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== Search Strategy ==
== Introduction ==
[[File:Neck pain1.jpg|right|frameless]]
The International Association for the Study of Pain (IASP) in its classification of Chronic Pain defines cervical spinal pain as "pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process".&nbsp;The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders describes Neck pain as "pain located in the anatomical region of the neck with or without radiation to the head, trunk, and upper limbs".


Databases Searched: Pubmed, Pedro<br>Keyword Searches: Chronic neck pain AND physical therapy, Chronic neck pain AND Manual Therapy, Chronic neck pain AND stretching, Chronic neck pain AND massage, chronic neck pain AND yoga<br>
Pain is classified as chronic when it has a duration of 12 weeks or more. Chronic neck pain often presents as widespread hyperalgesia on palpation and in both passive and active movements in neck and shoulder area<ref name="Misailidou et al.">Misailidou V, Malliou P, Beneka A, Karagiannidis A, Godolias G, Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools; Journal of Chiropractic Medicine Jun 2010; 9(2): 49–59. (5)</ref>. 


== Definition/Description ==
Considerable research has shown that psychosocial factors are an important prognostic indicator of prolonged disability in individuals with neck pain<ref>Childs MJ, Fritz JM, Piva SR, Whitman JM. [http://www.jospt.org/doi/pdf/10.2519/jospt.2004.34.11.686 Proposal of a classification system for patients with neck pain.] Journal of Orthopaedic & Sports Physical Therapy. 2004 Nov;34(11):686-700.</ref>.  It is well known that chronic pain is often associated with anatomical, psychological, social, and professional factors. This is consistent with the [[Biopsychosocial Model|biopsychosocial model]], which considers pain to be a dynamic interaction between biological, psychological, and social factors unique to each individual.  


The International Association for the Study of Pain (IASP) in its classification of chronic pain defines cervical spinal pain as pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process [17]. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders describes neck pain as pain located in the anatomical region of the neck with or without radiation to the head, trunk, and upper limbs (Guzman J. et al., 2008) It defines the posterior neck region from the superior nuchal line to the spine of the scapula and the side region down to the superior border of the clavicle and the suprasternal notch [17]. Chronic neck pain is described as an often-widespread sensation with hyperalgesia in the skin, ligaments, and muscles on palpation and in both passive and active movements in neck and shoulder area (Ylinen J, 2007) [17]. Another type of classification proposed by IASP is based on the duration of neck pain. Acute neck pain usually lasts less than 7 days, subacute neck pain lasts more than 7 days but less than 3 months, and chronic neck pain has duration of 3 months or more.
== Epidemiology  ==


== Clinically Relevant Anatomy  ==
Although the natural history of neck pain appears to be favourable, rates of recurrence and chronicity are high<ref name=":0">Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD, Beattie P, Boeglin E. [http://www.jospt.org/doi/pdf/10.2519/jospt.2017.0302 Neck Pain: Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association.] Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83</ref>. Blanpied et al reviewed the literature and found that:
* 30% of patients with neck pain will develop chronic symptoms, with neck pain of greater than 6 months in duration affecting 14% of all individuals who experience an episode of neck pain.
* 37% of individuals who experience neck pain will report persistent problems for at least 12 months. Five percent of the adult population with neck pain will be disabled by the pain, representing a serious health concern.
* Five percent of the adult population with neck pain will be disabled by the pain, representing a serious health concern.
The economic burden due to disorders of the neck is high, and includes costs of treatment, lost wages, and compensation expenditures


For a structure to be a potential source of pain, it must be innervated. The posterior neck muscles and the cervical zygapophysial joints are innervated by the cervical dorsal rami. The lateral atlanto-axial joint is innervated by the C2 ventral ramus, and the atlanto-occipital joint is supplied by the C1 ventral ramus. The median atlanto-axial joint and its ligaments are supplied by the sinuvertebral nerves of C1-3. These nerves also supply the dura mater of the cervical spinal cord. The innervation of the prevertebral and lateral muscles of the neck are innervated by branches of the cervical ventral rami. Because they are innervated, all of the muscles, synovial joints, and intervertebral disks of the neck are potential sources of neck pain, along with the cervical dura mater and the vertebral artery. It has been shown that noxious stimulation of the cervical zygapophysial joints causes neck pain and referred pain (Dwyer A. et al., Aprill C. et al.). Pain from muscles innervated by a particular segment should be perceived in the same location as pain from articular structures innervated by the same segment. A study showed that stimulation of upper cervical muscles could produce pain in the head (Cyriax J.)18.
Individuals with chronic neck pain are largely middle aged and the majority are female<ref name=":0" />. Clinicians should consider age greater than 40, coexisting low back pain, a long history of neck pain, cycling as a regular activity, loss of strength in the hands, worrisome attitude, poor quality of life, and less vitality as predisposing factors for the development of chronic neck pain<ref name=":0" />. 


== Epidemiology /Etiology ==
== Clinical Course ==
The overall balance of evidence supports a variable view of the clinical course of neck pain. Recovery appears to occur most rapidly in the first 6 to 12 weeks post injury, with considerable slowing after that and little recovery after 12 months<ref name=":0" /><ref>Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain. 2010;150:22-28. <nowiki>https://doi.org/10.1016/j</nowiki>. pain.2010.02.013</ref>. Once considered chronic, the course may be stable or fluctuating, but in most cases can be best classified as recurrent, characterised by periods of relative improvement followed by periods of relative worsening.


Chronic neck pain is a common disease in general population and employees. Chronic neck pain can occur one year after the initial episodes and it has been found in 60% tot 80% of employees. The incidence of chronic neck pain was higher in women (15%) then men (9%). Women have the highest incidence at the age of 45 and men at the age of 60. [1] Fejer et al also found that the prevalence is higher in women. Scandinavian people reported more neck pain than Europe or Asia. [2]
Pain intensity, level of self-rated disability, pain-related catastrophising, post traumatic stress symptoms (traumatic onset only), and cold hyperalgesia may indicate a potential for chronicity<ref name=":0" />.
== Assessment  ==


According to S. Kääriä et al, the strongest predictors for women are earlier acute neck pain and chronic low back pain. Other predictors are:<br>- high physical workload<br>- intermediate and high work-related emotional exhaustion<br>- experiencing and having earlier experienced bullying at work<br>- common mental disorders<br>- rare to occasional and frequent sleep problems<br>- overweight and obesity<br>The predictors for men are:<br>- chronic low back pain<br>- acute neck pain<br>- manual class as compared with managers and profes- sionals<br>- high work-related emotional exhaustion<br>- frequent sleep problems [1]<br>
Assessment of chronic neck pain should follow the usual [[Cervical Examination|examination for the cervical spine]].  However it is important to be aware of the differing impairments that individuals with chronic pain may present:
* Chronic conditions often have a lower degree of irritability<ref name=":0" />.
* Individuals with chronic neck pain often display impaired proprioception. A high-quality review by Stanton et al<ref>Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of impaired proprioception in chronic, idiopathic neck pain: systematic review. Phys Ther. 2016;96:876-887</ref> concluded that these individuals are worse than asymptomatic controls at head-to-neutral repositioning tests.
* Deficits in cervicoscapulothoracic strength and motor control may be present in individuals with subacute or chronic neck pain<ref name=":0" />
It is well know that [[The Flag System|Psychosocial factor]]<nowiki/>s may contribute to an individuals persistent pain and disability, and the transition of an acute condition to a chronic, disabling condition.  Certain outcome measures can be used to evaluate psychosocial factors:
* [[Fear Avoidance Belief Questionnaire|Fear Avoidance Questionnaire]]
* Beck Depression Inventory
* Depression Anxiety Screening Scale
* [[Pain Catastrophizing Scale]]


== Diagnostic Procedures ==
== Medical Management ==


The most common neck pain in a physician’s office is nonspecific. And it is usually caused by daily activities. The differential diagnosis of neck pain is focused on mechanical and non-mechanical. Chronic neck pain is when the complaints are longer than three months and this can be a mechanical or non-mechanical cause. Possible factors that can lead to chronicity are: fear ,catastrophizing , depression and anxiety.[19] The table below shows the possible causes of neck pain. [3]
There is a lack of evidence for medical management of chronic neck pain. Trials testing the use of botulinum injections, steroid injections and muscle relaxants have not proven to be efficacious.  


'''<br>'''
== Physical Therapy Management  ==


{| width="650" border="1" cellpadding="1" cellspacing="1"
=== Treatment Based Classification Approach ===
|-
The treatment based classification approach to neck pain revision in 2017<ref name=":0" /> (CLINICAL PRACTICE GUIDELINE) separately listed interventions for chronic neck pain: (level of evidence 1a)  
| '''Mechanical'''
| '''Infections'''
|-
| &nbsp; &nbsp; &nbsp; Nontraumatic
| &nbsp; &nbsp; &nbsp; Osteomyelitis&nbsp;
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Neck Strain
| &nbsp; &nbsp; &nbsp; Discitis&nbsp;
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Postural
| &nbsp; &nbsp; &nbsp; Meningitis
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Tension
| &nbsp; &nbsp; &nbsp; Herpes Zoster
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Torticollis (acquired)
| &nbsp; &nbsp; &nbsp; Lyme Disease
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Spondylosis* (degenerative arthritis)
| <br>
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Myelopathy*
| '''Neurologic'''
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Cervical Fracture* (see neoplasm)  
| &nbsp; &nbsp; &nbsp; Peripheral Entrapment&nbsp;
|-
|
| &nbsp; &nbsp; &nbsp; Brachial Plexitis
|-
| '''Traumatic'''
| &nbsp; &nbsp; &nbsp; Neuropathies
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Whiplash Syndromes*
| &nbsp; &nbsp; &nbsp; Reflex Sympathetic Dystrophy
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Disc Henation*
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Neck Sprain
| '''Referred'''
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Sports (Stinger*)  
| &nbsp; &nbsp; &nbsp; Thoracic Outlet Syndrome
|-
|
| &nbsp; &nbsp; &nbsp; Pancoast Tumor
|-
| '''Non Mechanical'''
| &nbsp; &nbsp; &nbsp; Esophagitis
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Rheumatologic/Inflammatory
| &nbsp; &nbsp; &nbsp; Angina
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Rheumatoïd Arthritis
| &nbsp; &nbsp; &nbsp; Vascular Dissection
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Ankylosing Spondylitis
| &nbsp; &nbsp; &nbsp; Carotidynia
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Fibromyalgie
| <br>
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Polymyalgia Rheumatic
| '''Miscellaneous'''
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Reiter Syndrome
| &nbsp; &nbsp; &nbsp; Sarcoidosis
|-
| &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Psoriatic Arthritis
| &nbsp; &nbsp; &nbsp; Paget Disease
|-
|
| <br>
|-
| '''Neoplastic'''
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Osteoblastoma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Osteochondroma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Giant Cell Tumor
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Metastases
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Hemangioma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Multiple Myeloma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Chondrosarcoma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Glioma
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Syringomyelia
|
|-
| &nbsp; &nbsp; &nbsp; &nbsp;Neurofibroma
|
|}


*With or without radiculopathy
'''Neck pain with mobility deficits'''


== Outcome Measures ==
Clinicians should provide a multimodal approach of the following:
# Thoracic manipulation and cervical manipulation or mobilization 
# Mixed exercise for cervical/scapulothoracic regions: neuromuscular exercise (eg, coordination, proprioception, and postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements 
# Dry needling, laser, or intermittent mechanical/manual traction
# Clinicians may provide neck, shoulder girdle, and trunk endurance exercise approaches and patient education and counseling strategies that promote an active lifestyle and address cognitive and affective factors.
'''Chronic neck pain with movement coordination impairments (including WAD)'''


== Examination ==
Clinicians may provide the following:
# Patient education and advice focusing on assurance, encouragement, prognosis, and pain management
# Mobilisation combined with an individualised, progressive sub maximal exercise program including cervicothoracic strengthening, endurance, flexibility, and coordination, using principles of cognitive behavioural therapy
# TENS
'''Chronic neck pain with headache'''


== Medical Management ==
Clinicians should provide cervical or cervicothoracic manipulation or mobilisations combined with shoulder girdle and neck stretching, strengthening, and endurance exercise.


== Physical Therapy Management ==
'''Chronic neck pain with radiating pain'''
# Clinicians should provide mechanical intermittent cervical traction, combined with other interventions such as stretching and strengthening exercise plus cervical and thoracic mobilisation/ manipulation.
# Clinicians should provide education and counselling to encourage participation in occupational and exercise activities 


== Key Research ==
== Chronic Whiplash Clinical Care Pathway==
<ref name=":1">Rebbeck T. [http://www.jospt.org/doi/pdf/10.2519/jospt.2017.7138 The Role of Exercise and Patient Education in the Noninvasive Management of Whiplash: A Clinical Commentary.] Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun 16(0):1-32.</ref>  (LOE 5) ==
[[File:Chronic whiplash clinical care pathway.png|frameless|668x668px]]


== Resources ==
=== Behavioural Interventions ===
Education is a key component of managing individuals with chronic neck pain and behavioural interventions should play a role in the management of people with chronic whiplash<ref name=":1" /> (LOE 5). Guidelines recommend that individuals be provided with information about how to cope with pain and disability, particularly as their symptoms transition to the chronic phase.  Key concepts to address include reducing catastrophic thought, addressing unhelpful beliefs, addressing fear of movement and providing active coping strategies to assist patients to cope with pain<ref name=":1" /> (LOE 5).  There is some preliminary evidence that pain neurophysiology education in chromic WAD improves both pain behavior and pain thresholds<ref name=":1" /> (LOE 5). 


== Clinical Bottom Line<br> ==
Cognitive Behavioural Therapy (CBT) is a method that can help manage problems by changing the way patients would think and behave. It is not designed to remove any problems but help manage them in a positive manner. The [[CBT Approach to Chronic Low Back Pain|CBT approach to LBP]] can be as effectively applied to neck pain and can be included in your [[The Inclusion of CBT in Physiotherapy Education|education strategy]]. 


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
If relevant psychosocial factors are identified, the rehabilitation approach may need to be modified. An emphasis on active rehabilitation and positive reinforcement of functional accomplishments is recommended. Graded exercise programs that direct attention towards attaining certain functional goals and away from the symptom of pain have also been recommended. Finally, graduated exposure to specific activities that a patient fears as potentially painful or difficult to perform may be helpful.  
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
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== References  ==
 
References will automatically be added here, see [[Adding References|adding references tutorial]].  


== References ==
<references />
<references />
[[Category:Occupational Health]]
[[Category:Pain]]
[[Category:Conditions]]
[[Category:Cervical Spine]]
[[Category:Cervical Spine - Conditions]]
[[Category:Mental Health]]
[[Category:Mental Health - Conditions]]

Latest revision as of 11:50, 15 November 2023

Original Editor - Axel Antoine

Top Contributors - Axel Antoine, Laura Ritchie, Kim Jackson, Rachael Lowe, Simisola Ajeyalemi, Claire Knott, Lauren Lopez, Jess Bell, Olajumoke Ogunleye, Admin, Evan Thomas, George Prudden, Joris Servranckx, Eva Roose1 and WikiSysop

Introduction[edit | edit source]

Neck pain1.jpg

The International Association for the Study of Pain (IASP) in its classification of Chronic Pain defines cervical spinal pain as "pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process". The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders describes Neck pain as "pain located in the anatomical region of the neck with or without radiation to the head, trunk, and upper limbs".

Pain is classified as chronic when it has a duration of 12 weeks or more. Chronic neck pain often presents as widespread hyperalgesia on palpation and in both passive and active movements in neck and shoulder area[1].

Considerable research has shown that psychosocial factors are an important prognostic indicator of prolonged disability in individuals with neck pain[2]. It is well known that chronic pain is often associated with anatomical, psychological, social, and professional factors. This is consistent with the biopsychosocial model, which considers pain to be a dynamic interaction between biological, psychological, and social factors unique to each individual.

Epidemiology[edit | edit source]

Although the natural history of neck pain appears to be favourable, rates of recurrence and chronicity are high[3]. Blanpied et al reviewed the literature and found that:

  • 30% of patients with neck pain will develop chronic symptoms, with neck pain of greater than 6 months in duration affecting 14% of all individuals who experience an episode of neck pain.
  • 37% of individuals who experience neck pain will report persistent problems for at least 12 months. Five percent of the adult population with neck pain will be disabled by the pain, representing a serious health concern.
  • Five percent of the adult population with neck pain will be disabled by the pain, representing a serious health concern.

The economic burden due to disorders of the neck is high, and includes costs of treatment, lost wages, and compensation expenditures

Individuals with chronic neck pain are largely middle aged and the majority are female[3]. Clinicians should consider age greater than 40, coexisting low back pain, a long history of neck pain, cycling as a regular activity, loss of strength in the hands, worrisome attitude, poor quality of life, and less vitality as predisposing factors for the development of chronic neck pain[3]. 

Clinical Course[edit | edit source]

The overall balance of evidence supports a variable view of the clinical course of neck pain. Recovery appears to occur most rapidly in the first 6 to 12 weeks post injury, with considerable slowing after that and little recovery after 12 months[3][4]. Once considered chronic, the course may be stable or fluctuating, but in most cases can be best classified as recurrent, characterised by periods of relative improvement followed by periods of relative worsening.

Pain intensity, level of self-rated disability, pain-related catastrophising, post traumatic stress symptoms (traumatic onset only), and cold hyperalgesia may indicate a potential for chronicity[3].

Assessment[edit | edit source]

Assessment of chronic neck pain should follow the usual examination for the cervical spine. However it is important to be aware of the differing impairments that individuals with chronic pain may present:

  • Chronic conditions often have a lower degree of irritability[3].
  • Individuals with chronic neck pain often display impaired proprioception. A high-quality review by Stanton et al[5] concluded that these individuals are worse than asymptomatic controls at head-to-neutral repositioning tests.
  • Deficits in cervicoscapulothoracic strength and motor control may be present in individuals with subacute or chronic neck pain[3]

It is well know that Psychosocial factors may contribute to an individuals persistent pain and disability, and the transition of an acute condition to a chronic, disabling condition. Certain outcome measures can be used to evaluate psychosocial factors:

Medical Management[edit | edit source]

There is a lack of evidence for medical management of chronic neck pain. Trials testing the use of botulinum injections, steroid injections and muscle relaxants have not proven to be efficacious.

Physical Therapy Management[edit | edit source]

Treatment Based Classification Approach[edit | edit source]

The treatment based classification approach to neck pain revision in 2017[3] (CLINICAL PRACTICE GUIDELINE) separately listed interventions for chronic neck pain: (level of evidence 1a)

Neck pain with mobility deficits

Clinicians should provide a multimodal approach of the following:

  1. Thoracic manipulation and cervical manipulation or mobilization
  2. Mixed exercise for cervical/scapulothoracic regions: neuromuscular exercise (eg, coordination, proprioception, and postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements
  3. Dry needling, laser, or intermittent mechanical/manual traction
  4. Clinicians may provide neck, shoulder girdle, and trunk endurance exercise approaches and patient education and counseling strategies that promote an active lifestyle and address cognitive and affective factors.

Chronic neck pain with movement coordination impairments (including WAD)

Clinicians may provide the following:

  1. Patient education and advice focusing on assurance, encouragement, prognosis, and pain management
  2. Mobilisation combined with an individualised, progressive sub maximal exercise program including cervicothoracic strengthening, endurance, flexibility, and coordination, using principles of cognitive behavioural therapy
  3. TENS

Chronic neck pain with headache

Clinicians should provide cervical or cervicothoracic manipulation or mobilisations combined with shoulder girdle and neck stretching, strengthening, and endurance exercise.

Chronic neck pain with radiating pain

  1. Clinicians should provide mechanical intermittent cervical traction, combined with other interventions such as stretching and strengthening exercise plus cervical and thoracic mobilisation/ manipulation.
  2. Clinicians should provide education and counselling to encourage participation in occupational and exercise activities

Chronic Whiplash Clinical Care Pathway[edit | edit source]

[6] (LOE 5) == Chronic whiplash clinical care pathway.png

Behavioural Interventions[edit | edit source]

Education is a key component of managing individuals with chronic neck pain and behavioural interventions should play a role in the management of people with chronic whiplash[6] (LOE 5). Guidelines recommend that individuals be provided with information about how to cope with pain and disability, particularly as their symptoms transition to the chronic phase. Key concepts to address include reducing catastrophic thought, addressing unhelpful beliefs, addressing fear of movement and providing active coping strategies to assist patients to cope with pain[6] (LOE 5). There is some preliminary evidence that pain neurophysiology education in chromic WAD improves both pain behavior and pain thresholds[6] (LOE 5).

Cognitive Behavioural Therapy (CBT) is a method that can help manage problems by changing the way patients would think and behave. It is not designed to remove any problems but help manage them in a positive manner. The CBT approach to LBP can be as effectively applied to neck pain and can be included in your education strategy.

If relevant psychosocial factors are identified, the rehabilitation approach may need to be modified. An emphasis on active rehabilitation and positive reinforcement of functional accomplishments is recommended. Graded exercise programs that direct attention towards attaining certain functional goals and away from the symptom of pain have also been recommended. Finally, graduated exposure to specific activities that a patient fears as potentially painful or difficult to perform may be helpful.

References[edit | edit source]

  1. ↑ Misailidou V, Malliou P, Beneka A, Karagiannidis A, Godolias G, Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools; Journal of Chiropractic Medicine Jun 2010; 9(2): 49–59. (5)
  2. ↑ Childs MJ, Fritz JM, Piva SR, Whitman JM. Proposal of a classification system for patients with neck pain. Journal of Orthopaedic & Sports Physical Therapy. 2004 Nov;34(11):686-700.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD, Beattie P, Boeglin E. Neck Pain: Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83
  4. ↑ Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain. 2010;150:22-28. https://doi.org/10.1016/j. pain.2010.02.013
  5. ↑ Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of impaired proprioception in chronic, idiopathic neck pain: systematic review. Phys Ther. 2016;96:876-887
  6. ↑ 6.0 6.1 6.2 6.3 Rebbeck T. The Role of Exercise and Patient Education in the Noninvasive Management of Whiplash: A Clinical Commentary. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun 16(0):1-32.
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