What is the next step in managing a patient with acute neck pain and reduced cervical spine range of motion?

Management of Acute Neck Pain with Reduced Cervical Range of Motion

Conservative management with analgesics, gentle exercises, and physical therapy is the recommended first-line approach for this patient with acute neck pain and reduced cervical range of motion. 1, 2

Initial Assessment and Management

• The patient presents with acute neck pain (7/10 severity) that began at work, with reduced range of motion and tenderness of cervical muscles, particularly on the left side 1
• No red flags are present (no focal neurological deficits, no trauma, no fever, normal consciousness) that would necessitate immediate imaging 1
• For acute mechanical neck pain without red flags, initial management should include:

Medication Options

• Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for acute neck pain and should be offered as first-line pharmacological treatment 2, 3
• Muscle relaxants can be beneficial for acute neck pain associated with muscle spasm 2, 3
• Consider acetaminophen/paracetamol as an alternative if NSAIDs are contraindicated 2

Physical Interventions

• Gentle mobilization and range of motion exercises should be started as soon as pain allows 1, 4
• Advise the patient to maintain normal activities as tolerated rather than strict rest 1, 2
• Heat application to the affected muscles may provide symptomatic relief 2
• A soft cervical collar may be used for very short-term relief (1-2 days maximum) but prolonged use should be avoided as it can lead to muscle deconditioning 5

Follow-up Plan

• If symptoms persist beyond 2 weeks despite conservative management, consider referral for physical therapy focusing on:

  • Core strengthening exercises 4
  • Neck range of motion exercises 4
  • Stretching of associated muscle groups 1, 4

• Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals may continue to experience some degree of pain or recurrences 3

Imaging Considerations

• Imaging is not indicated for acute neck pain in the absence of red flags 1

• Red flags that would warrant imaging include:

  • Focal neurological deficits 1
  • Signs of myelopathy 3
  • History of significant trauma 1
  • Suspected infection or malignancy 1, 3

• If imaging becomes necessary later due to persistent symptoms (>6 weeks) or development of neurological symptoms:

  • Plain radiographs have limited value in diagnosing the cause of neck pain 1
  • MRI would be the preferred modality if neurological symptoms develop 1, 3

Work Recommendations

• A short period (3-5 days) of modified duties may be appropriate given the patient's work at Costco food court involves movement and occasional heavy lifting 2
• Advise gradual return to normal activities as symptoms improve 1
• Provide education on proper ergonomics and body mechanics for work activities 2

Important Caveats

• Avoid prolonged immobilization as it can lead to muscle deconditioning and delayed recovery 5
• Exercise therapy has the strongest evidence among complementary treatments for neck pain 2
• Most acute neck pain is mechanical in nature and will improve with time and appropriate conservative management 2, 3
• If symptoms worsen or neurological symptoms develop, prompt reassessment is warranted 3