Table 5: Summary of Research-Based Treatment of Neck Pain

 

Neck Pain Categorization & Clinical Findings

Symptoms &           Outcome Measures

Physical Impairments & Special Tests

Treatments

Cervicalgia (ICD9-723.1)

Clinical findings:

  • Younger age(< 50)
  • Acute neck pain     (< 12 weeks)
  • Symptoms isolated to the neck
  • Limited cervical range of motion

 

  • Non-specific neck pain
  • Limited cervical range of motion
  • Referred pain into upper extremity may be present
  • Numeric Pain Rating Scale
  • Neck Pain and Disability Index
  • Patient Specific Functional Scale

 

  • Neck pain reproduced actively and passively at end range
  • Limited cervical range of motion
  • Decreased cervical and thoracic segmental mobility
  • Neck pain and referred pain is reproduced with provocation of involved segments

 

  • Cervical mobilization and/or manipulation
  • Thoracic mobilization and/or manipulation
  • Therapeutic Massage
  • Strengthening exercises
  • Stretching exercises
  • Patient education in home exercises

Cervicocranial syndrome (ICD9-723.2)

Clinical findings:

  • Headache aggravated or produced by provocation of cervical joints or myofascia
  • Limited cervical range of motion
  • Limited cervical segmental mobility
  • Below normal performance on cranial cervical flexion test

 

 

  • Non-specific neck pain
  • Referred headache
  • Headache is provoked by neck movements or sustained postures
  • Limited cervical range of motion
  • Numeric Pain Rating Scale
  • Neck Pain and Disability Index
  • Patient Specific Functional Scale

 

 

  • Headache produced or aggravated with provocation of involved cervical segments
  • Limited cervical range of motion actively and passively
  • Decreased cervical segmental mobility
  • Strength/endurance deficits in Cranial Cervical Flexion Test and Neck Flexor Endurance Test

 

 

  • Cervical mobilization and/or manipulation
  • Therapeutic Massage
  • Strengthening exercises
  • Stretching exercises
  • Patient education in home exercises

Strain and sprain of cervical spine (ICD9 847.0)

Clinical findings:

  • Chronic neck pain (>12 weeks)
  • Below normal performance on cranial cervical flexion test
  • Below normal performance on the deep neck flexor endurance test
  • Muscle strength and flexibility deficits in neck and upper quarter muscles

 

 

  • Non-specific neck pain
  • Referred symptoms into upper extremity may be present
  • Symptoms may be linked with a trauma or accident
  • Numeric Pain Rating Scale
  • Neck Pain and Disability Index
  • Patient Specific Functional Scale

 

 

  • Neck pain that increases with end-range movements
  • Neck pain and referred pain that increases with provocation of involved cervical segments
  • Strength/endurance deficits in Cranial Cervical Flexion Test and Neck Flexor Endurance Test
  • Possible cervical instability

 

 

  • Therapeutic Massage
  • Strengthening exercises
  • Proprioceptive exercises
  • Stretching exercises
  • Patient education in home exercises and return to normal activities

Cervical radiculopathy (ICD9-723.4)

Clinical findings:

  • Radicular or referred upper extremity symptoms
  • Limited cervical rotation toward the involved side

 

  • Neck pain with radiating symptoms into upper extremity
  • Upper extremity parathesias, numbness and/or weakness
  • Numeric Pain Rating Scale
  • Neck Pain and Disability Index
  • Patient Specific Functional Scale

 

  • Neck pain and related radicular symptoms
  • Neck pain and radicular symptoms are reproduced or worsened with cervical extension, lateral flexion and rotation toward the involved side (Spurling’s Test)
  • Upper extremity symptoms reproduced or worsened with Upper Limb Tension Test
  • Neck pain and radicular symptoms reduced or relieved with cervical distraction test

 

  • Cervical mobilization and/or manipulation
  • Thoracic mobilization and/or manipulation
  • Intermittent Cervical Traction
  • Nerve mobilization techniques
  • Patient Education in home exercises

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