Neck/Upper Cervical Spine Pain Categories

1st thing to do in any evaluation ever ever

determine if you can go ahead and treat, can treat but need co-management, or if it is a red flag emergency get them out of here

Common Symptoms: Neck Pain with Mobility Deficits

Central and/or unilateral neck pain

Limitation in neck motion that consistently reproduces symptoms

Associated (referred) shoulder girdle or upper extremity pain may be present

Expected Exam Findings: Neck Pain with Mobility Deficits

Limited cervical ROM

Neck pain reproduced at end ranges of active and passive motions

Restricted cervical and thoracic segmental mobility

Intersegmental mobility testing reveals characteristic restriction

Neck and referred pain reproduced with provocation of the involved cervical or upper thoracic segments or cervical musculature

Deficits in cervicoscapulothoracic strength and motor control may be present in individuals with subacute or chronic neck pain

How to determine condition stage: acute

highly irritable - pain experienced at rest or with initial to mid-range spinal movements before tissue resistance

How to determine condition stage: subacute

moderate irritability - pain experienced with mid-range motions that worsen with end-range spinal movements with tissue resistance

How to determine condition stage: chronic

low irritability - pain that worsens with sustained end-range spinal movements or positions with overpressure into tissue resistance

Interventions: Acute Neck Pain with Mobility Deficits

Thoracic manipulation

Cervical mobilization or manipulation

Cervical ROM, stretching, and isometric strengthening exercise

Advice to stay active plus home cervical ROM and isometric exercise

Supervised exercise, including cervicoscapulothoracic and UE stretching, strengthening, and endurance training

General fitness training (stay active)

Interventions: Subacute Neck Pain with Mobility Deficits

Cervical mobilization of manipulation

Thoracic manipulation

Cervicoscapulothoracic endurance exercise

Interventions: Chronic Neck Pain with Mobility Deficits

Thoracic Manipulation

Cervical Mobilization

Combined cervicoscapulothoracic exercise plus mobilization or manipulation

Mixed exercise for cervicoscapulothoracic regions - neuromuscular exercise: coordination, proprioception, and postural training; stretching; strengthening; endurance training; aerobic conditioning; and cognitive affective elements

Supervised individualized exercises

"Stay active" lifestyle approaches

Dry needling, low-level laser, pulsed or high-power ultrasound, intermittent mechanical traction, repetitive brain stimulation, TENS, electrical muscle stimulation

Common Symptoms: Neck Pain with Movement Coordination Impairments (WAD)

Mechanism of onset linked to trauma or whiplash

Associated (referred) shoulder girdle or UE pain

Associated varied nonspecific concussive signs and symptoms

Dizziness/nausea

Headache, concentration, or memory difficulties; confusion; hypersensitivity to mechanical, thermal, acoustic, odor, or light stimuli; heightened affective distress

Expected Exam Findings: Neck Pain with Movement Coordination Impairments (WAD)

Positive cranial cervical flexion test

Positive neck flexor muscle endurance test

Positive pressure algometry

Strength and endurance deficits of the neck muscles

Neck pain with mid-range motion that worsens with end-range positions

Point tenderness may include myofascial trigger points

Sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficits, postural balance or control

Neck and referred pain reproduced by provocation of the involved cervical segments

Interventions: Acute Neck Pain with Movement Coordination Impairments (WAD)

Education: advice to remain active, act as usual

Home exercise: pain-free cervical ROM and postural element

Monitor for acceptable progress

Minimize collar use

Interventions: Subacute Neck Pain with Movement Coordination Impairments (WAD)

Education: activation and counseling

Combined exercise: active cervical ROM and isometric low-load strengthening plus manual therapy (cervical mobilization or manipulation) plus physical agents: ice, heat, TENS

Supervised exercise: active cervical ROM or stretching, strengthening, endurance, neuromuscular exercise including postural, coordination, and stabilization elements

Interventions: Chronic Neck Pain with Movement Coordination Impairments (WAD)

Education: prognosis, encouragement, reassurance, pain management

Cervical mobilization plus individualized progressive exercise: low-load cervicoscapulothoracic strengthening, endurance, flexibility, functional training using cognitive behavioral therapy principles, vestibular rehabilitation, eye-head-neck coordination, and neuromuscular coordination elements

TENS

Common Symptoms: Neck Pain with Headache (Cervicogenic)

Noncontinuous, unilateral neck pain and associated (referred) headache

Headache is precipitated or aggravated by neck movements or sustained positions/postures

Expected Exam Findings: Neck Pain with Headache (Cervicogenic)

Positive cervical flexion rotation test

Headache reproduced with provocation of the involved upper cervical segments

Limited cervical ROM

Restricted upper cervical segmental mobility

Strength, endurance, and coordination deficits of the neck muscles

Interventions: Acute Neck Pain with Headache (Cervicogenic)

Exercise: C1-2 self-SNAG

Interventions: Subacute Neck Pain with Headache (Cervicogenic)

Cervical manipulation and mobilization

Exercise: C1-2 self-SNAG

Interventions: Chronic Neck Pain with Headache (Cervicogenic)

Cervical manipulation

Cervical and thoracic manipulation

Exercise for cervical and scapulothoracic region: strengthening and endurance exercise with neuromuscular training, including motor control and biofeedback elements

Combined manual therapy (mobilization or manipulation) plus exercise (stretching, strengthening, and endurance training elements)

Common Symptoms: Neck Pain with Radiating Pain (Radicular)

Neck pain with radiating (narrow band of lancinating/sharp pain) pain in involved extremity

UE dermatomal paresthesia or numbness, and myotomal muscle weakness

Expected Exam Findings: Neck Pain with Radiating Pain (Radicular)

Neck and neck-related radiating pain reproduced or relieved with radiculopathy testing: positive cluster includes upper-limb nerve mobility, Spurling's test, cervical distraction, cervical ROM

May have UE sensory, strength, or reflex deficits associated with the involved nerve roots

Interventions: Acute Neck Pain with Radiating Pain (Radicular)

Exercise: mobilizing and stabilizing elements

Low-level laser

Possible short-term collar use

Interventions: Chronic Neck Pain with Radiating Pain (Radicular)

Combined exercise: stretching and strengthening elements plus manual therapy for cervical and thoracic region: mobilization or manipulation

Education counseling to encourage participation in occupational and exercise activity

Intermittent traction