NECK INJURY GUIDELINES

Neck Injury Guidelines

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org

Table 2: Non-invasive neck pain treatment All interventionsNote: The scenarios above are presented separately as they were not classified in the grade system. *More research is needed to understand the impact of these treatments and greater clinical judgment should be used if considering these options. Modified version of: Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al. Treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders.

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Since 6-19-2010

Updated 3-03-2010
Grade of neck pain and scenario Likely helpful Possibly helpful Likely not helpful Not enough evidence *
Grade I and II (acute) traumatic neck pain Educational video, mobilization, exercises, mobilization plus exercises Pulsed electromagnetic therapy Pamphlet/neck booklet alone, passive modalities (heat, cold, diathermy, hydrotherapy), referral to fitness or rehab program, frequent early health-care service, methylprednisolone, passive modalities (ultrasound, TENS), exercise instruction, botulinum toxin A Manipulation, traction, non-steroidal anti-inflammatory drugs (NSAIDS), other drugs
Grade I and II (non-acute) traumatic neck pain Supervised exercises, coordinated multidisciplinary care Passive modalities (TENS, ultrasound), corticosteroid injections Manipulation, traction, NSAIDs, other drugs
Grade I and II non-traumatic neck pain Manipulation, mobilization, supervised exercises, manual therapy (manipulation, mobilization, massage) plus exercises, acupuncture, low-level laser therapy, analgesics Percutaneous neuromuscular therapy, brief intervention using cognitive behavioural principles Advice alone, collars, passive modalities (heat therapy, ultrasound, TENS, electrical muscle stimulation), exercise instruction, botulinum toxin A Magnetic stimulation, massage alone, traction, NSAIDS, other drugs
Grade III (suspected cervical radiculopathy)

Non-invasive neck pain treatment
Grade of neck pain and scenario Likely helpful Possibly helpful Likely not helpful Not enough evidence *
Cervicogenic headache Manipulation, mobilization, supervised exercises, manipulation or mobilization plus supervised exercises, water pillow Passive modalities, traction, NSAIDS, other drugs
Neck pain in workers Supervised exercises plus strength or endurance training and/or relaxation training with behavioral support Ergonomic interventions, forced work breaks, rehabilitation programs, stress management programs, relaxation training, physical training, exercise instruction Neck pain in workers

Grade of neck pain and scenario	Likely helpful	Possibly helpful	Likely not helpful	Not enough evidence *
Grade I and II (acute) traumatic neck pain	Educational video, mobilization, exercises, mobilization plus exercises	Pulsed electromagnetic therapy	Pamphlet/neck booklet alone, passive modalities (heat, cold, diathermy, hydrotherapy), referral to fitness or rehab program, frequent early health-care service, methylprednisolone, passive modalities (ultrasound, TENS), exercise instruction, botulinum toxin A	Manipulation, traction, non-steroidal anti-inflammatory drugs (NSAIDS), other drugs
Grade I and II (non-acute) traumatic neck pain		Supervised exercises, coordinated multidisciplinary care	Passive modalities (TENS, ultrasound), corticosteroid injections	Manipulation, traction, NSAIDs, other drugs
Grade I and II non-traumatic neck pain	Manipulation, mobilization, supervised exercises, manual therapy (manipulation, mobilization, massage) plus exercises, acupuncture, low-level laser therapy, analgesics	Percutaneous neuromuscular therapy, brief intervention using cognitive behavioural principles	Advice alone, collars, passive modalities (heat therapy, ultrasound, TENS, electrical muscle stimulation), exercise instruction, botulinum toxin A	Magnetic stimulation, massage alone, traction, NSAIDS, other drugs
Grade III (suspected cervical radiculopathy)

Non-invasive neck pain treatment
Grade of neck pain and scenario	Likely helpful	Possibly helpful	Likely not helpful	Not enough evidence *
Cervicogenic headache		Manipulation, mobilization, supervised exercises, manipulation or mobilization plus supervised exercises, water pillow			Passive modalities, traction, NSAIDS, other drugs
Neck pain in workers		Supervised exercises plus strength or endurance training and/or relaxation training with behavioral support	Ergonomic interventions, forced work breaks, rehabilitation programs, stress management programs, relaxation training, physical training, exercise instruction	Neck pain in workers