Welcome back to the Head to Sacrum series on Spine IQ’s Back Blog. This week we continue our discussion about acute neck pain, with a focus on clinical management strategies. Once acute neck pain has been graded and the cause is determined to be mechanical, conservative care clinicians can begin to turn attention towards treatment goals.
Most systematic reviews recommend including exercise as an integral part of neck pain management (1-3). Additionally, the Neck Pain Task Force recommends a variety of approaches for non-traumatic grades I and II neck pain, including manual therapy with exercises (4). This recommendation is supported further by the Ontario Protocol for Traffic Injury Management (OPTIMa), which endorses patient education, exercise and “multimodal care” (5). A systematic review of neck pain clinical practice guidelines defines multimodal care as a balance of manual therapy and modalities (6), including a combination of passive cervical spine mobilization, range of motion exercises, and spinal manipulation.
The Neck Pain Task Force advocates attempting a variety of therapies that are likely helpful, or diverse combinations of the recommended treatments in order to find relief. Due to the self-resolving nature of acute neck pain regardless of treatment, patients should be made aware that benefits from treatment are generally modest and short-lived. Further, lengthy treatment plans have not been shown to result in greater improvements. (4) Patients should be provided evidence-based information on all treatment options available, including supportive analgesics to assist with chiropractic care (4, 5), and be involved in a shared decision-making process.
Similar to headaches, an evidence-based practitioner should consider the possiblity of vascular pathologies like cervical artery dissection before a final treatment decision is made. While the occurrence is low, it is still of the utmost importance. The recently updated International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention provides a useful guide to both history and examination procedures that can be used to identify if a patient’s neck pain may have a vascular cause. (7)
More research is needed on the diagnosis and conservative treatment of acute neck pain to fully understand any long-term effects of treatments, and clinical judgement should be used when considering any treatment option (7). As with any condition, creating a conservative treatment plan both is a science and an art – tying together evidence-based clinical decision making and patient preferences.
1. Gross AR, Goldsmith C, Hoving JL, Haines T, Peloso P, Aker P, Santaguida P, Myers C; Cervical Overview Group. Conservative management of mechanical neck disorders: a systematic review. J Rheumatol. 2007 May;34(5):1083-102. Epub 2007 Jan 15. PMID: 17295434.
2. Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G; Cervical Overview Group. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine (Phila Pa 1976). 2004 Jul 15;29(14):1541-8. doi: 10.1097/01.brs.0000131218.35875.ed. PMID: 15247576.
3. Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith CH, Forget M, Hoving JL, Brønfort G, Santaguida PL; Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015 Jan 28;1:CD004250. doi: 10.1002/14651858.CD004250.pub5. PMID: 25629215.
4. Guzman J, Haldeman S, Carroll LJ, Carragee EJ, Hurwitz EL, Peloso P et al. Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders: from concepts and findings to recommendations. Spine. 2008; 33[4S]: S199-S213.
5. Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM, Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M, Ammendolia C, David Cassidy J, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016 Jul;25(7):2000-22. doi:10.1007/s00586-016-4467-7. Epub 2016 Mar 16. PMID: 26984876.
6. Parikh, P., Santaguida, P., Macdermid, J. et al. Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC Musculoskelet Disord 20, 81 (2019). https://doi.org/10.1186/s12891-019-2441-3
7. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al. Treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine. 2008; 33[4S]: S123-S152.
8. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al. Treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine. 2008; 33[4S]: S123-S152.