Patient handout

Mechanical neck pain (axial / radicular / myelopathy / whiplash)

PRODUCTION

1. Your condition

This handout is for mechanical neck pain (axial / radicular / myelopathy / whiplash). Your care team identified this based on: alert, stable adult with blunt head/neck trauma → canadian c-spine rule gate (stiell jama 2001 pmid 11597285; nejm 2003 pmid 14695411).

Other reasons your team may use this plan: acute axial neck pain <6 weeks ± referred pain (jospt 2017 blanpied pmid 28666405); subacute neck pain 6–12 weeks (bone & joint decade task force guzman spine 2008 pmid 18204387); chronic neck pain >12 weeks / flare of chronic neck pain (jospt 2017 blanpied pmid 28666405).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
stay active + reassurance + education	—	—	—	Favourable natural history; early activation and reassurance over rest/collar; whiplash symptoms plateau ~6 wk then improve (JOSPT 2017 Blanpied PMID 28666405; Griggs J Back Musculoskelet Rehabil 2015 PMID 25322732)
active cervico-scapulothoracic exercise programme	—	—	—	Specific strengthening + stretching: chronic NP long-term pain+function SMD −0.45 (95% CI −0.72 to −0.18); stabilisation SMD −14.90 (−22.40 to −7.39) (Gross Cochrane Man Ther 2016 PMID 27317503; JOSPT 2017 Blanpied PMID 28666405)
manual therapy adjunct ± thoracic mobilisation	—	—	—	Manual therapy combined with exercise improves pain/function in mobility-deficit neck pain (JOSPT 2017 Blanpied PMID 28666405)

Plan: Axial / whiplash neck pain — non-pharm-first symptom-control ladder (JOSPT 2017 Blanpied; Gross Cochrane 2016)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Improving / stable mechanical or whiplash neck pain

If you have:

Pain improving or stable, no arm weakness, no walking/balance change
Doing the prescribed neck/shoulder exercises
No fever, no new numbness, no hand clumsiness

Do this:

Stay active and keep doing your exercise programme — avoid prolonged collar use (JOSPT 2017 Blanpied PMID 28666405)
Use NSAID short-term as advised if you need it; avoid routine opioids
Expect gradual improvement; whiplash often plateaus around 6 weeks then improves (Griggs PMID 25322732)
Keep good posture and set up your workstation ergonomically

YELLOW — Not improving / new arm symptoms

If you have:

Pain not improving after several weeks of activity + exercise
New or worsening arm pain, numbness or tingling
Needing escalating pain medication

Do this:

Contact your provider for reassessment and phenotype review
Continue activity and exercise; do not start bed rest or a collar
Review your medications with your provider before escalating

Call your provider if:

Arm pain or numbness persisting or worsening
Pain not improving despite several weeks of the plan

RED — Cannot-miss neck-pain emergency

If you have:

New hand clumsiness, dropping things, trouble with buttons (myelopathy)
New problems walking or with balance, or new bladder/bowel control change
New arm/leg weakness, or weakness that is getting worse
Sudden severe back-of-head/neck pain, especially after neck strain or manipulation, with dizziness/double vision/slurred speech
Fever with severe neck pain, especially if immunosuppressed or inject drugs

Do this:

Go to the emergency department now
Bring your medication list
Tell the ED these are new neurological or systemic symptoms — emphasise possible spinal cord, infection, or artery problem

Call your provider if:

Always seek emergency care for any spinal-cord, severe-deficit, dissection, or infection feature (Guzman Spine 2008 PMID 18204387; Fehlings Global Spine J 2017 PMID 29164034)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Progressive degenerative cervical myelopathy — Hoffmann/hyperreflexia/clonus, gait-balance loss, hand clumsiness, bowel-bladder change (moderate/severe DCM) (Fehlings Global Spine J 2017 PMID 29164034)(life-threatening)
Sudden severe posterior neck/occipital pain + neurological signs ± Horner, after neck strain/manipulation or spontaneously (vertebral/carotid artery dissection)(life-threatening)
Canadian C-Spine Rule positive/indeterminate (age ≥65 / dangerous mechanism / paraesthesias / cannot rotate 45°) in blunt head/neck trauma (Stiell JAMA 2001 PMID 11597285; NEJM 2003 PMID 14695411)
Fever + severe neck pain with IVDU / immunosuppression / indwelling vascular catheter / recent bacteraemia (discitis–osteomyelitis–epidural abscess) (Guzman Spine 2008 Grade IV PMID 18204387)(life-threatening)
Known malignancy or constitutional symptoms with progressive neck pain (metastatic / pathological cervical lesion — Grade IV) (Guzman Spine 2008 PMID 18204387)
Progressive or severe motor weakness in a cervical-radicular or multi-level pattern without frank myelopathy (Radhakrishnan Brain 1994 PMID 8186959; Fehlings PMID 29164034)

5. Follow-up

Self-management, activity maintenance, neck/scapulothoracic exercise-programme adherence (Gross Cochrane PMID 27317503), ergonomic and work-participation counselling (JOSPT 2017 Blanpied PMID 28666405). Episodic recurrence is expected (Bone & Joint Decade model — Guzman Spine 2008 PMID 18204387). Persistent or worsening neck pain → re-evaluate phenotype, re-stratify, consider specialist referral; reinforce against opioid escalation, unnecessary imaging, and non-evidence-based interventional procedures (de Rooij Cochrane 2025 PMID 41293993)

6. Sources

Guideline: Bone & Joint Decade 2000–2010 Neck Pain Task Force (Guzman/Haldeman Spine 2008; WAD course/prognosis Carroll Spine 2008) + JOSPT Neck Pain Clinical Practice Guideline Revision 2017 (Blanpied) + Canadian C-Spine Rule (Stiell JAMA 2001 / NEJM 2003) + AO Spine Degenerative Cervical Myelopathy CPG 2017 (Fehlings) + DCM clinical review (Davies BMJ 2018) + cervical-radiculopathy provocative-test systematic reviews (Rubinstein 2006 / Thoomes 2017 / Lin 2025) + spontaneous carotid/vertebral artery dissection review (Schievink NEJM 2001); shared ACP/NICE mechanical-spine analgesia doctrine; 2026-floor surveillance anchor Cochrane nucleoplasty 2025