Guideline sources The following summarized guidelines for the management of neck pain-associated disorders are prepared by our editorial team based on guidelines from the Canadian Chiropractic Association (CCA 2016). 1 Guidelines 1. Nonpharmacologic interventions Multimodal therapy: consider either range-of-motion home exercises, medication, or multimodal manual therapy for reduction in pain and disability in patients with recent neck pain grades I to II. C Supervised graded strengthening exercises: consider supervised graded strengthening exercises rather than advice alone for patients with recent grade III neck and arm pain. C Supervised yoga: consider supervised yoga over education and home exercises for short-term improvement in neck pain and disability, for patients with persistent grades I to II neck pain and disability. C Supervised group exercises: consider supervised group exercises to reduce neck pain and disability for adult patients with persistent grades I to II neck pain that lasts > 6 months. C https://web.pathway.md/diseases/recSLJSLbVsoI2WYd 1/3 6/30/23, 1:15 AM Neck pain-associated disorders Pathway 2. Therapeutic procedures Manipulation or mobilization: consider manipulation or mobilization for patients with recent onset of grades I to II neck pain-associated disorders, based on patient preference. C High dose massage: consider high-dose massage therapy, based on patient preferences and resources available for patients with persistent grades I to II neck pain-associated disorders lasting > 3 months. C 3. Patient education General counseling: consider mixed supervised and unsupervised high-intensity strength training or advice alone in workers with persistent neck and shoulder pain. C Clinical findings Symptoms Past medical history Chronic back pain Cancer Decreased ability to move the head Meningitis Rheumatoid arthritis Difficulty sleeping Dizziness Fatigue Headache Neck pain radiating pain into the arm and upper back Numbness Shoulder pain Neurological exam Cognitive impairment Neck stiffness References 1. Bussi res AE, Stewart G, Al-Zoubi F et al. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39 8 523 564.e27. Open 2. Pierre C t , Jessica J Wong, Deborah Sutton et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management OPTIMa) Collaboration. Eur Spine J. 2016 Jul;25 7 2000 22. Open https://web.pathway.md/diseases/recSLJSLbVsoI2WYd 2/3 6/30/23, 1:15 AM Neck pain-associated disorders Pathway 3. Caio Vitor Dos Santos Genebra, Nicoly Machado Maciel, Thiago Paulo Frascareli Bento et al. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther. Jul-Aug 2017;21 4 274 280. Open https://web.pathway.md/diseases/recSLJSLbVsoI2WYd 3/3