Diagnosis for Non-specific Neck Pain (Includes NAD I and NAD II classifications)

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Clinical Cornerstone:

• Diagnosis is primarily clinical, relying on patient history and clinical examination, and aims to exclude identifiable pathologies.

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• Definition: Neck pain not attributable to a discernible, specific pathology (i.e. not attributable to infection, tumor, osteoporosis, disc herniation, etc).

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• Prevalence: Approximately 90% of all neck pain cases.

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• Risk Factors: Include psychosocial factors (e.g., stress, lack of social support, anxiety, depression); sociodemographic factors (e.g., female sex, older age); physical factors (e.g., repetitive strain, poor posture, prolonged periods of sitting or using computers and mobile devices); lifestyle factors (e.g., low physical activity, obesity); work-related factors (e.g., heavy physical labour, awkward  postures, prolonged use of computers).

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• Pain Location: Typically localized to the neck and upper shoulders.

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• Duration: Pain can be acute (lasting less than 6 weeks), subacute (6 to 12 weeks), or chronic (more than 12 weeks). Duration of the complaint helps to inform subsequent treatment recommendations  (e.g. consider adding low-level laser therapy for chronic non-specific neck pain, consider adding supervised strength training for acute neck pain with radiculopathy). (If there was a history of previous conservative treatment, imaging may be a consideration for persistent non-specific neck pain while referral may be a consideration for persistent neck pain with radiculopathy).

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• Signs and Symptoms:

  • Pain can be sharp, dull, shooting, or aching.

  • Pain intensity can vary from mild to severe.

  • Pain may be aggravated by specific movements, postures, or activities and relieved by others.

  • There may be associated muscle stiffness or spasms.

  • Referred pain into the arms may or may not be present.

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• Neurological Examination: Typically, there are no neurological deficits. If present, they are mild and do not follow a specific nerve root distribution.

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• Response to Conservative Management: Often responds to conservative treatments such as education, exercise, and manual therapy.

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• Psychosocial Factors: Consider psychosocial factors (yellow flags) that might influence pain perception and recovery (e.g., beliefs about pain, fear of movement, catastrophizing).