How Chiropractors Diagnose Neck Pain: Patient History

by: Arn Strasser, D.C.


History taking is the first step in diagnosing the cervical spine. Because chiropractors so often treat conditions that are "functional" in nature -- that is conditions in which there are not a frank medical disease, and in which signs and symptoms are often important clues to diagnosis -- chiropractors emphasize in-depth history taking.

Initially the chiropractor will want to know if there has been an accident or injury. A patient who has sustained a neck fracture will present with an abnormally stiff and painful neck. The chiropractor will want to know if there has been trauma to the neck from a fall or other traumatic incident. If there is suspicion of a neck fracture from such an incident, or secondary to an organic disease, the chiropractor will call for a spinal x-ray or imaging study prior to any further examination of the neck.

Chiropractic patient history taking is the same as in a typical medical office with some important differences. The "what, when, and how" of an injury, and the location and nature of the neck pain is supplemented with information on possible episodes of middle and lower back pain, as well as muscle and extremity joint pain. Even when neck pain is the primary presenting complaint, chiropractic always considers the whole spine, of which the neck is one part of an integrated biomechanical system.

Chiropractic views mechanical problems, such as neck pain or extremity injuries to the knee or the shoulder, in the context of the whole body, and the "whole person". All presenting complaints are seen in the context of the totality of work, family, habits, diet, exercise, and most importantly -- the life stresses that may be impacting the patient.

In diagnosing neck pain, the chiropractor will want to know if there has been shoulder or arm pain accompanying the neck symptoms and whether there has been numbness or loss of strength in the arms. Whether headaches accompany the neck pain or there has been a sudden onset of a severe headache, are important issues discussed during the chiropractic interview.