Multimodal management of mechanical neck pain using a treatment based classification system

Abstract

THE PURPOSE OF THIS CASE STUDY WAS TWOFOLD: 1) to illustrate the use of a treatment-based classification (TBC) system to direct the early intervention of a patient with mechanical neck pain, and 2) to show the progression of this patient with multimodal-modal intervention. The patient exhibited axial neck pain with referral into her upper extremity. Her pain peripheralized with cervical range of motion and centralized with joint mobilization placing her primarily in the centralization category. Her poor posture and associated muscle weakness along with the chronicity of symptoms placed her secondarily into the exercise and conditioning group resulting in a multi-modal treatment as the patient progressed. Although the design of this case report prevents wide applicability, this study does illustrate the effective use of the TBC system for the cervical spine as captured by accepted outcomes measures.

Keywords: Multi-Modal Intervention; Neck Pain; Treatment-Based Classification.

FIGURE 1

Proposed classification decision-making algorithm. MVA= motor vehicle accident, NDI = Neck Disability Index. Used with permission.

FIGURE 2

(A) Conventional radiograph (lateral view) portraying an increased lordotic curvature and (B) with cervical spine positioned in neutral, revealing disc degeneration primarily at C6–C7 and C7–T1 (large arrows) and secondarily at C4–C5 (small arrows). The presence of osteophytes at C6–C7 are magnified in (A) and demarcated by the arrow in (B).

FIGURE 3

(A) Postural assessment at initial visit reveals patient's excessive rounded shoulders and forward head posture. (B) Depicts the patient's improved cervical and thoracic posture at 10 weeks following initial evaluation.

FIGURE 4

Results of outcome scores administered at initial visit followed by visit 6 and visit 10. The Neck Disability Index (NDI) score represents improved function as the score lessens. The Single Alphanumeric Estimate (SANE) and the Short Form 12 (SF-12) mental component score (MCS) and physical component score (PCS) represent improved function as the score increases. All scores are in percentages.