Cervical Pain/Stiffness

Diagnosis/Definition

Cervical pain that is muscular, discogenic, or arthritic in nature.  Patient may be experiencing limited ROM of C-spine or have pain referred to the trapezius or upper extremity.  

Initial Diagnosis and Management

• History and physical examination.
• Radiograph of the spine if cervical pain started with trauma.
• MRI/CT not indicated initially.
• Initial Management:
  • NSAIDs.
  • Do not prescribe muscle relaxants as they are not effective.
  • Soft collar not recommended except for 1-5 days s/p high speed whiplash trauma (i.e., MVA).
  • Appropriate activity limitations on lifting, overhead work, heavy headgear, etc.
  • Ice packs every 20 minute q2h x 72 hours - then change to heat PRN.
  • Encourage gentle, pain-free ROM.

Ongoing Management and Objectives

• Should observe a reduction in pain level within 5-7 days.
• Chronic upper trapezius tension may persist for up to 2 months.
• Expect increased AROM of C-spine and decreased muscle spasm within 2 weeks, complete resolution will take longer.

Indications for Specialty Care Referral

• Specialty Care Referral (Physical Therapy):
  • No improvement after 7-10 days of initial primary care management.
  • If the patient has radicular symptoms.
• Specialty Care Referral (Orthopedic Spine Referral):
  • If the patient has neurological findings (motor, sensory, or reflex deficits) and/or has positive MRI findings.

Criteria for Return to Primary Care

Chronic conditions with a stable neurologic exam in patients that have been evaluated by Orthopedics or Neurosurgery and are not surgical candidates.