Physiotherapy Approaches to Neck Pain: A Comprehensive Review

Abstract

Neck pain is a prevalent and multifactorial condition with significant societal and economic impacts. In 2017, the global age-standardized prevalence and incidence rates of neck pain were 3551.1 and 806.6 per 100,000 individuals, respectively. The Task Force on Neck Pain classifies neck pain into four grades, with Grades I-III considered non-specific and Grade IV encompassing severe pathology. Numerous risk factors contribute to neck pain, including psychological factors (stress, anxiety, depression), work-related factors, neuromusculoskeletal disorders, autoimmune diseases, and genetic predisposition. Diagnosis involves history-taking, physical examination, and potentially diagnostic imaging to rule out serious pathology and identify prognostic factors. Clinical prediction rules, such as the Keele STarT Back Screening Tool adapted for neck pain, can stratify patients into risk categories. Prognosis varies, with 50-85% of individuals not achieving full recovery, indicating the often episodic and recurrent nature of neck pain. Physiotherapy treatment combines manual therapy, exercise, and education, with moderate-quality evidence supporting the effectiveness of strength, endurance, and stabilization exercises for chronic neck pain. Cervical mobilizations and manipulations are equally effective, while thoracic manipulations may provide greater benefits compared to inactive treatment. Future research priorities include evaluating the effectiveness and cost-effectiveness of interventions, translating findings into clinical practice, and developing risk stratification tools.