unsafe with certain stomach, kidney, heart, bleeding, pregnancy, or medication-related conditions. Follow the product label and ask a pharmacist or clinician if you are unsure. Do not use pain relief to push through an activity that is worsening the injury.

Match treatment to the underlying problem

Hands-on chiropractic care

Chiropractic treatment commonly focuses on improving restricted joint movement, reducing mechanical strain, and supporting more comfortable motion. Depending on the examination, care may include gentle manual techniques, mobility work, soft-tissue treatment, and advice about posture or activity.

High-velocity neck manipulation is not suitable for every patient. Anyone with significant trauma, severe osteoporosis, bleeding risk, suspected instability, neurological deterioration, or certain vascular conditions needs medical evaluation before such treatment. A qualified practitioner should review your history and explain the proposed technique.

True Health Chiropractic and Acupuncture describes its neck-pain approach as addressing joint restriction, muscle imbalance, disc irritation, and posture rather than providing only temporary symptom relief. The clinic also states that treatment may include chiropractic care, acupuncture, spinal decompression, or cold laser therapy depending on the condition.

Exercise and physical therapy

Exercise becomes especially important when weakness, poor endurance, or recurring postural strain contributes to the problem. A physical therapist or other qualified clinician may prescribe:

• Gentle range-of-motion exercises.
• Deep neck-flexor and upper-back strengthening.
• Shoulder-blade control work.
• Stretching for tight chest and upper-shoulder muscles.
• Progressive return to lifting, work, or sport.

Exercises should be controlled and comfortable. Stop and seek advice if movement causes increasing arm pain, numbness, weakness, dizziness, severe headache, or loss of coordination.

Acupuncture and other supportive treatments

Acupuncture is used by some patients as part of a broader pain-management plan. It should be performed by a properly trained, licensed practitioner using sterile, single-use needles. People taking blood thinners, those with bleeding disorders, and anyone who is pregnant or medically complex should discuss safety beforehand.

Massage, heat, ergonomic changes, and supervised rehabilitation may complement treatment. They should support an appropriate diagnosis rather than substitute for evaluation when symptoms are severe or unusual.

Medication, injections, and surgery

A physician may recommend prescription medication when pain is severe or persistent. In selected cases, injections are considered for inflammation or nerve-related pain. Surgery is generally reserved for situations such as progressive neurological deficits, spinal-cord compression, serious structural disease, or pain that remains disabling despite appropriate nonsurgical care.

These options require an individualized medical assessment. A treatment advertised as “instant” or suitable for everyone deserves caution.

When neck pain needs prompt medical attention

Seek emergency care after a significant accident or blow to the head or neck, especially if there is severe pain, inability to move the neck, weakness, numbness, or loss of sensation.

Get urgent medical assessment for:

• New or worsening weakness in an arm or leg.
• Difficulty walking, poor coordination, or loss of bladder or bowel control.
• Fever, severe headache, unusual sensitivity to light, or marked illness.
• Neck pain with chest pain, shortness of breath, sweating, nausea, or pain spreading to the jaw or arm.
• Unexplained weight loss, a history of cancer, or immune suppression.
• Sudden severe neck pain with neurological or visual symptoms.

Even without emergency signs, arrange an appointment if pain is not improving, keeps returning, disrupts sleep or daily activities, or extends into the shoulder or arm. Persistent symptoms should not be repeatedly masked with medication or forceful stretching.

What happens at an evaluation?

A useful appointment is more than locating the sore spot. Expect questions about when the pain began, what makes it better or worse, previous injuries, work demands, sleep, headaches, and symptoms in the arms or hands.

The examination may assess:

• Neck and shoulder range of motion.
• Tenderness, muscle tension, and joint movement.
• Strength, reflexes, sensation, and coordination.
• Posture and movement patterns.
• Signs that suggest nerve or spinal-cord involvement.

The findings should lead to a clear plan: what activities to modify, which treatments are appropriate, how progress will be measured, and when reassessment is needed. At True Health Chiropractic and Acupuncture, the stated first-visit process includes listening to how the pain affects daily life, examining neck movement, and explaining findings in straightforward language.

Questions patients often ask

How long does neck pain usually take to improve?

Minor strain and tension-related pain often improve within a week or two, although complete resolution can take longer. Many mild to moderate episodes improve within a few weeks with self-care. Persistent or recurrent pain deserves evaluation, particularly when it affects work, exercise, sleep, or arm function.

Is exercise safe with neck pain?

Gentle, pain-free movement is usually preferable to complete inactivity for uncomplicated stiffness. Avoid jerking, forceful twisting, and exercises that increase radiating pain or neurological symptoms. A clinician should guide exercise after an accident or when numbness or weakness is present.

Should I use ice or heat?

Either may provide relief, depending on the situation. Cold is often useful after a recent aggravating injury, while heat may relax tight muscles. Keep a barrier between the skin and the pack, limit exposure, and stop if the skin becomes painful or numb.

Will treatment help immediately?

Some people notice relief after an initial visit, while others improve over several days or require a longer plan. The response depends on the cause, severity, and duration of the pain. Immediate relief does not necessarily mean the underlying problem has fully resolved, so follow the recommended activity and follow-up plan.

How does chiropractic care differ from physical therapy?

Chiropractic care often emphasizes joint mobility and hands-on treatment, while physical therapy commonly emphasizes targeted exercise, strengthening, and functional rehabilitation. The approaches can overlap, and the appropriate choice depends on the examination. Some care plans combine manual treatment with exercises and lifestyle changes.

What if the pain keeps coming back?

Recurring pain often reflects an unresolved contributor such as workstation setup, reduced strength, repetitive loading, restricted movement, or an incompletely assessed injury. Reassessment is more useful than simply repeating the same short-term remedy. The goal is to restore comfortable movement and build habits that reduce repeated strain.

The idea of an MVC (Model-View-Controller) framework is to separate the different concerns of your code, and that usually this allows you to design a data model, and then let your tools create a scaffolding of your site. Such things aren’t new; I implemented a Chinese Chess web site in Ruby on Rails which uses this approach in 2005. I loved the MVC approach.

Still, it’s nice that ASP.NET has caught up, and that it’s intended to take a lot of the labour out of creating an ASP.NET website, though it is radically different to traditional ASP.NET websites.

In an ASP.NET MVC site, typically, the data model is a bunch of tables in a database, and ASP.NET MVC can then create the classes (Controllers) and forms (Views) to allow you to view a list of the rows in that table, and to create, update, read or delete those rows. That sounds like a lot of what SharePoint offers – lists, and the user interface to modify them.

This set me wondering – are ASP.NET MVC solutions actually a competitor to SharePoint, at least for some solutions? Which would I rather work with? I mean, SharePoint is about lists of things and CRUD operations, and MVC’s Index is about lists of things, and has CRUD operations.

Well, it seems to me that ASP.NET MVC applications have a lot of advantages:

1. You can auto-generate forms that are then easily modify. SharePoint forms are a bugger to modify, even with things like the Client Rendering in SharePoint 2013.
2. You can design and work directly with a proper SQL database. No Query Throttle Limit.
3. Runs under Azure quite happily. Using Office 365 for SharePoint can become hazardous if you approach the query throttle limit, and there are a number of features of SharePoint not available in the cloud version.
4. MVC is more amenable to automated testing and lifecycle management. SharePoint is harder in terms of lifecycle management, and downright awkward for unit testing.
5. MVC is much lighter. SharePoint requires a lot of hardware to work well.

There are a few disadvantages too:

1. MVC requires a developer to create a new view. It’s quick to do, but not like a SharePoint user being able to produce their own ListView.
2. In fact, MVC requires a developer for a lot of things. In theory, SharePoint would allow ‘business users’ to create solutions in SharePoint. In practice, I don’t think that this happens very often.
3. SharePoint does give you quite a lot ‘for free’. For example, versioning of documents in a library – it’s not rocket science, and you could write similar in MVC very easily, but you would have to do your own. There are loads of examples, but it’s worth noting, a lot of them don’t get used very often.
4. I’d really miss SharePoint Search. The Search service is really good for, well, allowing you to search across structured and unstructured data. Making MVC search unstructured data doesn’t sound fun.

I dunno, I guess I just found myself looking at some of the things I’ve been asked to build over the last couple of years and thinking, for the smaller, more constrained-scope projects, that they could be implemented in MVC for less effort than deploying SharePoint, and then trying to eke out the functionality you need from that monster.

I suppose I’d consider doing things in MVC if:

• A system is particularly large scale. MVC will give you more flexibility than SharePoint. And sometimes, 30 million items in a list isn’t enough…
• If the system is particularly small – MVC doesn’t need the elephant of SharePoint.

And, I’ve got to be honest, I enjoyed working with MVC. It’s much nicer than the old ASP Page model. I was quite impressed.

Right, so this is one of the 4 exams you’ll need for the MCSD SharePoint Applications. We decided to fling me at this one without preparation – I’m a SharePoint developer, so shouldn’t I be good at this one without lots of learning?

The Core Solutions exam focuses on the core stuff that you’d get in SharePoint Foundation. There was no search, BCS, Access Services, Excel Services, Visio Services, Secure Store, or any of that Enterprise edition stuff, which was a relief.

Like the ASP.NET MVC exam (yes, I did that recently; I’ll come back to it), this one consisted of some case studies – 4, in fact – plus a set of 22 questions that can be about anything. They were presented to me as 2 case studies, the 22 questions, and the other 2 case studies. Count the case studies as you do them. I thought that by ‘4 case studies’ it meant ‘3 case studies and a general questions bit’, then lost count mid-way, and then got a bit of a shock when I had 2 case studies to complete at the end. I thought the general questions would finish it, but they were in the middle for me. Time did start to become an issue, which is a first for me in a Microsoft exam.

The case studies are a lot of work; there’s a lot to read through, but some of the questions require you to have pulled together details from different parts of the information provided. I think if I’d just scanned the documentation after I’d read the questions, I’d have missed some of the details I needed. Reading the case studies is time consuming, though.

I found the first case study a right pain, but it did get easier thereafter.

General areas that seemed to get a lot of attention:

• Apps – App Licensing, App Permissions (i.e. the perms granted to an app), how to add/remove/uninstall an App, how to control who can add an app to a site, different App hosting models – all the stuff in the syllabus, really.
• Claims Auth – Lots and lots about this, particularly in the case studies. I didn’t do so well at these; this is worth more attention for me in the future. Claims auth, OAuth, etc..
• Workflow(!) – For some strange reason, there was quite a lot about workflow in this exam.
• Packaging Solutions – how to package and deploy a third party assembly, importing solutions you created with SharePoint Designer (Workflow) and by other means. This was a bit weird – I’m just used to writing solutions from scratch, not deploying third party code, but I guess it’s good to know.

All in all, there was a fair range of topics – it was very broad. I found my background in the previous versions of SharePoint useful, and the prevalence of Apps and Claims Auth will hardly be a surprise to anyone, and all the above are on the syllabus.

Oh, and there were questions about the Sandbox and Autohosted SharePoint Apps, which was a bit weird, as these are both deprecated now. I was lucky enough to know the basics about both.

And yes, I passed. It wasn’t a bad pass, either. 4 down, one more exam to go.

Well, I found that my site was spending a lot of bandwidth serving jQuery.

Yup, 10% of my site’s bandwidth was being spent on… serving jQuery. That’s not efficient, so I found this post, which describes how to make the site use a CDN instead. Note that the functions.php file it mentions is the one in your theme.

Hopefully, that’ll reduce the bandwidth used. I also changed the css files for the theme, by minimising them; that should save another 200Mb per month. In total, that should be about a 12% saving on bandwidth.

It’s funny how this all mounts up!

Technology Issues

No options for dealing with Query Throttle Exceptions. Consider this – you’ve been using a list for a while, and have lots of useful data in it. Suddenly, some of your views start to return Query Throttle exceptions. You’ve just tipped over the magic 5000 items limit in a large list. What do you do? Well, in normal SharePoint you’ve a number of options, the main one being to create an index or indices on the list so that your queries can be more efficient, and thus avoiding throttling. However, that action is itself throttled – so you’d have to either a) get a Farm Admin to do it, or b) have to define a “happy hour” window late at night when throttling was turned off, and add the index during that window.

The problem is that neither of these options are available in Office 365. You don’t have a Farm Admin, and you don’t have a happy hour. One might expect that you could raise a ticket with Microsoft and that their support would be able to add an index for you – but we (or rather, our customer) tried this, and Microsoft said that they couldn’t. Essentially, if you’ve not got your design exactly right and you want to make changes to a list that contains 5000 items or more, you’re fucked.

As this includes changes like ‘Adding a new column’, which isn’t that rare an activity, this is a show-stopper for me. Hopefully Microsoft will introduce some approach for dealing with this.

Search Latency in SharePoint Online can be very long. I blogged about this previously, and I still don’t think that your typical business user would expect to wait 8 hours for new content to get indexed. I mean, in an on-prem SharePoint system the Continuous Crawl kicks in every 5 minutes – that’s more like the timescale we need. Worse, this compounds the problems with large list queries described above, as it makes it difficult to use the Search Service (which is probably better suited to that kind of query) instead.

Browser Support. Office 365 will no longer supports Internet Explorer 8. This is unfortunately, because although IE8 is junk, it is still used by a lot of our customers. In short, they’ll lose the ability to not upgrade their browsers for years on end. (I might rejoice, but from their point of view it’s an expense with little benefit).

Logging and Fault Diagnosis. Essentially, Office 365 doesn’t have any. Take a moment, and read that again – Office 365 doesn’t have any logging for fault diagnosis. There is a PowerShell API for retrieving log information from SharePoint Online’s logging service – but the only thing that writes to the log is Business Connectivity Services.

It’s possible that Microsoft have more access to logs than we do – I did wonder if the issue is that all customers sharing a tenant machine would be able to read each other’s ULS log entries – but the point remains that we have very limited logging information to go on. Mostly, it’ll just be the standard error message “An exception has occurred”. Great.

Reliability. Which developing with SharePoint online I found I was getting more errors than I’d expect to see. For example, when migrating documents using the client side object model, I would occasionally receive errors like “The server did not respond” which I don’t expect to see normally. Browsing around was similar – you’d occasionally get “Server did not respond” errors. And sometimes I’d see weird transient errors that I couldn’t repeat, such as problems changing the appearance of a site. Now, these problems might not be due to the platform itself – I sometimes question our Internet connection – but still, reliability was worse than having our own server on the same network.

No easy way to do ‘Timed Jobs’. You know how it is, sometimes you just want to be able to perform a timed job for something. For example, it might be ‘Archive completed tasks and the end of the month’. There’s no easy way to do this, though. I’ve had a play with using Azure Scheduler to perform such actions, and it kind of works – but it was hard to get working, and password expiry breaks it. I really miss timer jobs.

Unconvinced about Apps. To be honest, that could be a post of it’s own, so that’s what I’ll do.

Conclusion

I suppose my conclusion is simply that there are a number of issues with running SharePoint Online projects, and I might not rush to do too many projects in it. In particular, the lack of ways of handling the Query Throttle, and the surprisingly long search latency are, to my mind, major issues. SharePoint online might still be a good way of doing your project – but caveat emptor.

Broadly, I think, these issues can be broken down in to two categories – problems with the customer, and problems with the technology.

Customer Issues

I suppose that many of these are normal for projects, but there are a few that stand out as particularly Microsoft problems…

Nobody gets that the different Plans are. Our customers don’t get it, our salesmen don’t get it, I don’t get it. You’ve Office 365 P (*), K1, K2, E1, E2 (*), E3, E4 plans, Small Business, Small Business Premium, Midsize Business, Government, and Education variants. And the SharePoint Only P1 and P2 plans, not to be confused with the Office plan. (Though those marked with * might be retired). Anyway, it’s too damn complicated, and it makes selecting the right plan a drag on the project – and customers do get it wrong, bless ‘em.

Whose responsibility is out-of-the-box functionality that doesn’t work properly? In every project I’ve done in Office 365 there’s been some feature or functionality that a) doesn’t work, b) doesn’t work as expected, or c) is so damn complicated nobody can figure out what ‘working’ would be. In an ordinary SharePoint project, I might have to build some work around for it – but with SharePoint Online my options as developer are very limited. Raising tickets with Microsoft usually gets a response of “That’s how it is”, which is, at one level, fair enough. However, at another, the customer just wants a working system, is paying me a lot of money, and it’s hard for them not to blame me for some element of SharePoint that isn’t working as anybody expected. I do not feel excited about getting into this situation.

Customers get confused about wanting “Off the Shelf” – but expecting bespoke functionality. This one does baffle me, but somehow our customers are led to believe that Office 365 will do whatever curious things they want “Off the Shelf”. I’m mystified how it happens. At least if they’re developing a bespoke system they recognise this, but for some reason Office 365 does seem to exacerbate this.

It’s cloud, so you don’t have to worry about Infrastructure.” This seems to be a favourite idea and it can be true. As long as you’re not worried about your bandwidth to the Internet. And you’ve thought of having redundant connections, preferably leaving from the other side of the building, and connecting to a separate exchange, run by a separate supplier. And that you don’t want to synchronise or link your user’s AD accounts to Office 365. The advertising makes it sound like it’s like creating a Hotmail account – and it can be. But in reality, there are a lot of other aspects to it that probably mean you want to involve IT…

In part II, I’ll look at the technology issues.