Management of Left-Sided Neck Pain
For uncomplicated left-sided neck pain without red flags, initiate a multimodal conservative program combining manual therapy (cervical manipulation or mobilization 1-2 times weekly), supervised strengthening exercises targeting cervical and scapulothoracic stabilization (3 times weekly), and NSAIDs for pain control. 1, 2
Initial Assessment: Screen for Red Flags
Before initiating treatment, evaluate for serious pathology requiring urgent imaging or specialist referral 3, 1, 2:
- Progressive neurological deficits (weakness, numbness, or sensory changes) 3, 1
- Myelopathy signs (gait disturbance, bowel/bladder dysfunction, hyperreflexia) 3, 1
- History of malignancy or unexplained weight loss 3, 1
- Fever or suspected infection (particularly with IV drug use history) 3, 1
- Inflammatory conditions (ankylosing spondylitis, rheumatoid arthritis) 3, 2
- Trauma or prior neck surgery 3, 2
- Intractable pain despite appropriate therapy 3, 2
- Vertebral body tenderness on palpation 3, 2
If red flags are absent, imaging is NOT indicated as radiographic findings rarely correlate with symptoms or alter management, and MRI shows high rates of abnormalities in asymptomatic individuals 3, 2, 4.
First-Line Treatment Protocol (4-Week Course)
Manual Therapy
- Cervical manipulation or mobilization performed 1-2 times per week for 4 weeks 1, 2
- Target restricted motion segments, particularly if lateral rotation is limited 1
- Must be combined with exercise and other modalities—manual therapy alone is insufficient 1
Supervised Exercise Program
- Cervical and scapulothoracic stabilization exercises 3 times per week for minimum 4 weeks 1, 2
- Include range-of-motion exercises emphasizing rotation and extension movements 1, 2
- Strengthening exercises targeting cervical musculature and external rotation 1
- Exercise therapy reduces pain and improves function with sustained benefits for 2-6 months 3
Pharmacological Management
- NSAIDs as first-line: Ibuprofen 400-800 mg three to four times daily for pain control 1, 2, 5, 6
- Acetaminophen: 1000 mg every 6 hours (maximum 4g daily) for continuous pain control 1
- Muscle relaxants may be considered for acute neck pain with muscle spasm 4, 5
- Avoid opioids—they provide no additional benefit over NSAIDs and carry significant risks of harm 3, 1, 2
Adjunctive Modalities
- Heat therapy may provide symptomatic relief as part of multimodal care 3, 1
- Soft tissue massage combined with manipulation shows moderate evidence for chronic neck pain 1
- Mind-body practices (yoga, tai chi, acupuncture) can improve neck pain without serious harm 3
Interventions to AVOID
Do NOT perform interventional procedures for mechanical neck pain 1, 2:
Do NOT use cervical traction, TENS, or laser therapy—insufficient evidence supports their efficacy 1, 2
Avoid overhead pulley exercises—they encourage uncontrolled movements and can exacerbate symptoms 1
Treatment Duration and Monitoring
- Reassess at 4 weeks for pain, disability, and range of motion 1, 2
- Most acute neck pain resolves within 6 weeks, though 50% may have residual or recurrent episodes 2, 4, 5
- If symptoms persist beyond 3 months despite appropriate conservative management, consider MRI to evaluate for nerve root compression or structural pathology 1, 2
- Progressive worsening of neurological symptoms warrants urgent reevaluation and imaging 1
Clinical Context and Prognosis
- Approximately 75-90% of patients with cervical radiculopathy achieve symptomatic relief with nonoperative conservative therapy 2
- Nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences beyond the acute episode 4, 5
- Genetics and psychosocial factors are risk factors for symptom persistence 5
- Surgery is more effective than conservative treatment in the short term but not in the long term for most patients with radiculopathy or myelopathy 4, 5