Jun 25, 2018

Clinical Practice Guidelines Neck Pain: Revision 2017


Summery of neck examination

1.Excluding red flags and differential diagnosis: Clinicians should perform assessments and identify clinical findings in patients with neck pain to determine the potential for the presence of serious pathology (e.g., infection, cancer, cardiac involvement, arterial insufficiency, upper cervical ligamentous insufficiency, unexplained cranial nerve dysfunction or fracture), and refer for consultation as indicated. 2. IMAGING : Clinicians should utilize existing guidelines and appropriateness criteria in clinical decision making regarding referral or consultation for imaging studies for traumatic and non-traumatic neck pain in the acute and chronic stages. 3. OUTCOME MEASURES: Clinicians should use validated self-report questionnaires for patients with neck pain, to identify a patient’s baseline status and to monitor changes relative to pain, function, disability, and psychosocial functioning. 4. ACTIVITY LIMITATIONS AND PARTICIPATION MEASURES: Clinicians should utilize easily reproducible activity limitation and participation restriction measures associated with the patient’s neck pain to assess the changes in the patient’s level of function over the episode of care. 5. PHYSICAL IMPAIRMENT MEASURES: When evaluating a patient with neck pain over an episode of care, clinicians should include assessments of impairments of body function that can establish baselines, monitor changes over time, and be helpful in clinical decision making to rule in or rule out (1) neck pain with mobility deficits, including cervical active range of motion (ROM), the cervical flexion-rotation test, and cervical and thoracic segmental mobility tests; (2) neck pain with headache, including cervical active ROM, the cervical flexion-rotation test, and upper cervical segmental mobility testing; (3) neck pain with radiating pain, including neurodynamic testing, Spurling’s test, the distraction test, and the Valsalva test; and (4) neck pain with movement coordination impairments, including cranial cervical flexion and neck flexor muscle endurance tests. Clinicians should include algometric assessment of pressure pain threshold for classifying pain.

6. DIAGNOSIS/CLASSIFICATION : Clinicians should use motion limitations in the cervical and upper thoracic regions, presence of cervicogenic headache, history of trauma, and referred or radiating pain into an upper extremity as useful clinical findings for classifying a patient with neck pain into the following categories: • Neck pain with mobility deficits • Neck pain with movement coordination impairments (including whiplash-associated disorder [WAD]) • Neck pain with headaches (cervicogenic headache) • Neck pain with radiating pain (radicular)

Read details of the guidelines: https://www.




New Posts
  • info
    Jul 18, 2018

    Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline •Extrinsic risk factors(type of sport practiced) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS. •When treating patients with an acute LAS, modifiable risk factors such as deficiencies in proprioception and ROM should be identified and if possible included in a prevention and/or rehabilitation programme to mitigate the risk for recurrent sprains. •Extrinsic risk factors(type of sport practised) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS. *Prognostic factors Adequate attention should be directed towards the patient’s current level of pain, their workload and level of sports participation. These may all negatively influence recovery and increase the risk of future injury recurrence. *Diagnostic Regarding the clinical assessment of damage to the anterior talofibular ligament, the sensitivity (8️4%) and specificity (9️6%) of assessment using the anterior drawer are optimized if clinical assessment is delayed for between 4️ and 5️ days post injury. In case of a suspected fracture, the OAR should be applied. *Treatment •Rest Ice Compression Elevation (RICE) There is no evidence that RICE alone, or cryotherapy, or compression therapy alone has any positive influence on pain, swelling or patient function. •Non-steroidal anti-inflammatory drugs NSAIDs may be used by patients who have incurred an acute LAS for the primary purpose of reducing pain and swelling. However, care should be taken in NSAID usage as it is associated with complications and may suppress or delay the natural healing process. •Immobilization Use of functional support and exercise therapy is preferred as it provides better outcomes compared with immobilization. If immobilization is applied to treat pain or oedema, it should be for a maximum of 10 days after which functional treatment should be commenced. *Functional treatment •Functional support Use of functional support for 4–6 weeks is preferred over immobilization. The use of an ankle brace shows the greatest effects compared with other types of functional support. •Exercise Exercise therapy should be commenced after LAS to optimize recovery of joint functionality. Whether exercise therapy should be supervised or not remains unclear. •Manual mobilisation A combination with other treatment modalities, such as exercise therapy, enhances the efficacy of manual joint mobilization and is therefore advised. •Surgical therapy Despite good clinical outcomes of surgery after both chronic injuries and an acute complete lateral ligament rupture, functional treatment is still the preferred method as not all patients require surgical treatment. •Other therapies As no strong evidence exists on the effectiveness of these treatment modalities, they are not advised in the treatment of acute LAS. *Prevention •Functional support Both tape and brace have a role in the prevention of recurrent LAS (limited evidence). •Exercise therapy It is advised to start exercise therapy, especially in athletes, as soon as possible after the initial sprain to prevent recurrent LAS. Exercise therapy should be included into regular training activities as much as possible as home-based exercise. •Footwear No recommendations can be made concerning shoe wear. •Return to work To speed up return to work, a brace and immediate functional treatment in combination with a return to work schedule are advised. •Return to sports Supervised exercises focusing on a variety of exercises such as proprioception, strength, coordination and function will lead to a faster return to sport.
  • info
    Jul 17, 2018

    The aim is to reduce pain and improve function. No single treatment has proven to be totally effective, treatment selection depends on the patient's clinical picture and informed by current best evidence. 1- Advice and education: About the nature of the problem how to modify and control pain and activity till pain and function are regained. 2- Exercises: The gold standard is eccentric exercises using small weight or theraband. 3- manual therapy; Mobilization for elbow and radioulnar joints mobilization with movement: lateral glide with or without belt or pain release phenomenon (stretching or resisted wrist extension 20 seconds) mobilization of cervical (mostly C5, 6) or upper thoracic spine 4- Taping: usually in lateral direction 5- Dry needling: 6- Braces/Splints/Strap: has no clear evidence 7- electrotherapeutic modalities: like TENS, shock wave. Has mixed evidence in short term some has little evidence like ultrasound.
  • info
    Jul 17, 2018

    Tennis elbow, also known as lateral epicondylitis, is a condition in which the lateral aspect of the elbow becomes painful and tender. The pain may also extend into the posterior aspect of the forearm and grip strength may be weak. Onset of symptoms is generally gradual. Diagnosis is typically based on the symptoms with medical imaging used to rule out other potential causes. Signs and symptoms: - Pain on the lateral aspect of the elbow (lateral epicondyle). - Point tenderness over the lateral epicondyle and there may be trigger points in the wrist muscles. - Pain from gripping and movements of the wrist, especially resisted wrist/finger extension. (e.g. turning a screwdriver) and lifting movements. Pain can also be present when the muscles are stretched. Pathophysiology: Histopathological findings have displayed no evidence of an acute, or a chronic inflammatory process. Histologic studies have demonstrated that this condition is the result of tendon degeneration, which replaces normal tissue with a disorganized arrangement of collagen with formation of reparative tissue (angiofibroblastic hyperplasia) . Therefore, the disorder is more appropriately referred to as tendinopathy rather than tendinitis. Common Causes include: - Unaccustomed hand use. eg painting a fence, hammering, lots of typing. - Excessive gripping or wringing activities. - Poor forearm muscle strength or tight muscles. - pain referred from cervical spine . The most common segment that refers to lateral elbow is C5,6. Differential Diagnosis: - Radial Tunnel Syndrome - Cervical Radiculopathy - Posterior Interosseus Syndrome Outcome Measures pain: Numeric Pain Rating Scale (NPRS) or visual Analogue Scale (VAS). Self-reported functional Questionnaires: - Quick DASH (Disabilities of the Arm Shoulder and Hand) - The Upper Limb Functional Index (ULFI). - Patient Rated Tennis Elbow Evaluation (PRTEE)

Primephysio is a registered training company in England and wales. Registration number 7029865.

  Primephysio UK 



Terms and Conditions


Privacy Policy

  Events and News 


Courses and conferences

Free online courses