Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Neck pain - non-specific - Management
How do I assess someone with neck pain?

  • Exclude non-musculoskeletal causes, such as cardiovascular, respiratory, and oesophageal diseases, and acute upper respiratory tract infection and sore throat.
  • Look for 'red flags' (that suggest a serious spinal abnormality). If present, refer urgently for investigations and further assessment.
  • If the neck pain and other symptoms follow recent sudden or excessive hyperextension, flexion, or rotation of the neck, see the CKS topic on Neck pain - whiplash injury.
  • If the neck pain is due to acute spasm with no obvious underlying cause, see the CKS topic on Neck pain - acute torticollis.
  • If the neck pain varies with different physical activities and with time, or is related to an awkward movement, poor posture, or overuse, suspect non-specific neck pain.
  • If there is unilateral neck, shoulder, or arm pain that approximates to a dermatome, suspect cervical radiculopathy, see the CKS topic on Neck pain - cervical radiculopathy. There may be altered sensation or numbness, or weakness in related muscles. However, the presence of pain or paraesthesia radiating into the arm is not specific for nerve root pain and may be present in people with non-specific neck pain.
  • Identify risk factors for developing neck pain:
    • Workplace associated risks: awkward neck postures, neck flexion, arm force, arm posture, duration of sitting, twisting or bending of the trunk, hand-arm vibration, and some workplace designs.
    • Excessive use of pillows.
  • Identify psychosocial factors that may indicate increased risk for chronicity and disability. Identify any excessive concerns about the neck pain, unrealistic expectations of treatment, disabling sickness behaviour, and problems with compensation, work, family, mood, and emotions.
  • Cervical X-rays, and other imaging studies and investigations are not routinely required to diagnose or assess neck pain with radiculopathy and non-specific neck pain.

© NHS Institute for Innovation and Improvement