The purpose of this clinical guideline is to describe the evidence based physical therapy practice including diagnosis, prognosis, intervention and assessment of outcome for musculoskeletal disorders related to neck pain that are commonly managed with orthopaedic physical therapy techniques.
More specifically, in the paragraphs that follow, there will be a review of recommendations related to: diagnosis and classification, examination, and treatment/interventions. These recommendations will be supported with a grade of evidence based on Guyatt et al, as modified by MacDermid. In this modified system, the typical A, B, C, and D grades of evidence have been modified to include the role of consensus expert opinion and basic research to demonstrate baseic biological or biomechanical plausibility.
Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.
If a patient’s impairments fall outside of the ranges of the classification system or the interventions do not fail to improve the symptoms the clinician should consider serious pathological conditions or psychosocial factors as being a possible explanations to the patient’s pain.
Validated self-report questionnaires should be used with patients complaining of neck pain. The Neck Disability Index and the Patient Specific Functional Scale are two examples of these questionnaires. The main reason for this recommendation is that these tools establish a baseline status for pain, function, and disability that can be used later in intervention selection and goal tracking.
Although the cause of neck pain may often be related to degenerative changes or pathology the tissue causing the pain is most often unknown. Therefore, a clinician must examine for muscle, connective tissue, and nervous tissue dysfunction during their examination and evaluation.
Manipulation and mobilization techniques including thrust and not thrust motions have been shown to reduce symptoms in patient with neck pain and headaches. Exercises that improve the coordination, strength and endurance of cervical musculature have also been shown improvements in this patient group. Although each of these techniques are beneficial, the patients that receive a combination of the two treatments show the most reduction in symptoms.
Especially following a traumatic event, patients should be encouraged to return to pre-accident function levels as quickly as safely possible. They should also be reassured that neck pain patients normally have a good prognosis and regaining normal function is highly likely.
These interventions have been shown beneficial and are even more effective when paired with manual therapy and exercise.
The use of thrust manipulations and mobilizations can reduce symptoms in patients with neck and neck related arm pain.
The patient should be limited to functional activity that does not cause an increase in symptoms throughout the treatment period. This helps the clinician to assess changes in the patients level of function during an episode of care.
↑ 2.0 2.1 Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.