Neck Pain Treatments for Non-Specific Cervical Spine Conditions

Emerging Best Practices for Neck Pain Treatment

woman holding neck in pain
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The myriad ways that exist for classifying and describing cervical spine, or neck, pain is part of the reason neck pain treatments vary. The various classifications factor in signs and symptoms, anatomical changes in specific parts of the spinal structures (whether they arise from wear and tear, genes, or trauma), and if your spinal nerves have been affected. Not only that, but the label for a particular type of neck pain may be a composite of two or more “official” classifications.

But in recent decades, the way practitioners categorize neck pain has begun to change. Previously, the location and timing of symptoms along with what films revealed about spinal anatomy represented a few of the most important and standard information bits necessary for a doctor to diagnose cervical spine pain. Now, the trend is toward a treatment oriented model, especially when it comes to conservative, non-surgical care.

Proponents believe this is a cost effective way to diagnose and treat non-specific neck pain and dysfunction.

Treatment Categories

A treatment model, as opposed to a “pathoanatomical model,” is based on the goals of the treatment and how those goals are achieved. In other words, for each basic category—mobility impairment, pain control, exercise and conditioning, headache, or radiating pain—the model offers the therapies and/or procedures that would likely best serve the purpose of getting your neck back to a functional and pain free state.

Each treatment category is further broken down into sub-categories: acute, sub-acute, and chronic stages. This layer of detail is useful, as the time from the onset of the trauma or symptoms plays an important role in determining the types and intensity of treatment that may safely work best.

You may find your diagnosis falls into more than one treatment category. For example, strains, sprains, and whiplash are primarily filed under pain control, but according to Chad Cook, physical therapist and PhD, it may also be found in the exercise and conditioning category.

In 2008, the treatment based classification was included as part of the APTA Orthopedic Guidelines. These guidelines now categorize neck pain in four of the five ways mentioned above. They leave out the exercise and conditioning category, but some in the know add it back in, perhaps because exercise is one of the most effective ways to relieve pain associated with many common cervical spine conditions.

Either way, experts continue to develop and suggest for inclusion new treatment categories.

Screening

Before treatment based classification can be applied, your doctor will likely screen you for serious underlying disease or spinal pathology, which are called red flags. In many cases, these types of problems are what cause the symptoms. If your doctor finds something that suggests a serious health condition, she’ll likely refer you to a specialist or for more testing.

She may also screen you for psychosocial factors, called yellow flags. These relate to the roles you play in the various aspects of your life, as well as your financial situation and motivations and your attitude about things. This type of screening helps her to determine if you are a good fit for treatment at the current time.

Once you’ve cleared these hurdles, you may be referred to physical therapy. If so, it’s now time to determine the treatment group into which you fall.

Mobility Impaired Neck Pain Treatment

Those in the mobility impaired treatment category often experience centrally located neck pain, or neck pain that’s on one side only. If either describes you, you may also find that your neck is limited as to how far it can go, but that when you do move it, this elicits your symptoms. Another symptom of mobility impairment in the neck area is referred shoulder or arm pain.

The medical history and physical exam conducted by your doctor help her determine, among other things, if you need to be referred to a specialist.

Your doctor will likely look for what is known as psychosocial issues, which many in the chronic pain field believe make a difference both in terms of treatment progress and whether or not you develop a long term condition. If she detects psychosocial elements in your clinical picture, she may refer you to short term therapy called cognitive behavioral therapy. This treatment may help you learn how to keep the pain and disability in perspective.

In the mobility impairment category, the emphasis is on getting your neck to move. Treatments for this goal may include hands on mobilization or manipulation of your neck and or upper back, neck exercises to increase the range of motion and both supervised and home stretching and strengthening programs. You’ll also likely be encouraged to engage in general fitness activities and remain active in your daily life.

As your treatment progresses, coordination and posture training may be added to your exercise programs.

Once you’re past the sub-acute phase, adjunct treatments such as dry needling, low level laser, ultrasound, traction, TENS, and muscle e-stim may be added.

Pain Control, Coordination, & Whiplash

Authors differ in the way they name and describe this category but basically it occurs after trauma, whiplash, and/or sprain or strain of structures in the neck. Generally, your tissues will be highly irritated in this category, and in the case of strain or sprain, the pain is usually severe.

Symptoms may include referred pain to the shoulder and/or arm, concussion symptoms, dizziness or nausea, headaches, confusion or memory problems, distress, hypersensitivity to external stimuli such as sounds, temperature, touch, light and more, and finally, tenderness in your neck muscles.

Once you communicate your symptoms to your doctor, what you can and cannot physically do, plus information on any other health conditions, she will determine the top treatment priorities. She does this by identifying and considering movement and pain patterns, among other things.

Similar to all the other categories of treatment, the pain category is subject to change as therapy progresses. This means that regular re-evaluation will likely help you remain on-track with your healing.

Treatment for pain generally consists of physical therapy modalities, strength exercises, and mobilization or manual therapy.

Pain Control Treatment Phases

During the acute phase, your doctor or physical therapist may advise you to remain active and resume your normal activities and will give you a home exercise program. Increasing your neck flexibility and posture will be key goals during this time. Wearing a collar is sometimes prescribed in this early phase.

As with the acute phase, during the sub-acute phase, your therapist will likely encourage you to remain active. Your home exercise program will probably target neck flexibility, plus strength. Other sub-acute phase pain control treatment goals include increasing muscle endurance, developing your coordination, improving posture, and stabilizing your core.

Manual therapy and/or mobilization is another potential treatment at this point. Ice, heat, and a supervised in-clinic exercise program are also common.

Once enough time has elapsed, you’ll be in the chronic phase. At this point, pain management is the key focus.

The ball is in your court during the chronic phase, and remaining an active participant in your healing is a key ingredient of success. Along with the goals mentioned above, your therapist may present you with more complicated and/or challenging exercises, as well as functional movement training.

And an important aspect of pro-active pain management is how you respond to triggers. As mentioned above, cognitive behavior therapy is a short term experience that helps many people put their chronic pain in perspective and gives them the tools to manage it successfully on a day-to-day basis.

Headache Treatment

If your neck problem causes headaches, you may find that your soft tissues feel irritated—another way of saying your tissues can't handle physical stress all that well. Such irritation may be related to how your treatment is progressing, and/or how much inflammation is present in your tissues.

Certain aspects of your lifestyle and psychological state may play roles here, too. These include, but are not limited to, how much disability you feel you have and if your sleep is disrupted and if so, to what extent. The amount of medication you take and the degree to which you participate in life’s activities are also key.

Generally, treatment is focused on mobilization and specific strengthening exercises. As muscle tension is likely a factor in your neck pain and headaches, massage and stretching may also be recommended.

In the chronic phase, upper back mobilization may be added, as may more exercises targeting neck, upper back, and shoulders. Exercise in this phase will likely put emphasis on strengthening, muscle endurance, control, coordination, and posture.

Radicular Symptoms (Centralization)

The final category in the treatment based model is radicular pain. Some experts refer to this classification as centralization.

Radicular pain is pain due to compression or irritation of a spinal nerve root. It is most commonly due to a herniated disc, but other causes exist as well.

Symptoms include neck and arm pain, and possibly nerve symptoms that go down one arm. Examples are pins and needles type sensations, numbness, and/or weakness associated with the distribution of nerves that arise from the spinal nerve root that is irritated or compressed.

Treatment, in this case, seeks to “centralize” the pain, which means to move the symptoms from the extremities back, or at least closer, to the spine. An example might include arching your back to relieve the leg symptoms associated with a herniated disc.

As with the headache category, the degree to which your tissues can handle physical stress in large part determines your treatment activities. In other words, treatment will likely progress according to tolerance. Also as with headaches, certain lifestyle and psychological factors may play a role in your recovery.

In the acute phase of radicular pain, you may get an exercise program designed to relieve symptoms, increase your flexibility and mobility, stabilize your core, and strengthen your body in general. Other treatments may include low level laser and wearing a collar for a short period of time.

In the chronic phase, treatment may consist of stretching and strengthening, plus manual therapy for your neck and/or upper back. Intermittent traction is another possible treatment.

A Word From Verywell

In general, neck pain is not a reason to retreat to your bed. Staying active and doing prescribed exercises will likely go a long way in helping you feel better and move more.

From exercise programs to physical therapy modalities and more, a combination of treatments may yield the best result. And as for the need to adapt to pain and movement limitation, you might consider cognitive behavioral therapy. Many people report that using this method teaches them how to successfully deal with their condition without the need to sacrifice life’s responsibilities and experiences.

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