Douleurs au cou

• Use culturally safe, trauma- and violence-informed care. Explain why questions matter, seek permission before sensitive topics, and adapt communication to the patient’s language, identity, culture, disability and previous health care experiences (Public Health Agency of Canada 2018).
  
• Informations sociodémographiques : age, sex, gender identity, language, occupation, school, caregiving responsibilities, hand dominance when relevant, and the patient’s preferred ways of communicating and participating in decisions.
  
• Primary concerns:
  • Context and onset: spontaneous or gradual onset; recent or remote trauma; collision details when relevant; prior episodes; previous neck, head, shoulder or arm injury; surgery; and whether symptoms are improving, stable, fluctuating or worsening.
  • Location and pattern: duration, course, intensity, irritability and pattern of neck, shoulder or arm symptoms.
  • Aggravating and relieving activities; movement, position, load and time-related behaviour; and previous episodes.
  • Aggravating and relieving activities and postures, including sustained positions and screen or device use.
  • Associated symptoms, including headache, dizziness, visual or speech disturbance, facial or limb sensory change, weakness, gait or balance change, hand clumsiness, bowel or bladder change, fever, systemic illness and effects on sleep, work, school, driving, caregiving and participation.
    
• Revue des systèmes corporels : select relevant cardiovascular, neurological, respiratory, gastrointestinal, genitourinary, rheumatological, infectious and constitutional questions based on the presentation.
  
• Santé, mode de vie et histoire : past health conditions and musculoskeletal concerns; cancer, infection, inflammatory disease, osteoporosis or fracture risk; injuries, hospitalizations and surgeries; migraine or headache history; current medications and supplements, including anticoagulants and corticosteroids when relevant; physical activity, sleep, smoking, alcohol and substance use.
  
• Social determinants of health: work, education, caregiving, income, housing, food security, discrimination, safety, social support and access to appropriate care when relevant to health, access or participation (Public Health Agency of Canada 2026a).
  
• Soins et interventions antérieurs : advice, treatment, investigations or self-management tried; what helped or did not help; adverse effects; and reasons care was difficult to use or continue.
  
• Patient perspective: understanding of the problem, priorities, preferences, cultural context, concerns, expectations, confidence, strengths and previous experiences of care.
  
• Flag review: check Red Flags and use the fixed Orange Flags and Yellow Flags sections when relevant.

​​Outcomes measures: Use a small set of measures that are meaningful to the patient and practical to repeat. Record a baseline and reassess often enough to guide decisions. The following are examples, not an exclusive list.

• Patient-specific functioning: Patient-Specific Functional Scale (PSFS)
• Disability and participation: WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
• Qualité de vie : the patient’s own rating or a validated measure suitable for the setting, such as WHOQOL-BREF.
• Additional measures can include the Neck Disability Index or measures of symptom impact, perceived recovery, sleep, work or school when the result will inform care.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful but is not required.

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

• Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
• Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
• Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

• Suicide or self-harm thoughts: thoughts without immediate danger.
• Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
• Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

• Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
• Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
• Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
• Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

• Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
• Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, draping, pace and support, and confirm ongoing consent, especially before provocative, neurological or hands-on testing.
  
• Condition-specific safety: begin with the history and observations needed to decide whether examination is appropriate. Defer or modify procedures when suspected fracture, instability, acute neurological compromise, vascular pathology, severe irritability or another safety concern makes testing inappropriate.
  
• Observation and relevant vital signs: general appearance, distress, gait, balance, posture, movement behaviour, guarding and use of supports; blood pressure, pulse, temperature or other observations when the presentation indicates.
  
• Movement and range of motion: active cervical, shoulder and arm movement first, with passive or resisted testing only when safe and relevant; note range, quality, symptom response and functional meaning.
  
• Palpation : tenderness, tone, swelling, and temperature changes in the bones, joints, and soft tissues of the cervical spine and shoulder.
  
• Neurological examination when indicated: upper-limb myotomes, sensation and reflexes; upper motor neuron, gait, balance, coordination or cranial nerve screening when the history raises concern; and repeat findings when symptoms change.
  
• Vascular hypothesis: use history-led clinical reasoning and an adapted examination when vascular pathology is a concern. No single positional or pre-manipulative test can exclude vascular pathology; do not provoke symptoms when emergency assessment is indicated (Rushton et al. 2023).
  
• Radicular presentation: use a combination of history, neurological findings and relevant tests rather than relying on one test. Include shoulder, peripheral nerve and other upper-quarter sources in the differential.
  
• Évaluation fonctionnelle : select tasks relevant to the patient’s goals, such as lifting, reaching, desk or device use, driving, work, school, caregiving, recreation and sleep positioning.
  
• Radicular presentation: use a combination of history, neurological findings and relevant tests rather than relying on one test. Include shoulder, peripheral nerve and other regional sources in the differential.
  
• Imaging is not routine for uncomplicated neck pain without red flags. Use imaging when serious pathology is suspected, after relevant trauma using an applicable validated rule, or when the result is likely to change care or referral. The Canadian C-Spine Rule applies to alert, stable adults after blunt head or neck trauma and is not a general rule for non-traumatic neck pain (ACR 2024 Update; Stiell et al. 2001).
  
• Repeat and adapt the examination when needed to review progress, revisit the working clinical presentation or decide whether further assessment or referral is appropriate.

Classification frameworks: After Red Flag screening, select the applicable classification framework. Use the Bone and Joint Decade classification of neck pain and associated disorders (NAD) for neck pain not classified as WAD. Use the Quebec Task Force WAD classification for a presentation following an acceleration-deceleration event consistent with whiplash. Do not routinely assign both grades. If both must be recorded for a specific reporting or governance purpose, write each full label and do not use an unexplained grade number. These classifications support triage and communication; they are not tissue diagnoses or complete clinical presentations (Guzman et al. 2008; Spitzer et al. 1995; Bussières et al. 2016; Côté et al. 2016).

• NAD Grade I: no signs or symptoms suggesting major structural pathology and no or minor interference with activities of daily living.
• NAD Grade II: no signs or symptoms of major structural pathology, but major interference with activities of daily living.
• NAD Grade III: no signs or symptoms of major structural pathology, with neurological signs such as decreased deep tendon reflexes, weakness or sensory deficits. This grade can include a radicular presentation but does not by itself establish a tissue diagnosis.
• NAD Grade IV: signs or symptoms of major structural pathology. This grade follows Red Flags and is not managed as routine musculoskeletal care in this pathway.
• WAD Grades 0-IV: use the Quebec Task Force classification only when the presentation follows an acceleration-deceleration event consistent with whiplash. Grade 0: no neck complaint and no physical signs. Grade I: neck complaint without physical signs. Grade II: neck complaint with musculoskeletal signs. Grade III: neck complaint with neurological signs. Grade IV: neck complaint with fracture or dislocation. WAD Grades I-III are within this pathway after safety screening; Grade 0 does not describe a symptomatic care presentation, and WAD Grade IV and other major injuries follow Red Flags or the appropriate trauma pathway (Spitzer et al. 1995; Bussières et al. 2016).

Working clinical presentations

Add one or more working clinical presentations when they help assessment, communication or care planning. Clinical presentations can overlap or change and do not replace the applicable NAD or WAD classification.

• Non-specific or mechanical presentation: neck-dominant pain or stiffness with movement or loading sensitivity and no evidence of serious pathology or a more specific neurological disorder.
  
• Referred-symptom presentation: neck symptoms accompanied by non-dermatomal shoulder or arm pain without objective nerve-root impairment.
  
• Radicular-pain or radiculopathy presentation: arm symptoms in a nerve-root pattern, with radiculopathy supported by relevant motor, sensory or reflex findings. Severity, progression, functional effect and response guide referral through the applicable jurisdiction or service pathway.
  
• Associated-headache presentation: the neck presentation plausibly contributes and primary headache, neurological, vascular and systemic causes have been assessed. A principal dizziness or vestibular concern follows the separate CCG dizziness pathway or other appropriate medical or vestibular care.
  
• Persistent or recurrent presentation: symptoms or activity limitations continue or recur and are shaped by interacting physical, psychological, social, occupational and environmental factors; this presentation does not imply irreversible damage.
  
• Alternative or overlapping presentation: document the working clinical impression, uncertainty, required safety-netting, and any referral or shared-care plan when the presentation does not fit the descriptions above.

Base care on the presentation, safety, goals, context and response. Use adaptable options rather than a ranked sequence, and repeat meaningful outcomes to guide change.

Education, self-management and participation

• Options include clear, non-alarming explanations; activity, sleep, work and pacing strategies; and gradual resumption of usual activity (Bussières et al. 2016; Côté et al. 2016).

Physical activity and exercise

• Options include individualized cervical, shoulder and arm motor-control, strengthening, endurance, mobility and coordination exercise, and general physical activity. Type, dose and progression reflect capacity and response (Blanpied et al. 2017; Bussières et al. 2016; El-Allawy et al. 2025).

Hands-on care

• Options include manual therapy, mobilization, manipulation vertébrale, soft-tissue care and clinical massage as adjuncts to active care. Apply the IFOMPT framework when vascular pathology is a concern (Blanpied et al. 2017; Bussières et al. 2016; Côté et al. 2016; Rushton et al. 2023).
• Traditional or community-based approaches identified by the patient can form part of care.

Psychological, social and interdisciplinary support

• Options include psychologically informed strategies for fear, distress, sleep and coping, and coordination with relevant clinical, workplace, community, Indigenous or culturally specific supports (Bussières et al. 2016; Côté et al. 2016).

Médicament

• Medication options include short-term NSAIDs when clinically appropriate. Review contraindications, interactions and adverse effects with an authorized prescriber or pharmacist (El-Allawy et al. 2025).

Monitoring and reassessment

• Set a reassessment point based on presentation, safety, goals, care being tried, patient needs and access.
• Repeat the baseline outcome set and review symptoms, relevant neurological findings, functioning, participation, benefits, harms, burden and goals.
• Continue, adapt or stop care according to response; revisit the presentation, differential diagnosis, safety and referral when needed.

• Expected course: prognosis is individual. Neck pain often follows an episodic course with variable recovery between episodes. Early change and response over time are more informative than a fixed timeline (Guzman et al. 2008).
  
• Factors associated with a less favourable course: in non-specific neck pain, higher pain catastrophizing and psychological distress are associated with persistence or recurrence. Evidence for other physical predictors is limited or inconsistent (Yu et al. 2025).
  
• Potential supports for recovery: positive but realistic expectations, self-efficacy, active coping, supportive relationships and workplaces, feasible accommodations, access to care and progress toward meaningful activity may support recovery.
  
• Discussing prognosis: describe uncertainty, ask what the patient wants to know, and use repeated outcomes that matter to the patient and the observed course to adjust the plan rather than treating a prognostic factor or screening score as a fixed prediction. Revisit the working clinical presentation and referral needs when the course differs materially from what was expected.