KNGF Guidelines - Neck pain

The severity of Neck pain is classified in 4 grades

Grades of Neck pain

Grade I

• neck pain with no signs of suggestive major structural pathology and no/ minor interference with ADLs

Grade II

• neck pain with no signs of suggestive major structural pathology but may significantly affect ADLs

Grade III

• neck pain with no signs of suggestive major structural pathology but may significantly affect ADLs

• It has neurological symptoms (hernia, spinal stenosis)

• Symptoms → reduced tendon reflexes, muscle weakness, or sensory disorders (hypoesthesia or hyperesthesia) in the upper extremity.

Grade IV

• neck pain that suggests major structural pathology, or serious condition

• Major pathologies → fracture, vertebral dislocation, injury to the spinal cord, infection, neoplasm, or systemic disease including the inflammatory arthropathies.

Physical therapy is indicated for PT with grade I -III neck pain, grade IV refer GP

Course and prognosis

• 70 % of people suffer from an episode of neck pain in their lives

• usually no interference with ADLs

• Usually PT recovers before 6 weeks, if pain is still there after 6 weeks the course of recovery is considered “deviant“

• Neck pain can change in severity

• recurrent pain and limitation in ADLs in the first 6 weeks after the first symptoms are considered the same episode of neck pain

• “recurrent pain“ is used when pain recurs after 6 weeks

there is a distinction between work related neck pain and trauma related neck pain

• NP after trauma → result of trauma (whish -plash)

• NP due to work → its classified into subgroups

Diagnostic process

• We need to distinguish between the grades

History

1) exclude grade IV with red flags (screening)

2) Anamnesis

• exclude Grade III looking for signs indicating cervical radiculopathy (neurological signs)

• nature of complaints (can they do ADLs?, does it has effects on their participation levels?)

Physical examination

Grade III (cervical radiculopathy) has a different treatment than Grade I & II

Grade III

• neurological symptoms, muscle weakness, reduced reflexes, or sensory disorders

• to rule Grade III out → Spurling’s test + Traction/ distraction test + ULTT x median nerve

• Grade III excluded if there are any neuro symptoms

basically this:

Questions to differentiate the different Grades

Treatment profiles

• they are organized based on:

  • the severity or grades of NP

  • course of symptoms (normal/deviant)

  • presence of psychosocial factors

If PSCH. Fact. play a role → profile B or C

If Grade I → profile A

Treatment profile A (Grade I & II with normal course)

• short -term treatment

• information and advice

• max 3 treatment sessions

Treatment profile B → Grade I and II with deviant course of recovery, PSCH Fact NOT present

• Info and advice as Profile A

Add therapy:

• exercise therapy + cervical/thoracic mobilizations