Neck pain is very common. After low back pain, neck pain is the second most leading musculoskeletal condition, even more common than osteoarthritis. Up to 70 per cent of people will experience some neck pain in their lifetime. In most cases neck pain will not seriously interfere with daily activities and participation. The risk that neck pain is caused by serious pathology is probably less than two per cent.
In general, several factors have been identified in the literature that are likely related to a poorer prognosis: previous episodes of neck pain, concurrent low back pain, concurrent headaches, poor health, psychological factors (such as anxiety, worry, frustration and depression) and work-related symptoms (such as low job satisfaction, high physical job demands and little influence on work situation). In contrast, younger age, an active coping style and optimistic outlook appear to be related to a favorable prognosis.
Unfortunately, in research we have as yet been unable to validly categorise patients. Having said this, there is some evidence that people who report a trauma as a possible cause of their neck pain, and have a lot of pain, have a poorer prognosis than other people with neck pain. People whose neck pain is work related, meaning working makes the pain worse and the pain decreases during time off, are also known to have a poorer prognosis.
Clinical prediction rules are a tool to identify patients who are at risk of poor prognosis. Clinical prediction rules are the way to go in the future, especially when these prediction rules are developed in combination with targeted treatments. At the moment research in this area is emerging, but not yet mature enough to be able to draw firm conclusions.
In general, we found education, exercise, manipulations and mobilisations, preferably combined, to be effective treatments. The benefit of education (or advice) is not frequently evaluated, as it is regarded an essential part of the communication between the physiotherapist and the patient. Exercises should be an important part of a physiotherapy treatment. Fortunately, no specific exercise was found to be superior to any other kind of exercise. Thoracic manipulations are equally, if not more, effective compared to cervical manipulations, although the evidence is not very strong. Also, mobilisations are considered as effective as manipulations.
Treatments should be tailored to specific patient needs as that enhances compliance with the advice given by the physiotherapist, or the exercises they ask people to do at home. It is good to know that physiotherapy care is equally effective compared to surgery. This knowledge boosts your self-confidence and can help in reassuring patients that the pain is not a serious condition.