• Initial assessment should include a thorough patient history, physical examination, and patient self-assessment questionnaire to rule out serious underlying pathology (red flags) ^[2].
• The number and severity of symptoms at onset, self reported disability at onset, and a past history of headache or head injury are risk factors for the development of chronicity. The former risks should be assessed by using the Neck Disability Index and Visual Analogue Scale during the initial consultation ^[2].
• Diagnostic tests such as X-rays, CT or MRI scans are only required in a minority of cases. Routine imaging will not increase understanding of causation. The Canadian C-spine rule should be used to determine whether X-ray of the neck is required to diagnose fracture/dislocation ^[2].
• Psychosocial and occupational risk factors (yellow flags) are associated with progression from acute to chronic pain and are potentially modifiable with early intervention ^[1]. These issues should be considered from day one. Explicit screening for psychosocial risk factors should be undertaken where no improvement has occurred four to six weeks following the injury, or where recurrent episodes occur ^[2].

• Provision of accurate and positively expressed information and education about neck pain or whiplash, including advice to act as usual, is an important intervention ^[2].
• The most important intervention in neck pain and whiplash is advice to 'act as usual' ^[2]. Advise the injured worker to remain active, and that voluntary restriction of activity may delay recovery. Encouraging resumption of normal activities, including work and movement of the neck is recommended ^[2].
• Gentle neck exercises commenced early post-injury are more effective compared to rest and analgesia ^[1].
• Collars should not be prescribed for acute neck pain attributed to a whiplash associated disorder. If prescribed, a collar should not be used for greater than 48 hours ^[2].
• Multimodal (combined) treatments including passive mobilisation/manipulation in combination with specific, gentle, neck exercises may be of benefit where symptoms have not settled in the first few days ^[2].
• Short periods of passive care (ie, mobilisation/manipulation performed by a recognised health professional) may be helpful: lengthy treatment is not associated with greater improvements.
• An outcome measure or screening tool (eg the Neck Disability Index) should be used to evaluate treatment effectiveness and justify ongoing treatment ^[2].

1. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain. Bowen Hills: Australian Academic Press; 2003.
2. TRACsa Trauma Injury and Recovery. Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. Adelaide: TRACsa; November 2008

Where an individual has not recovered within the expected recovery timeframe, the diagnosis and management plan should be reconsidered. Reassess for serious underlying pathology (red flags), undertake screening for psychosocial risk factors (yellow flags), and reconsider treatment type and intensity.

Expected recovery timeframes for neck pain can be found below.

Sprain/strain including whiplash
Expected healing time: 40% have recovered by 4 weeks, 60% have recovered by 6 weeks, 85% are recovered by 3 months
Notes: In some cases symptoms are recurrent. The chance of recovery is maximised by undertaking as much activity as can be tolerated and by not keeping the neck in a flexed position for periods of more than 10-20 minutes.

Cervical nerve root lesions – treated conservatively
Expected healing time: 6 weeks-2 years
Notes: Generally these lesions spontaneously improve with most recovery occurring in the first 12 months.

Cervical nerve – treated surgically
Expected healing time: 6 weeks-6 months
Notes: If cervical fusion has also occurred, then heavy physical activity will need to be avoided until the fusion is solidly healed.

The provision of accurate, positively expressed information and education about neck pain is an important intervention, which can promote effective self management of symptoms. A number of fact sheets are available to provide to injured workers. Examples include:

TRACsa: trauma and injury recovery A simple guide to whiplash for consumers

National Health and Medical Research Council Acute Neck Pain Information sheet

TRACsa: trauma and injury recovery

Clinical guidelines for best practice management of acute and chronic whiplash associated disorders

National Health and Medical Research Council

Evidence-based management of musculoskeletal pain
Evidence-based management of musculoskeletal pain – A guide for clinicians