• Pierre Côté, Jessica J Wong, Deborah Sutton, Heather M Shearer, Silvano Mior, Kristi Randhawa, Arthur Ameis, Linda J Carroll, Margareta Nordin, Hainan Yu, Gail M Lindsay, Danielle Southerst, Sharanya Varatharajan, Craig Jacobs, Maja Stupar, Anne Taylor-Vaisey, Gabrielle van der Velde, Douglas P Gross, Robert J Brison, Mike Paulden, Carlo Ammendolia, David CassidyJJUniversity of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada., Patrick Loisel, Shawn Marshall, Richard N Bohay, John Stapleton, Michel Lacerte, Murray Krahn, and Roger Salhany.
• Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada. pierre.cote@uoit.ca.
• Eur Spine J. 2016 Jul 1; 25 (7): 2000-22.

PurposeTo develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).MethodsThis guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration.Recommendation 1Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.Recommendation 2Clinicians should assess prognostic factors for delayed recovery from NAD.Recommendation 3Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.Recommendation 4For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.Recommendation 5For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.Recommendation 6For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

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