Treatment‐based classification approach to neck pain

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Original Editors

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Search Strategy

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Definition/Description

After ruling out red flags, a pathoanatomical diagnosis does not lead the physical therapist to a particular treatment intervention when managing patients with neck pain.  This classification system is designed to assist the clinician with matching an initial treatment intervention strategy to a patient’s presentation. This classification system was originally published in the Journal of Orthopaedic Sports Physical Therapy in 2004 and updated in 2009 as part of the APTA Orthopedic section ICF Guidelines.  The four current classification categories include: neck pain with mobility deficits, neck pain with radiating pain, neck pain with movement coordination impairments, and neck pain with headache.  Neck pain arising from whiplash trauma is not comprehensively covered in the current classification system and is better described separately: Whiplash Disorders .   

Clinically Relevant Anatomy

Beyond identifying serious pathology such as fractures, diagnostic imaging is not often useful in identifying the tissue source of the patient’s neck pain.  Many imaging findings such as spondylosis and herniated discs are found commonly in individuals without pain.¹ Therefore, the cervical classification is based on the patient’s presenting signs, symptoms, and impairments rather than pathoanatomical sources of pain. 

Epidemiology /Etiology

 54% of individuals have experienced neck pain within the last 6 months.¹ 50% have symptoms that persist for greater than 12 months.² Neck pain increases with age and is most common in women in their fifties.¹   Neck pain is the second most common reported workman’s compensation injury second to low back pain and account for approximately 25% of people receiving outpatient physical therapy.¹ Proposed causes of neck pain include: degenerative changes, disc protrusion, nerve impingement, osteophytosis, spondylosis and impaired function of muscle, connective tissue and nervous tissue.¹

Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

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Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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