Neck Pain

Many environmental and personal factors influence the onset and course of neck pain. For all those who suffer from neck pain, several risk factors have been identified (including occupational posture, depressive moods, obesity, body height and age), however the causes of the onset of neck pain can be complex and challenging to address efficiently.

Neck pain is not a disease but a constellation of symptoms reported by the patient and what’s more, currently there is no reliable correlation between imaging and the source of neck pain. Not only is imaging not necessary in most cases, it results in higher cost for the same outcome. Patients who first received an MRI in effort to diagnose an issue prior to being referred to physical therapy spent an average of $4,793 more for their care despite a similar outcome for those who did not have imaging. Neck pain requires several components to gather information in order to treat appropriately, with imaging used only in conjunction with a thorough history and physical examination. ⁱⁱ There are multiple potential causes of neck pain as well as associated symptoms such as upper extremity radiating symptoms (radiculopathy).

Symptoms related to neck pain can vary. Symptoms can differ in quality such as dull, sharp or burning. The area involved can be over a small or broad area, and may extend beyond such as into the trunk, scapulae or upper extremities. Neck pain is classified by behavior and duration of symptoms as well as by specific diagnoses to indicate the contributing anatomy.

Duration of symptoms can be of three types:

Acute: Symptoms lasting less than three months
Recurrent: Acute symptoms that have occurred in two or more episodes
Chronic: Symptoms lasting greater than three months

A specific diagnosis helps to indicate potential sources of symptoms and start on an optimal course of action for reduction of those symptoms. All clinicians use sets of distinct diagnoses worldwide to improve consistency in definitions, these are known as ICD codes (International Statistical Classification of Diseases and Related Health Problems). These diagnoses have a specific corresponding number in order to cross language barriers among the world’s healthcare professionals. Physical therapy is indicated for most categories and diagnoses of neck pain, with interventions aimed at normalization of the patient’s impairments of function.

Differential Diagnosis

Not all neck symptoms stem from anatomical structures of the spine or are orthopedic in nature. Serious conditions such as cancer or organ dysfunction can also result in neck, jaw, upper extremity or trunk pain. Therefore physical therapists consider all diagnostic possibilities including those associated with serious medical conditions or psychosocial factors. Physical therapists are trained to initiate referrals to appropriate medical practitioners when physical therapy is not indicated or a more insidious condition is suspected.

Examination

Your physical therapist will perform a thorough evaluation that includes:

Once your examination is complete, your physical therapist will assess the results, identify the factors that have contributed to your specific neck problem, and design an individualized treatment plan for you.

Intervention

Physical therapy was born of the medical profession more than a century ago and utilizes evidence-based practice to efficiently address issues such as neck pain. Treatments are tailored to your specific issues as assessed in examination and may include manual therapy techniques such as spinal, peripheral joint and soft tissue manipulation. Treatment may also involve modalities such as specific exercise, traction and training/education depending on your situation. Treatments used by physical therapist have undergone strenuous review through research to establish effectiveness. The U.S. Department of Health and Human Services has established national guidelines for treatment of neck pain (2011). These guidelines determine the most effective treatments for neck pain by review and distillation of current research. The guidelines reveal that manual techniques (mobilization) combined with active exercises are rated as highly recommended. Both manual therapy and an active treatment program are best provided by a licensed physical therapist, as this is expertise of the physical therapy profession. This course of action in the treatment of neck pain is ranked significantly higher than the second-line treatment course of using muscle relaxants, heat or cold therapies, ibuprofen or acetaminophen. The U.S. Department of Health and Human Services also has established a not recommended category of treatments for neck pain. These treatments include regular or routine manipulation or mobilization, prolonged treatment (manipulation several times a month for years), prophylactic (preventative) treatment, and routine use of opioids for acute non-malignant pain conditions.ⁱⁱⁱ

As research evolves, building on previously understood causes and concepts, new evidence is discovered. Not all research and conclusions are of the same statistical power and impact. The resulting evidence from amassed research is graded in a recognized system of hierarchy. Active Lifestyles Physical Therapy is apprised of the most efficacious treatments available today for neck pain. Interventions are employed depending on the acuity and behavior of symptoms as well as the structures involved as discovered through examination. The treatment modalities chosen are based on evaluation findings, your values and goals as well as current legitimate research and the level of evidence related to that research.

Your physical therapist at Active Lifestyles Physical Therapy can help you restore or improve mobility and reduce your neck pain. It is now known that bed rest or immobilizing your neck for longer than one day can negatively impact your recovery. It is imperative that you stay active and avoid

prolonged positioning such as sitting. Your physical therapist will provide you information regarding the neuroscience of pain, specific beneficial activities to perform, proper positioning and ergonomics.

See “Beware of the Chair” for more information regarding proper positioning.

Physical therapy plays an important role not only in treating persistent or recurrent neck pain, but also in preventing it, reducing your risk of having it come back. The latest research suggests we all need to move and more often. There often exists barriers to movement, physical therapists are known in the medical community as the movement experts and the best choice to address movement barriers. If you are experiencing any orthopedic obstacles to improving your movement and your health, contact your physical therapist or contact our office today.

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Author: Christopher Harper, PT, DPT, OCS
July 2016

References
ⁱHoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010

ⁱⁱFritz JM, Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy
Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care
Utilization and Charges. Health Serv Res. 2015 Dec;50(6):1927-40. doi: 10.1111/1475-6773.12301. Epub
2015 Mar 16.

ⁱⁱⁱU.S. Department of Health and Human Services (2011) Cervical and thoracic spine disorders. In: Hegmann
KT, editor(s). Occupational medicine practice guidelines. Evaluation and management of common health
problems and functional recovery in workers. 3rd ed. Elk Grove Village (IL): American College of
Occupational and Environmental Medicine (ACOEM); 2011. p. 1-332.