ABSTRACT:
Neck pain is a prevalent musculoskeletal condition impacting individuals worldwide, with significant personal, occupational, and socioeconomic consequences.[1][2] Clinical presentation varies from acute to chronic pain, often accompanied by mobility deficits, movement coordination impairments, or radiculopathy. Physiotherapy plays a crucial role in assessment, diagnosis, and evidence-based management of neck pain, encompassing education, manual therapy, exercise, and psychological interventions.
INTRODUCTION:
Neck pain affects up to 70% of the population at some point in their lives, frequently leading to disability and occupational impairment.[3][4] It may arise from traumatic events, such as whiplash, or insidious causes, such as postural dysfunction and degenerative changes.[5][6] Chronic and recurrent neck pain can impair quality of life, productivity, and mental health.[7][8] Given the multifactorial nature of neck pain and variability in clinical features, physiotherapy has emerged as a multidisciplinary approach integrating education, active rehabilitation, manual therapy, ergonomic advice, and psychological support.[1][2][9]
CLINICAL FEATURES:
Neck pain may present acutely or chronically, often classified into three groups: neck pain with mobility deficits, neck pain with movement coordination impairments (e.g., whiplash-associated disorders), and neck pain with radiating pain (cervical radiculopathy).[6][10] Common clinical features include:
– Localized or diffuse pain along the cervical spine, often radiating to the upper back, shoulder, or occipital region.[11][12]
– Reduction of neck range of motion, muscle stiffness, and tenderness over cervical paraspinal and trapezius muscles.[10][13]
– In cases with radiculopathy, sensory changes, weakness, and diminished reflexes in the corresponding dermatome/myotome.[10][13]
– Postural dysfunction and muscle imbalances frequently observed in office workers and individuals with sedentary lifestyles.[6][14]
– Psychological distress including anxiety and fear of movement, particularly in chronic cases.[15][16]
INVESTIGATION:
Proper evaluation aims to rule out serious pathologies and identify the underlying cause of neck pain.[17][18] Key investigative modalities include:
– Detailed history taking and physical examination focusing on onset, duration, aggravating factors, and neurological symptoms.[19][20]
– Clinical tests such as Spurling’s test, neck distraction test, and assessment of muscle strength, reflexes, and sensation.[21][22]
– Radiological imaging (X-ray, MRI, or CT) selectively indicated for trauma, suspected radiculopathy, or when initial conservative management fails.[18][23]
– Screening for ‘red flags’ (cancer, infection, fracture, myelopathy) is essential to prevent misdiagnosis.[24]
– Patient-reported outcome measures such as Neck Disability Index (NDI) and Visual Analogue Scale (VAS) assist in quantifying pain and functional impairment.[25]
DIFFERENTIAL DIAGNOSIS:
Neck pain is attributed to numerous conditions. The differential diagnosis is vital for appropriate management.[13][17][26] :
Condition Key Features
Cervical radiculopathy – Radiating pain, sensory deficits, weakness in distribution of involved nerve root.[27]
Cervical spondylosis Chronic pain, stiffness, occasional neurological symptoms due to degenerative changes.[28]
Mechanical neck pain Localized pain, often due to muscle strain or postural dysfunction, no neurological deficits.[6]
Muscle spasm/sprain Acute onset, tenderness, restricted movement, no sensory or motor involvement.[29]
Postural neck pain Gradual onset, related to poor ergonomics, muscle fatigue, improves with postural correction.[14]
Serious pathology Systemic symptoms (fever, weight loss, neurological deficits), warrants urgent referral.[24]
MANAGEMENT:
Management of neck pain should be tailored to presentation, chronicity, and patient preferences.[2][10][23] Evidence-based practices include:
Conservative Strategies:
– Manual Therapy: Techniques such as Maitland’s mobilization, soft tissue therapy (myofascial release, muscle energy technique), and manipulation for pain relief and improved ROM.[30][31]
– Exercise Therapy: Strengthening, endurance, flexibility, sensorimotor control, and postural training have demonstrated moderate benefits; individualized progressive programs are recommended.[1][4][32]
– Education and Advice: Reassurance regarding prognosis, pain neuroscience education, and strategies for resuming daily activities are first-line treatments.[1][16][33]
– Activity Modification: Ergonomic interventions and advice on working posture prevent recurrence, especially in office workers.
Pharmacological and Adjunct Therapies:
– Analgesics (NSAIDs), muscle relaxants, and, occasionally, corticosteroid injections for acute and severe cases.[23][34]
– Application of transcutaneous electrical nerve stimulation (TENS) and cold/heat therapy for symptom relief.[10]
Psychological Interventions:
– Cognitive Behavioral Therapy (CBT): Addresses maladaptive beliefs, anxiety, and fear-avoidance; shown to reduce disability when combined with physiotherapy.[15]
Multidisciplinary Approach:
– Chronic, persistent cases may require combined physiotherapy, psychology, occupational therapy, and workplace liaison.[2]
– Early identification and intensive rehabilitation for delayed recovery or risk for chronicity.
Role of Physiotherapy
Physiotherapists play a central role in evidence-based neck pain management. Their contributions include:
Assessment and Diagnosis
– Performing thorough musculoskeletal and neurological assessments, identifying functional deficits and contributing factors.[1][17][19]
Therapeutic Interventions
– Exercise Prescription:In dividually tailored programs focusing on strength, endurance, flexibility, and sensorimotor control are fundamental for restoring function and reducing pain.[1][4][32]
– Manual Therapy: Mobilisation techniques and soft tissue management alleviate pain and improve movement, as supported by randomized trials and systematic reviews.[30][31]
– Education: Patient-centered information on prognosis, self-care, ergonomic modification, and pain coping strategies.[1][16][33]
– Psychological Support: Incorporation of CBT and motivational interviewing to address psychological aspects, especially in chronic or disabling pain.[15]
– Multimodal Approaches: Combining manual therapy, exercise, education and psychological interventions optimizes outcomes.[9]
Prevention and Long-term Management
– Ergonomic modification, workplace interventions, and lifestyle guidance reduce recurrence and promote long-term recovery.[14]
– Early physiotherapeutic intervention is crucial to prevent chronicity and disability.
Special Populations
– Office workers benefit from targeted exercise and ergonomic changes; individuals with trauma-induced neck pain require individualized protocol.[5]
– Guidance for return to normal activities and workplace liaison for persistent cases ensures societal and occupational integration.
REFERENCES:
[1] Best Evidence Rehabilitation for Chronic Pain Part 4: Neck … https://pmc.ncbi.nlm.nih.gov/articles/PMC6723111/ [2] The role of physiotherapy in the management of non- … https://pubmed.ncbi.nlm.nih.gov/16332949/ [3] A Systematic Review With Meta-analysis of Randomized … https://www.jospt.org/doi/10.2519/jospt.2023.12063 [4] Chronic neck pain and postural rehabilitation: A literature … https://www.sciencedirect.com/science/article/abs/pii/S1360859222000766 [5] Role of Manual Therapy for Neck Pain and Quality of Life in … https://jpalliativecare.com/role-of-manual-therapy-for-neck-pain-and-quality-of-life-in-head-and-neck-cancer-survivors-a-systematic-review/ [6] Neck Pain: Revision 2017 – jospt https://www.jospt.org/doi/10.2519/jospt.2017.0302 [7] A Quick and Comprehensive Guide to Differential … https://pmc.ncbi.nlm.nih.gov/articles/PMC9610337/ [8] Clinical Practice Guideline for Physical Therapy … https://pubmed.ncbi.nlm.nih.gov/29228289/ [9] Neck Pain: Initial Evaluation and Management https://www.aafp.org/pubs/afp/issues/2020/0801/p150.html [10] Clinical Practice Guideline for Physical Therapy Assessment … https://academic.oup.com/ptj/article/98/3/162/4689128 [11] Neck Pain: 6 Common Causes and Treatments https://my.clevelandclinic.org/health/symptoms/21179-neck-pain [12] Neck Pain: Clinical Practice Guidelines Revision 2017 https://www.orthopt.org/uploads/content_files/files/Neck%20Pain%20Revision%20Decision%20Tree%202017%20-%20Ortho%20Section.pdf [13] Differential Diagnosis Of Neck Pain – PHYSIOTHERAPIST INDIA https://physiotherapistindia.com/differential-diagnosis-of-neck-pain/ [14] Physiotherapy management of neck pain https://pubmed.ncbi.nlm.nih.gov/33358545/ [15] Neck pain differential diagnosis https://www.wikidoc.org/index.php/Neck_pain_differential_diagnosis [16] APA | Management of neck pain https://australian.physio/inmotion/management-neck-pain [17] Evaluation of neck pain – Differential diagnosis of symptoms https://bestpractice.bmj.com/topics/en-us/943 [18] COMMON NECK PAIN AND WHIPLASH MAY 2003 … https://www.has-sante.fr/jcms/c_267806/fr/physiotherapy-in-common-neck-pain-and-whiplash-guidelines-pdf [19] References – Physiotherapy Interventions for the … https://www.ncbi.nlm.nih.gov/books/NBK524925/ [20] Treatment of Neck Pain: Noninvasive Interventions https://pmc.ncbi.nlm.nih.gov/articles/PMC2271098/ [21] Referencing – Physiotherapy https://libguides.mq.edu.au/c.php?g=953038&p=7027618 [22] A qualitative single case study of a Canadian university https://www.sciencedirect.com/science/article/pii/S2468781225001535 [23] Neck Pain https://www.jospt.org/doi/pdf/10.2519/jospt.2008.0303 [24] Physical Therapy for Neck Pain Relief https://www.spine-health.com/treatment/physical-therapy/physical-therapy-neck-pain-relief [25] Red flags for potential serious pathologies in people with neck … https://www.archivesofphysiotherapy.com/index.php/aop/article/view/3245 [26] Effects on Neck Disability and Pain – A Systematic Review … https://pmc.ncbi.nlm.nih.gov/articles/PMC12008560/ [27] Mechanism-based Classification of Pain for Physical … https://pmc.ncbi.nlm.nih.gov/articles/PMC3098553/ [28] Network meta-analysis of the effect of exercise therapy on … https://www.sciencedirect.com/science/article/pii/S2590093524000535 [29] Physiotherapy Treatment for Neck Pain https://www.physiotattva.com/treatment/neck-pain [30] Exercise Therapy for Chronic Neck Pain: Tailoring Person- … https://pmc.ncbi.nlm.nih.gov/articles/PMC10671970/ [31] Quality of reporting matched interventions for non-specific … https://www.sciencedirect.com/science/article/pii/S0031940625003530 [32] Know More About Physiotherapy for Neck Pain Relief https://www.southgatephysio.co.uk/know-more-about-physiotherapy-for-neck-pain-relief/ [33] The Essential Role of Physical Therapy treatment … https://www.tandfonline.com/doi/abs/10.1080/10669817.2023.2267391About the Authors
Dr. Shweta Pradhan1, Dr. Gajraj Singh Rathore2, Dr. Mayank Jethiwal3, Dr. Tushar Agarwal4, Dr. Pinky Saini5
1HOD, Physiotherapy and Rehabilitation Unit, Dr. Girendra Pal Homoeopathic Medical College, Hospital, Saipura, Sanganer, Jaipur
2HOD, Dept of Homoeopathic Pharmacy, Dr. M.P.K. Homoeopathic Medical college, Hospital, and Research Center, Saipura, Sanganer, Jaipur
3PG Scholar, Dept of Homoeopathic Pharmacy, Dr. M.P.K. Homoeopathic Medical college, Hospital, and Research Center, Saipura, Sanganer, Jaipur
4PG Scholar, Dept of Paediatrics, Dr. M.P.K. Homoeopathic Medical college, Hospital, and Research Center, Saipura, Sanganer, Jaipur 5PG Scholar, Dept of Practice of Medicine, Dr. M.P.K. Homoeopathic Medical college, Hospital, and Research Center, Saipura, Sanganer, Jaipur
