by Alan Jordan
Recently an international panel of research experts in the field of neck science published a wide ranging series of studies regarding neck pain. The panel was led by Dr Scott Haldeman and Dr David Cassidy. Their work was carried out during a 10 year period – The Bone & Joint Decade – and was published as the content of an entire Journal. They were sponsored by the World Health Organisation. Their work covered every imaginable aspect of neck pain including epidemiology, the evaluation of all types of treatment, risk factors and so forth.
Classification System for Neck Pain
This article will deal with the classification for neck pain. As I have discussed in an earlier article dealing with lower back pain, it can be literally impossible to determine which tissue is responsible for the pain and this is also true of neck pain. The research scientists involved in this project arrived at the same conclusion and developed a classification system based primarily upon the severity of symptoms as well as physical findings. It is a 4 tiered system and is presented below.
Grade 1
Mild stiffness or achiness in the neck region which does not prevent individuals from working or participating in their chosen leisure activities.
Grade 2
Neck pain which is interfering with an individual’s ability to carry out their work or participate in their chosen leisure activities.
Grade 3
Neck pain with significant radiating symptoms to one or both arms.
Grade 4
Red flags are identified and additional investigations are required.
This classification system was based upon the original Quebec Task Force on Whiplash Associated Injuries due to the fact that it is also impossible to determine the exact tissues which are responsible for the patient’s pain.
Conclusion
Treatment should obviously measure up to the magnitude of the problem as should investigations. Conventional treatments such as manipulation, exercise, medication and acupuncture are all reasonably effective in treating neck pain and none appears to be vastly superior to the others. This will be dealt with in a coming article. In closing I will quote from one of the recommendations of this research group “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain” Needless to say, this is the most common treatment pathway used at our clinic.
