Development of a Clinical Prediction Rulefor Neck Manipulation

Development of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Cervical Spine Manipulation and Exercise

Cervical spine manipulation has been shown to be helpful for some patients with neck pain. This study sought to determine factors which were predictive of which patients with neck pain would benefit from manipulation.

Inclusion Criteria:

• age 18 to 60 years
• primary report of neck pain with or without unilateral upper extremity symptoms
• baseline neck disability index score of 10 points (out of 50) or greater

Exclusion Criteria:

• any medical red flags suggesting that the etiology of symptoms might be nonmusculoskeletal
• diagnosis of cervical spinal stenosis (as identified in the patients' medical intake form)
• bilateral upper extremity symptoms
• evidence of central nervous system involvement
• history of whiplash injury within 6 weeks of the examination
• pending legal action regarding their neck pain
• 2 or more positive neurologic signs consistent with nerve root compression (changes in sensation, myotomal weakness, or decreased deep tendon reflexes)
• any history of cervical spine surgery, rheumatoid arthritis, osteoporosis, osteopenia, or ankylosing spondylitis.