How can I help you?

People who experience neck pain are not always easy to help. As a younger clinician I have found myself frustrated in my attempts to figure out how to help patients with neck pain. Recently I read a research article which helped me immensely with treating the neck. The article offers a treatment-based classification system for patients with neck pain (Fritz JM, Brennan GP. Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain. Physical Therapy. 2007;87:513-524).

Underlying the authors' reasoning is the premise that patients with neck pain should not all be treated the same. Rather, these patients should be grouped into categories based on diagnostic testing and patient history. A good deal of discerning symptom trends and discriminatory placement is involved. Once a patient has been 'placed' in the correct group they can be helped with group-matched treatment. Here are definitions of each category as well as matched treatments (taken from the article verbatim):

1) MOBILITY: younger patients with more acute symptoms and without signs of nerve root compression (e.g. pain down into the arm). These patients benefit from upper thoracic spinal mobilization/manipulation and deep neck flexor exercise.

2) CENTRALIZATION: patients with distal symptoms and signs of nerve root compression (e.g. pain down into the arm). Neck retraction (chin tucking) exercises and traction are used.

3) EXERCISE AND CONDITIONING: patients who have chronic neck pain, but who do not have signs and symptoms of nerve root compression. Strengthening of deep neck flexors and the upper quarter (arm and neck muscles) is recommended.

4) PAIN CONTROL: patients with acute, traumatic onset of neck pain with a whiplash mechanism and with very high levels of pain and disability. Evidence for patients fitting this subgroup recommends mobilization, neck active range-of-motion exercises, and avoidance of immobilization.

5) HEADACHE: patients with a chief complain of headache presumed to originate from structures in the cervical spine. Evidence supports strengthening of the deep neck flexors and upper quarter muscles along with mobilization or manipulation of the cervical spine.

My most recent instructor added the following category:

6) NEURAL TENSIONING: patient with thoracic outlet like symptoms (e.g. numbness and tingling into the arm and potentially compromised arm circulation) as well as patients exhibiting positive neural tension tests. According to my instructor these patients benefit from neural tensioning or sliding, positional training, and spinal mobilization.


Ambiguity has been the number one source of frustration for me as I learn how to help people. And so this classification system has been terrific in providing concrete guidance on how to direct the best treatment to various patients with neck pain. Far from being written in stone as the absolute rule of how to treat the neck, this classification system is however a good beginning at definitively expressing how to treat the neck.