Evidence Based Guidelines for Neck Pain

This study looked to combine data from numerous sources and studies to provide guidelines for the treatment of neck pain. It looked to combine all the available information to give primary care, chiropractors, and physical therapists the best information on how to treat neck pain.

The study group came up with a system in dividing patients into four basic groups. In a treatment office we tend to see most of the first two groups. The first group is people with mild neck pain and without pathology. The second group includes people with neck pain and functional limitations. These two groups probably combine for most of the neck pain patients in the world and the ones most likely to come into a primary care setting. Group 3 included individuals with radicular symptoms or neurologic deficit. Group 4 included pathology, and the collection of conditions I like to call the “really big bad nasty stuff” in the world. These are the types of conditions that require emergency room and immediate medical intervention. This also includes people who should be in the emergency room because of significant trauma to the neck.

Since you are reading this you are probably either group 1 or group 2. (Group III keepreading and group IV GO TO THE EMERGENCY ROOM!) Information wasprovided on how to actively treat your neck pain symptoms in group 1 and 2. As you might expect from reading some of the other studies on this website chiropractic, mobilization, exercises, stretching, and cold laser produce significant benefit. Acupuncture was another positive treatment that could be provided forindividuals with neck pain. Analgesics are always shown to produce relief in acute symptoms.

This synthesis of data once again suggests that conservative treatment is a great approachfor grade 1 and grade 2 individuals. Treatment is about decreasing pain and muscle spasms in the affected area. Establishing motion, strength, endurance, and flexibility in that region in theneck is a primary and important goal. Additional treatments maybe utilized to enhance therapeutic at outcomes including cold laser, manual therapy, massage therapy, and Graston Technique to meet and reach therapeutic goals. In the end it is about returning a patient to their best possible status for their desired home, work, and recreational functional abilities.

Moral the story is if you have something big, bad, and nasty go to the emergency room. Without trauma it is very appropriate to seek chiropractic care for grade one, two, and three. Numerous providerscan be great at getting you out of pain in the early stages. Asyou transition through the acute-care your treatment and therapeutic goal should shift to reaching functional outcomes for the long term.

More neck pain information can be found at Massage therapy and physical therapy and Neck Pain Exercises and Treatment.

More information on therapeutic treatments utilizing Physical Therapy or Chiropractic can be directedto Google+. The abstract is provided for your reading pleasure at the bottom of this article.

Journal of Manipulative and Physiological Therapeutics

Volume 32, Issue 2, Supplement , Pages S227-S243, February 2009

Clinical Practice Implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Jaime Guzman, MD, MSc, FRCPC(C), Scott Haldeman, DC, MD, PhD, Linda J. Carroll, PhD, and et al.


Study Design

Best evidence synthesis.


To provide evidence-based guidance to primary care clinicians about how to best assess and treat patients with neck pain.

Summary of Background Data

There is a need to translate theresults of clinical and epidemiologic studies into meaningful and practical information for clinicians.


Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians.


The Neck PainTask Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture shouldbe further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercisesand mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck painwithout trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.


The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offeredthe listed noninvasive treatments if short-term relief is desired.

© 2008 Lippincott Williams & Wilkins. Published by Elsevier Inc. All rights reserved. PubMed