A Clinical Model for the Diagnosis and Management of Patients with Cervical Spine Syndromes
SOURCE: Australasian Chiropractic & Osteopathy 2004 (Nov); 12 (2): 57–71
Donald R. Murphy DC, DACAN
Clinical Director, Rhode Island Spine Center
Clinical Teaching Associate
Department of Community Health
Brown University School of Medicine
Background: Disorders of the cervical spine are common and often disabling. The etiology of these disorders is often multifactorial and a comprehensive approach to both diagnosis and management is essential to successful resolution.
Objective: This article provides an overview of a clinical model of the diagnosis and management of patients with disorders related to the cervical spine. This model is based in part on the scientific literature, clinical experience, and communication with other practitioners over the course of the past 20 years.
Discussion: The clinical model presented here involves taking a systematic approach to diagnosis, and management. The diagnostic process is one that asks three essential questions. The answers to these questions then guides the management process, allowing the physician to apply specific methods that address the many factors that can be involved in each individual patient. This clinical model allows the physician to individualize the management strategy while utilizing principles that can be applied to all patients. At times, the management strategy must be multidisciplinary, and cooperation with other physicians and therapists is often necessary for effective patient care. This model is currently being used by the author in practice, as well as forming the basis upon which further research can be conducted to refine or, if necessary, abandon any of its aspects, as the evidence dictates. It is the purpose of this paper to present this clinical model and the clinical and scientific evidence, or lack thereof, of its components.
Key Words Cervical spine, chiropractic, conservative management, neck pain, headache, rehabilitation.
Neck pain and related disorders are a group of conditions that are common and often disabling. It can be argued that the importance of these disorders is under-appreciated. Because of the prevalence of low back pain and its great cost to society, much clinical attention and research dollars are focused on the low back. But epidemiological research suggests that cervical related disorders are as common and may be more costly to society than low back disorders. [1-4]
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Fifty to seventy percent of adults will experience neck pain some time in their lives.  Bovim, et al  found that at any given time, 1/3 of people experience neck pain. With regard to headache, Jensen, in a review of the epidemiological literature,  found that the lifetime prevalence in the general population was 78%, while the 1 year prevalence was 74%. The point prevalence on a randomly selected day was 11%.