Mechanical neck pain is defined as pain in the anatomical region of the neck for which it is not possible to identify a specific pathological cause of pain [55,56]. It generally includes neck pain, with or without pain in the upper limbs which may or may not interfere with activities of daily living. These are classed as Grade 1 and 2 type neck problems.

Diagnosis

Diagnosis of mechanical neck pain is derived from the patient’s history. Signs and symptoms indicating significant neurological compromise (Grade 3) or major structural pathology (Grade 4 including fracture, vertebral dislocation, neoplasm, etc.) indicate referral more imaging and possible medical management. Imaging is only indicated in patients with a positive neurological exam or presence of a “red flag” [55,57]. Chiropractors are trained to take a thorough medical history and perform an examination including neurological and orthopaedic tests to determine whether chiropractic care is appropriate, or whether a medical referral is indicated.

Evidence based summary for manual therapy [53]

Randomised controlled research trials (RCT) and reviews (the highest current standards of scientific evidence) suggests that there is moderate (on a scale of inconclusive, moderate and high) quality evidence that spinal manipulation/mobilization combined with exercise is effective for chronic non-specific neck pain [56,58]. There is also moderate quality evidence that thoracic spinal manipulation/mobilization is effective for acute/subacute non-specific neck pain [59.60,61,62]. RCT research shows moderate quality evidence that spinal manipulation is similar to mobilization for chronic non-specific neck pain [56,58]. There is moderate quality evidence from RCTs that massage therapy is effective for non-specific chronic neck pain [68]. Research shows moderate quality of evidence that mobilization combined with exercise is effective for acute whiplash-associated disorders [56].

Other effective non-invasive physical treatments or patient education [53]

Exercise, low-level laser therapy, acupuncture [56]

Back-in-Action clinical comment

Chiropractic assessment and treatment of mechanical neck pain is aimed at finding and reducing tension and the causes of tension in the joints and muscles. In our experience treating the symptoms and underlying causes of mechanical neck pain benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, cranial work, neck exercises, referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling.