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Neck pain assessment template

Uses the Canadian C-spine rule after trauma, screens for serious causes and records function with the Neck Disability Index.

What it is built on

  • Imaging decision after trauma. Canadian C-spine rule (Stiell et al., JAMA 2001)
  • Function. Neck Disability Index (Vernon and Mior, 1991)

How to use it: Free Evidence-Based Physiotherapy Note Templates

Subjective

  1. History of the presenting problem Written answer Onset, mechanism, duration, behaviour over 24 hours, aggravating and easing factors.
  2. Pain now (0–10) Scale 0 to 10
  3. Pain at worst in the last week (0–10) Scale 0 to 10
  4. What it stops them doing Written answer Work, sleep, sport, daily tasks.
  5. Patient's goals Written answer In their words.

After trauma: Canadian C-spine rule

  1. Recent trauma (for example a car accident or fall) Tick box
  2. High-risk factor: age 65 or over, dangerous mechanism, or pins and needles in the arms or legs Tick box Any high-risk factor: medical assessment and imaging before movement testing.
  3. A low-risk factor allows safe testing of movement Tick box Simple rear-end collision, sitting up, walking since, delayed onset of neck pain, or no midline tenderness.
  4. Can actively rotate 45° to the left and right Tick box

Serious causes screened

  1. Signs of cord compression: clumsy hands, unsteady walking, change in bladder or bowel Tick box
  2. Dizziness, double vision, difficulty speaking or swallowing, drop attacks, facial numbness Tick box Possible vascular cause. Stop and refer.
  3. Fever, unexplained weight loss, history of cancer, or severe night pain Tick box
  4. None of the above Tick box

Objective

  1. Body chart Body chart, drawn on
  2. Posture and range of movement Written answer
  3. Neurological screen of the upper limbs Written answer
  4. Neck Disability Index score (%) Number

Assessment and plan

  1. Clinical impression Written answer
  2. What was explained to the patient Written answer
  3. Treatment today Written answer
  4. Home program given Written answer
  5. Plan and expected number of visits Written answer
  6. Referral or imaging needed? Choose one: No · Yes — to GP · Yes — imaging · Yes — specialist · Yes — urgent / emergency

A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.