Clinical Pattern Recognition - Neck Pain

From anatomy to discovering the patient!

• 22% to 70% of the population will have neck pain some time in their lives

• At any given time 10% to 20% of the population reports neck problems, with 54% of individuals having experienced neck pain within the last 6 months

• Prevalence of neck pain increases with age

• Most common in women around the fifth decade of life

• See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here

• Meet the 5 common neck pain patients from the Clinical Practice Guidelines!

---

Clinical Pattern Recognition

Click on the pain pattern to learn about the patients and develop your clinical patterns!

1. Cervical Facet Syndrome/Spondylosis - Neck Pain and Mobility Deficit (1-minute video)

2. Cervical Radiculopathy - Neck Pain and Radiating Arm Pain (1-minute video)

3. Whiplash - Neck Pain and Movement Coordination Impairments (1-minute video)

4. Neck sprain/strain - Neck Pain and Movement Coordination Impairments (1-minute video)

5. Cervicogenic headache - Neck pain and headache (1-minute video)

Cervical Facet Syndrome/Spondylosis

Neck Pain with Mobility Deficits

• Patients with cervical facet syndrome or spondylosis tend to present with unilateral neck pain and complaints of limited range of motion. Pain can also be referred to the scapula and shoulder regions! If you do not know the common clinical findings no problem! Click here

---

Anatomy

Image via Complete Anatomy 2018 by 3D4 Medical

---

Key Finding

The cervical spine quadrant assessment elicits maximal strain to the facet joints via coupling of side bend, rotation and extension movements. Although discomfort is common with this test, if the patient experiences reproduction of their primary complaint the likelihood of facet pathology is increased. (Click image to watch 1-2 minute video)

Treatment

If the patient meets the criteria and is deemed appropriate, the patient may benefit from cervical spine thrust manipulation! Research shows that thrust manipulation and/or non-thrust mobilization in conjunction with therapeutic exercise produces better outcomes than either treatment alone! (Click image to watch 1-2 minute video)

Therapeutic Exercise

After improving range of motion it is important to instruct the patient on how to move properly in this new range! (Click image to watch 1-2 minute video)

*As always, remember to assess the whole individual and do not forget to address other impairments, which may be contributing to the patient’s primary complaint!

Cervical Radiculopathy

Neck Pain with Radiating Pain

• If you have a patient who presents with a clinical pattern similar to that of cervical radiculopathy, here are some things to consider!

  o  If you do not know the common clinical findings no problem! Click here

---

Anatomy

---

Special Tests

The above tests are part of the “Cervical Radiculopathy Cluster” designed to help the Physical Therapist better ascertain the likelihood of Cervical Radiculopathy as a diagnosis. Click the images to see how they are done!

Treatment

Gentle distraction of the cervical spine may be an appropriate initial intervention especially in patients with acute symptoms or those who are highly irritable.

Therapeutic Exercise

 Therapeutic exercises chosen should always closely match treatment give in clinic; in this case self traction; however, do not forget to address posture!

Whiplash

Neck Pain with Movement Coordination Impairments

•  If a patient presents to clinic after a traumatic event such as a motor vehicle accident with neck pain and potentially back, shoulder, or arm pain, it is likely that they suffer from whiplash syndrome! For more clinical findings click here!

---

Anatomy

---

Special Test

• Research shows that motor control of the deep neck flexors is impaired in individuals with whiplash. The craniocervical flexion test is an excellent and reliable exam for evaluating deep neck flexor function Don’t forget to look for compensations! (Click image to watch 1-2 minute video)

• Clinical Side Note: If cervical spine ligamentous instability or vertebral artery insufficiency cannot be ruled out during subjective examination, it is imperative to assess for these conditions prior to further cervical spine examination! (Click here to see how this is done) 

Treatment/Therapeutic Exercise

•  If deep neck flexor endurance proves to be insufficient then the craniocervical flexion test or deep neck flexor endurance test can become a treatment option. Research also demonstrates that individuals with whiplash have impaired proprioception with respect to cervical movement. Use of pillows to unload sensitive structures while performing gentle range of motion exercises can help to improve this proprioceptive deficit! (Click image to watch 1-2 minute video)

Education

Education is perhaps the most important part of the rehabilitation process for individuals with whiplash. Considering that research demonstrates a significant likelihood of chronic pain occurrence in individuals with whiplash secondary to a motor vehicle accident, it is imperative that the patient is educated properly in order to intervene in this cycle. (Click image to watch 1-2 minute video)

Neck Sprain/Strain

Neck Pain with Movement Coordination Impairments

• Neck sprain/strains can occur due to a variety of factors including posture, ergonomic set up, excessive loading, and trauma. If your patient complains of tightness or spasm in the neck region along with difficulty maintaining static postures, a neck sprain/strain could be the culprit! For more clinical findings click here!

---

Anatomy

---

Key Finding

• The upper trapezius can often times be a tissue source in patients with a neck sprain/strain. Lengthening, contracting, and palpating the suspected muscle can help the clinician better rule in the likelihood of strain! Take a look at how to assess upper trapezius length. (Click image to watch 1-2 minute video)

•  Clinical Side Note 1: Considering that the upper trapezius and levator scapulae share similar locations, assessment of the levator scapulae may prove to be beneficial as well. 

Treatment

 Often times the upper trapezius (or levator scapulae for that matter) becomes irritated, not necessarily due to overactivity in a shortened position, but due to overactivity in a lengthened position secondary to variables such as poor posture. This forced activation in a lengthened position can eventually result in irritation of the tissue over time. The purpose of the post isometric relaxation technique is not to stretch the muscle, but to help relax it. Take a look at how its done! (Click image to watch 1-2 minute video)

Therapeutic Exercise

• As mentioned previously, the middle trapezius is one of the muscles that is often under-active in individuals with a neck sprain/strain. Strengthening of the scapulothoracic musculature can assist with supporting the strained tissues and further reduce the amount of strain over time! (Click image to watch 1-2 minute video)

• Clinical Side Note 2: Postural impairments tend to be present in these individuals. Do not forget to address posture and ergonomics. Make a functional change in something they are doing daily!

• Clinical Side Note 3: Research also supports the use of thoracic spine manipulation (if deemed appropriate) in individuals with neck pain! If thoracic spine hypomobility is considered to be an associated impairment, consider adding this to the treatment plan!