Neck Injury Guidelines

This section was compiled by Frank M. Painter, D.C.
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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 scenarioLikely helpfulPossibly helpfulLikely not helpfulNot enough evidence *
Grade I and II (acute) traumatic neck painEducational video, mobilization, exercises, mobilization plus exercisesPulsed electromagnetic therapyPamphlet/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 AManipulation, traction, non-steroidal anti-inflammatory drugs (NSAIDS), other drugs
Grade I and II (non-acute) traumatic neck pain   Supervised exercises, coordinated multidisciplinary carePassive modalities (TENS, ultrasound), corticosteroid injectionsManipulation, traction, NSAIDs, other drugs
Grade I and II non-traumatic neck painManipulation, mobilization, supervised exercises, manual therapy (manipulation, mobilization, massage) plus exercises, acupuncture, low-level laser therapy, analgesicsPercutaneous neuromuscular therapy, brief intervention using cognitive behavioural principlesAdvice alone, collars, passive modalities (heat therapy, ultrasound, TENS, electrical muscle stimulation), exercise instruction, botulinum toxin AMagnetic stimulation, massage alone, traction, NSAIDS, other drugs
Grade III (suspected cervical radiculopathy)      
Non-invasive neck pain treatment
Grade of neck pain and scenarioLikely helpful Possibly helpfulLikely not helpfulNot 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 supportErgonomic interventions, forced work breaks, rehabilitation programs, stress management programs, relaxation training, physical training, exercise instructionNeck pain in workers