Treating Adult Neck Pain

Diagnosis and Treatment Decision Assister

This assister is based on a published Clinical Practice Guideline. See About this decision assister. Clinical Practice Guidelines contain evidence-based recommendations based on best available evidence at the time of publication. 

Healthcare professionals are encouraged to review recent high-quality studies to further guide clinical decisions where appropriate.


History and Examination

Conduct a thorough patient history and physical examination to establish the nature of the condition and to identify any red flags including, but not limited to, any dissection related or stroke risk factors or symptoms.

  • Ask probing questions to understand key features of the patient's patient history and symptoms.
  • Perform a physical examination including
    • Ranges of motion
    • Orthopedic testing
    • Palpatory examination
    • Full neurological examination


To determine the recommended care, select the options as they appear.

   


Signs or symptoms of neurovascular impairment, vertebral artery dissection, or serious pathology, including, but not limited to, the following:

(Select all that apply)


Dysarthria
Dysphagia
Dizziness
Drop attacks
Diplopia
Nystagmus
Numbness
Nausea
Ataxia
Severe neck pain
Neck pain with headache
Cervical fracture

Clinical Emergency or Immediate Referral
  • Signs or symptoms of stroke or cervical dissection requires emergency services.
  • Neck pain caused by serious pathology (for example, cervical fracture) requires immediate referral.

Classify Neck Pain

Signs or symptoms of the following problems:

(Select all that apply)


Serious local pathology
Systemic disease
Radicular source
WAD

Complicated Neck Pain

Provide appropriate treatment or refer.

For WAD, see Practice Guide for the Management of Whiplash-Associated Disorders in Adults.

Non-Specific Neck Pain

Duration:

(Select one)


Less than 3 months
Greater than 3 months

Acute Non-Specific Neck Pain

Recommended treatment options:

  • Spinal manipulative therapy (SMT) in combination with advice, exercise, and mobilization. Treatment frequency: 4-5 sessions over 2 weeks or an average of 15 sessions over 12 weeks.
  • Mobilization in combination with advice and exercise. Treatment frequency: 4 sessions over a 2-week period.
  • Home exercise with advice and training. Treatment frequency: 6-8 repetitions daily for 12 weeks with 2 1-hour advice and training sessions 1-2 weeks apart.

Outcomes supported:

  • Cervical range of motion (cROM)
  • Pain
  • Disability
  • Mobility
  • Days to recovery
  • Muscle strength
  • Quality of life (QoL)
  • Intensity of symptoms
  • Medication use

Chronic Non-Specific Neck Pain

Recommended treatment options:

  • Spinal manipulative therapy (SMT). Treatment frequency: 2 treatments per week for 9 weeks.
  • SMT in combination with advice, upper thoracic SMT, low-level laser therapy, soft tissue therapy, mobilizations, pulsed short wave diathermy, exercise, massage, and stretching. Treatment frequency: a number of treatments over several weeks.
  • Mobilization. Treatment frequency: none specified.
  • Manual therapy in combination with advice, stretching, and exercise. Treatment frequency: none specified.
  • Home exercise with advice and training. Treatment frequency: 3-5 times per week.
  • Home strengthening and endurance exercise with advice, training, and supervision. Treatment frequency: 3-7 times per week.
  • Exercise (stretching, isometric, stabilization, and strengthening) in combination with infrared radiation, massage, or other physical therapies. Treatment frequency: 2-5 times per week for several weeks.
  • Massage in combination with self-care, stretching, and exercise. Treatment frequency: 5-10 upper body and neck massage sessions lasting 60-75 minutes.

Outcomes supported:

  • Cervical range of motion (cROM)
  • Pain
  • Disability
  • Mobility
  • Days to recovery
  • Muscle strength
  • Quality of life (QoL)
  • Intensity of symptoms
  • Medication use


About this Decision Assister

This decision assister was created by Vic Weatherall, DC (as technical writer and e-learning developer): initial release July 8, 2015; last modification date July 8, 2015. It is based on the Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain(1) of the Evidence-Based Guidelines for the Chiropractic Treatment of Adults with Neck Pain.(2)

The clinical practice guideline (CPG) is credited to the following people on behalf of the Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (Federation) Clinical Practice Guidelines Project:

  1. Bryans R, Decina P, Descarreaux M, Duranleau M, et al. Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain. Canadian Chiropractic Association (CCA) and Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (Federation) Clinical Practice Guidelines Project. 2014 Mar.
  2. Bryans R, Decina P, Descarreaux M, Duranleau M, et al. Evidence-Based Guidelines for the Chiropractic Treatment of Adults with Neck Pain. J Manipulative Physiol Ther. 2014 Jan;37(1):42-63.