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Acute Neck Pain Natural History

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Written by: Dr Jeremy Steinberg ā€“ created: 26 April 2025; last modified: 26 April 2025

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This article serves as an update to Chapter 4 of "Management of Acute and Chronic Neck Pain: An Evidence-based Approach," by Bogduk and McGuirk published in 2006.[1] Understanding the natural history of neck pain remains fundamentally important for two key reasons.

  • It establishes a baseline against which the effectiveness of any intervention must be judged. If the natural course of the condition is inherently favorable, this improvement over time may account for a substantial portion of the perceived benefit derived from treatment.
  • Knowledge of a typically favorable natural history allows clinicians to provide evidence-based reassurance to patients, which can itself be a powerful therapeutic intervention.

Since the original publication of this chapter in 2006, the evidence base concerning the natural course and prognosis of neck pain has expanded considerably. Neck pain is a globally prevalent condition, affecting roughly one-third of adults annually, with women often reporting it more frequently. It significantly contributes to the global burden of disease and disability.

While acute episodes of neck pain are often self-limiting for many individuals, the perspective presented in 2006 suggesting a generally favorable prognosis requires refinement. More recent epidemiological data indicate that while initial improvement is common, a substantial proportion of individuals experience persistent or recurrent symptoms long after the acute phase.[2]

Surrogate Data

The inherent difficulties in observing the completely untreated course of neck pain mean that researchers often rely on surrogate data, typically from the control groups of clinical trials. However, as noted previously, this approach has significant limitations. Firstly, control groups rarely receive 'no intervention'. They may receive placebo treatments, sham therapies, advice, or simply the attention associated with study participation, all of which can have non-specific effects that may influence outcomes beyond the natural biological healing process. Secondly, participants enrolled in clinical trials may not be representative of the broader population of individuals with neck pain seen in typical clinical practice, potentially introducing selection bias.[1]

Despite a large number of clinical trials investigating treatments for neck pain published since 2006, these fundamental limitations persist. Systematic reviews attempting to synthesize evidence on prognosis or treatment effects frequently grapple with heterogeneity across studies in terms of patient populations (acute, subacute, chronic, WAD, non-specific), the nature of the 'control' or 'usual care' interventions provided, and the outcome measures used. This makes isolating the 'natural' trajectory challenging.

Even studies comparing active treatments against minimal interventions, such as advice or usual general practitioner care, demonstrate improvement in these minimal intervention groups.[3] For instance, a large Norwegian general population cohort study tracked individuals with new episodes of acute neck or low back pain who largely did not seek formal healthcare (only 1 in 5 sought care). This study observed a rapid decline in pain intensity within the first month, with little change thereafter. The magnitude of this 'natural' improvement was comparable to effect sizes reported in some intervention studies.[4]

Observational and Cohort Studies

Percentages of patients stating at successive measurement points to be recovered or much improved[2]

The post-2006 evidence refines the earlier view of a generally favorable prognosis. These studies generally depict a common trajectory for acute non-specific neck pain: an initial period of relatively rapid improvement in pain and associated disability, typically occurring within the first few weeks to three months, followed by a plateau phase where further significant improvement becomes less likely.

Early Improvement, Then Plateau: A consistent finding across cohorts is rapid initial improvement in pain and disability, typically within the first 1 to 3 months. A large Norwegian general population study observed the most significant pain reduction within the first month, with little change thereafter over the following 11 months.[4] This pattern is also seen in Whiplash-Associated Disorders (WAD), where recovery, if it occurs, mostly happens within the first 3 months before plateauing.[5]

Persistence: Despite early gains, complete and sustained recovery is not the norm for many. Studies suggest approximately 50% or more experience persistent or recurrent symptoms 1 to 5 years later. For example, one general practice cohort found that while 76% felt "recovered" or "much improved" at 1 year, 47% still reported ongoing neck pain.[2] Another general population study found 50-75% of those with current neck pain reported it again 1-5 years later.[6] Neck pain often follows an intermittent or recurrent course rather than being continuous. In one general population study tracking new episodes, 43% with neck pain achieved complete pain resolution (NRS 0) at 1 year. [4]

Recurrence: In the Dutch study 5.6% reported a recurrence of neck pain (defined as a new episode after a pain-free period of at least 3 months). They caution that the rate may be underestimated because of this strict definition. They note that neck pain appears to follow a recurrence and intermittent course rather than just continuous symptoms.[2]

WAD Chronicity: Following whiplash injury, the transition to chronic symptoms is particularly common, affecting around 50% of individuals. Within this group, a significant minority (estimated at ~16% of all WAD cases) develop severe, persistent pain-related disability.[5] An Australian study found similar early partial improvement followed by incomplete recovery. Among individuals with compensable Whiplash-Associated Disorders (WAD), 33.6% were classified as recovered at 3 months, 38.9% at 6 months, and 51.7% at 2 years, based on achieving a Functional Rating Index (FRI) score ā‰¤ 25. Despite ongoing symptoms, most participants were able to maintain work and daily activities by two years post-injury

It is important to acknowledge the heterogeneity in reported rates across studies. This variability stems from differences in the populations studied (e.g., general population vs. primary care vs. secondary care), varying definitions of 'acute' pain (e.g., <4 weeks, <6 weeks, <3 months), inconsistent definitions of 'recovery' (e.g., pain score reduction, disability score threshold, global perceived effect, return to work), differing follow-up durations, and the use of diverse outcome measurement tools.[7]

Table 1: Recovery and Persistence Rates in Acute Non-Specific Neck Pain (Selected Post-2006 Cohorts)

Study Population Follow-up Time Outcome Measure(s) Key Finding(s)
Vos et al. 2008 [2] General Practice 1 year Self-rated recovery; Ongoing pain 76% reported "fully recovered" or "much improved"; 47% reported ongoing neck pain.
Carroll et al. 2008[6] General Population 1-5 years Self-reported neck pain Between 50% and 75% with current neck pain reported pain again 1-5 years later.
Vasseljen et al. 2013[4] General Population 1 year Pain NRS (0-1) 43% with initial neck pain had complete resolution
Ritchie et al. 2016[5] WAD 2 years Pain, disability, psychological symptoms 50% fully recover, 50% have ongoing pain and disability. Recovery plateaus after about 3 months.
Rebbeck et al. 2006[8] WAD 2 years Functional Rating Index (FRI) 33.6% recovered at 3 months; 51.7% recovered at 2 years. 84% work participation at 2 years. Mental health scores unchanged.

Note: Definitions of 'acute', 'recovery', and populations vary between studies.

Prognostic Factors

A major development in neck pain research since 2006 has been the intensified focus on identifying prognostic factors ā€“ characteristics present early in the course of the condition that predict future outcomes.2 This research is driven by the recognition that recovery trajectories vary significantly between individuals and the understanding that identifying those at higher risk of poor outcome could allow for better patient education, expectation management, and potentially more targeted or stratified management approaches.[6]

Strong Predictors of Outcome:

  • High Baseline Pain Intensity and Disability: Across numerous systematic reviews and primary studies encompassing both non-specific neck pain and WAD, high levels of self-reported pain intensity and neck-related disability at the initial assessment consistently emerge as the strongest predictors of poor long-term outcome, characterized by persistent pain and disability.[6] This is perhaps the most robust and consistently reported finding in the prognostic literature.

Significant Influence of Psychosocial Factors:

There is compelling evidence that psychological factors significantly influence recovery from acute neck pain:

  • Post-Traumatic Stress Symptoms (PTSS): Particularly relevant in the context of WAD, higher levels of acute PTSS (e.g., intrusive thoughts, avoidance behaviors related to the traumatic event) are strongly associated with poor recovery and the development of chronic pain and disability. There is evidence suggesting PTSS may interact with physiological changes like sensory hypersensitivity.[9]
  • Pain Catastrophizing: Defined as an exaggerated negative mental set brought to bear during actual or anticipated pain experience (including rumination, magnification, and helplessness), pain catastrophizing is consistently linked to worse pain intensity, higher disability levels, and delayed recovery in both WAD and non-specific neck pain populations.[6]
  • Fear-Avoidance Beliefs and Kinesiophobia: Beliefs that activity and movement will cause harm or increase pain, leading to avoidance behavior, are associated with increased disability.[10] While strongly implicated, the evidence might be slightly less consistent across all reviews compared to catastrophizing.
  • Recovery Expectations and Self-Efficacy: Patients' beliefs about their likelihood of recovery and their confidence in their ability to manage their pain and function (self-efficacy) are predictive. Negative expectations and lower self-efficacy are associated with poorer outcomes.[11]
  • Depression, Anxiety, and Stress: Symptoms of depression, anxiety, and perceived stress are frequently associated with the onset, severity, and persistence of neck pain.[10] Pre-existing psychological problems or a high acute psychological response to the injury are considered adverse prognostic factors.[6]

Biological and Clinical Factors:

  • Cold Hyperalgesia: Evidence is accumulating, particularly from WAD research, suggesting that increased sensitivity to cold stimuli (cold hyperalgesia) measured shortly after injury is predictive of poor long-term outcome.[6] This finding points towards the potential involvement of altered central nervous system processing (central sensitization) in the transition to chronicity.
  • WAD Grade: A higher initial WAD classification according to the Quebec Task Force (QTF) system (Grade II - neck complaint plus musculoskeletal signs; or Grade III - neck complaint plus neurological signs) is associated with a poorer prognosis compared to Grade I (neck complaint only).[12]
  • Sensorimotor Deficits: While reduced cervical range of motion (ROM) is a common clinical finding, systematic reviews provide inconsistent evidence regarding its independent prognostic value for long-term outcome.[11] Other sensorimotor disturbances, such as altered movement control (e.g., reduced movement speed or smoothness), dizziness, and balance deficits, are common, particularly in WAD, and associated with a more severe clinical presentation, but their specific predictive capacity requires further investigation.[13]

Factors with Limited, Inconsistent, or No Demonstrated Association:

  • Collision Factors (WAD): Specific details of the motor vehicle collision, such as impact direction (e.g., rear-end), speed, headrest position, or occupant awareness prior to impact, have generally shown poor predictive value for long-term outcome.[7]
  • Imaging Findings: For non-specific neck pain and WAD Grades I-III, findings of degenerative changes (e.g., spondylosis, disc degeneration) or minor disc pathology on routine imaging (X-ray, MRI) are common, particularly in older adults, but are generally not associated with prognosis.2 This does not apply to cases involving fracture or significant instability (WAD Grade IV).
  • Age: Generally predicts poorer outcome in non-specific neck pain, though evidence is mixed, and less consistent for WAD. One review noted middle age might carry the poorest prognosis.[7][11]
  • Gender: Although neck pain is more prevalent in females, systematic reviews suggest that female gender is not consistently or strongly associated with a poorer prognosis, particularly following WAD.[7]
  • Compensation and Legal Factors: The role of compensation status or litigation remains controversial. Some meta-reviews find an association between seeking compensation or legal involvement and poorer outcomes.[12] However, other high-quality systematic reviews conclude there is inconsistent, weak, or no clear evidence for compensation status itself being an independent adverse prognostic factor, particularly when initial injury severity and psychological factors are considered.[7] While claim closure is associated with reporting recovery [8], the direction of causality is unclear. The relationship is complex and likely confounded by factors such as injury severity (more severe injuries leading to both claims and poorer outcomes), psychological distress, and potential negative effects of adversarial legal or insurance system processes. Attributing poor outcomes solely to the pursuit of compensation appears to be an oversimplification.
  • General Exercise Levels: Baseline general physical activity levels (distinct from specific therapeutic exercise) were found to be unassociated with outcome in one large general population study.[2]

Whiplash (Updated Perspective on WAD)

Whiplash is defined not as a diagnosis itself, but as the mechanism of injury involving sudden acceleration-deceleration energy transfer to the neck, typically resulting from motor vehicle accidents but also other mishaps.[14] The resulting clinical manifestations are termed Whiplash-Associated Disorders (WAD), commonly classified using the QTF system from Grade 0 (no symptoms) to Grade IV (neck complaint with fracture/dislocation).[14] WAD remains a significant public health problem, imposing substantial socioeconomic costs related to healthcare utilization, work disability, and reduced quality of life.[10]

The perspective on the natural history of WAD presented in 2006, which suggested a generally favorable course with high recovery rates (e.g., ~80% recovery within a year based on specific cohorts, or even higher based on insurance claim closures,[1] requires significant revision based on post-2006 evidence. Systematic reviews and large prospective cohort studies consistently indicate that the transition from acute to chronic WAD is common, affecting approximately 50% of those injured.[7] Some reviews cite rates of chronic symptoms (persisting beyond 3-6 months) between 40-60%[15], with one noting up to 40% still reporting symptoms 15 years post-injury.[16]

Recovery trajectories are typically non-linear. The most substantial improvements in pain and disability, if they are to occur, tend to happen within the first 3 months following the injury. Beyond this period, recovery often plateaus, with minimal further gains observed for many individuals.[5] For instance, a large Australian cohort study using the Functional Rating Index (FRI ā‰¤ 25 defining recovery) found that only 33.6% were recovered at 3 months, rising slightly to 38.9% at 6 months, and reaching 51.7% at 2 years.[8] This contrasts sharply with earlier, more optimistic estimates. Furthermore, a significant minority of those who develop chronic WAD, estimated at around 16% of the total injured population, experience severe and persistent pain-related disability.[9]

As detailed in the previous section, the most consistent predictors of poor outcome following WAD are high initial levels of neck pain and disability, coupled with significant psychological distress, particularly PTSS and pain catastrophizing. The presence of early sensory hypersensitivity (e.g., cold hyperalgesia) is also an important adverse prognostic indicator. Conversely, factors related to the collision mechanics, occupant demographics like age and gender, and non-specific degenerative findings on imaging have limited prognostic utility.[7]

Comparing WAD with non-specific neck pain reveals important distinctions and overlaps. Studies comparing patients presenting to secondary care settings have found that those with WAD typically report higher baseline pain intensity, greater disability, and a higher prevalence of associated symptoms such as dizziness and memory difficulties compared to patients with persistent non-specific neck pain. Correspondingly, the WAD group tends to experience worse outcomes over a 12-month follow-up period.[11]

However, despite these differences in average severity and outcome, there is considerable overlap in the factors that predict poor prognosis. High initial pain and disability, along with psychological factors like catastrophizing and negative recovery expectations, are predictive in both groups.[11] This suggests that while the whiplash mechanism may result in a more severe initial injury or a more pronounced systemic response in many individuals, leading to worse average outcomes, the pathways driving persistence likely share commonalities with severe non-specific neck pain. The traumatic nature of the whiplash event itself may be particularly potent in triggering adverse psychological responses (like PTSS) and associated neurophysiological changes (like central sensitization) that significantly contribute to the poorer prognosis often seen in WAD, distinguishing it from insidious-onset neck pain even when initial tissue disruption levels might appear similar.[7] The pathophysiology of WAD is recognized as complex, involving potential contributions from musculoskeletal tissues, neurological pathways (including sensory hypersensitivity and sensorimotor control disturbances), inflammatory processes, and psychological factors, often interacting within a specific social context.[13]

Implications

Nuanced Reassurance: Reassurance remains vital, supported by evidence of significant early improvement for many. However, given high persistence rates (~50%), clinicians should foster realistic expectations, avoiding guarantees of complete recovery.[4] Clinical guidelines continue to recommend reassuring patients that recovery is generally expected within the first 2 to 3 months[17]

Prognostic Stratification: Identifying high-risk individuals (high pain/disability, adverse psychological factors) early allows for tailored education and potentially stratified care models, directing those at risk towards more targeted interventions sooner. Clinical guidelines are evolving to incorporate classifications based on factors linked to prognosis. Clinical practice guidelines are beginning to incorporate classification systems based on clinical presentations, including factors associated with prognosis (e.g., classifying neck pain based on mobility deficits, movement coordination impairments including WAD, associated headaches, or radiating pain).[18]

Biopsychosocial Assessment: Clinicians need a broad perspective, assessing pain, function, relevant psychosocial factors, and potential sensitization indicators (like cold hyperalgesia) from the outset.

Beyond "Wait and See": While minimal intervention may suffice for low-risk individuals, a purely passive approach is likely insufficient for those with poor prognostic indicators. Active prognostication can inform shared decision-making and proactive, evidence-informed care planning[2]

Further high-quality research is needed to refine prognostic models, validate clinical prediction rules, investigate the predictive ability of specific physical factors like sensorimotor control measures[19], and to determine the effectiveness of early interventions specifically targeted at modifiable risk factors (such as PTSS, catastrophizing, or fear-avoidance) in preventing the transition to chronic neck pain.[9]

Resources

Neck and back pain prognosis - vasseljen 2013.pdf
Neck pain prognosis - vos 2008.pdf
Neck pain prognosis - carroll 2008.pdf
whiplash prognosis - ritchie 2016.pdf
whiplash prognosis - rebbeck 2006.pdf

Summary

Current evidence provides a more nuanced picture of the natural history of acute neck pain than was available previously:[5][20][21][7]

  • Prognosis is Variable: While many individuals with acute neck pain experience significant improvement, particularly within the first 1 to 3 months, the prognosis is not universally favorable. A substantial proportion, potentially 50% or more, report persistent or recurrent symptoms 1 to 5 years later. This suggests a lower rate of complete, sustained recovery than previously estimated (e.g., ~40% full recovery in older studies).
  • Early Improvement Followed by Plateau: The most substantial recovery typically occurs within the first 3 months after onset. After this period, improvement often slows or plateaus, particularly for Whiplash-Associated Disorders (WAD).
  • Whiplash-Associated Disorders (WAD) Chronicity: Following whiplash injury, the transition to chronic symptoms is common, affecting approximately 50% of individuals. Within this group, a notable subgroup (around 16%) experiences severe, ongoing pain-related disability. Recovery trajectories for WAD are often non-linear, with the majority of improvement, if it occurs, happening within the first 3 months post-injury.
  • Strong Prognostic Indicators: High initial pain intensity and high levels of neck-related disability at baseline are consistently identified as strong predictors of poor long-term outcome (persistent pain and disability) for both non-specific neck pain and WAD.
  • Significant Psychosocial Influence: Psychological factors play a crucial role in recovery trajectories. Factors strongly associated with delayed recovery or the development of chronic neck pain include post-traumatic stress symptoms (particularly prominent in WAD), pain catastrophizing, negative recovery expectations, and low self-efficacy. Fear-avoidance beliefs, depression, and anxiety are also frequently implicated.
  • Limited Predictive Value of Collision/Imaging Factors: For WAD, specific characteristics of the collision (e.g., impact direction) and findings on routine structural imaging (in the absence of fracture or instability) generally demonstrate little association with long-term prognosis.

References

  1. ā†‘ 1.0 1.1 1.2 Bogduk and McGuirk. Management of Acute and Chronic Neck Pain. 2006
  2. ā†‘ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Vos, Cees J.; Verhagen, Arianne P.; Passchier, Jan; Koes, Bart W. (2008-07). "Clinical Course and Prognostic Factors in Acute Neck Pain: An Inception Cohort Study in General Practice". Pain Medicine. 9 (5): 572ā€“580. doi:10.1111/j.1526-4637.2008.00456.x. ISSN 1526-2375. Check date values in: |date= (help)
  3. ā†‘ Sterling, Michele (2014-03). "Physiotherapy management of whiplash-associated disorders (WAD)". Journal of Physiotherapy. 60 (1): 5ā€“12. doi:10.1016/j.jphys.2013.12.004. ISSN 1836-9553. Check date values in: |date= (help)
  4. ā†‘ 4.0 4.1 4.2 4.3 4.4 Maher, Christopher G. (2013-08). "Natural course of acute neck and low back pain in the general population: the HUNT Study". Pain. 154 (8): 1480ā€“1481. doi:10.1016/j.pain.2013.04.031. ISSN 0304-3959. Check date values in: |date= (help)
  5. ā†‘ 5.0 5.1 5.2 5.3 5.4 Ritchie, Carrie; Sterling, Michele (2016-10). "Recovery Pathways and Prognosis After Whiplash Injury". Journal of Orthopaedic & Sports Physical Therapy (in English). 46 (10): 851ā€“861. doi:10.2519/jospt.2016.6918. ISSN 0190-6011. Check date values in: |date= (help)
  6. ā†‘ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Carroll, Linda J.; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Haldeman, Scott; Holm, Lena W.; Carragee, Eugene J.; Hurwitz, Eric L.; CĆ“tĆ©, Pierre; Nordin, Margareta; Peloso, Paul M.; Guzman, Jaime (2008-02). "Course and Prognostic Factors for Neck Pain in the General Population: Results of the Bone and Joint Decade 2000ā€“2010 Task Force on Neck Pain and Its Associated Disorders". Spine (in English). 33 (Supplement): S75ā€“S82. doi:10.1097/BRS.0b013e31816445be. ISSN 0362-2436. Check date values in: |date= (help)
  7. ā†‘ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 Walton, David M. (2013-09-20). "An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project". The Open Orthopaedics Journal (in English). 7 (1): 494ā€“505. doi:10.2174/1874325001307010494. PMC 3793581. PMID 24115971.CS1 maint: PMC format (link)
  8. ā†‘ 8.0 8.1 8.2 Rebbeck, T.; Sindhusake, D.; Cameron, I. D.; Rubin, G.; Feyer, A.-M.; Walsh, J.; Gold, M.; Schofield, W. N. (2006 Apr). "A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population". Injury Prevention (in English). 12 (2): 93. doi:10.1136/ip.2005.010421. PMID 16595423. Check date values in: |date= (help)
  9. ā†‘ 9.0 9.1 9.2 de Zoete, Rutger M. J.; Coppieters, Iris; Farrell, Scott F. (2022-11-10). "Editorial: Whiplash-associated disorderā€”advances in pathophysiology, patient assessment and clinical management". Frontiers in Pain Research. 3: 1071810. doi:10.3389/fpain.2022.1071810. ISSN 2673-561X. PMC 9686416. PMID 36438446.CS1 maint: PMC format (link)
  10. ā†‘ 10.0 10.1 10.2 Kazeminasab, Somaye; Nejadghaderi, Seyed Aria; Amiri, Parastoo; Pourfathi, Hojjat; Araj-Khodaei, Mostafa; Sullman, Mark J. M.; Kolahi, Ali-Asghar; Safiri, Saeid (2022 Jan 3). "Neck pain: global epidemiology, trends and risk factors". BMC Musculoskeletal Disorders (in English). 23: 26. doi:10.1186/s12891-021-04957-4. PMID 34980079. Check date values in: |date= (help)
  11. ā†‘ 11.0 11.1 11.2 11.3 11.4 Anstey, Ricci; Kongsted, Alice; Kamper, Steven; Hancock, Mark J. (2016-10). "Are People With Whiplash-Associated Neck Pain Different From People With Nonspecific Neck Pain?". Journal of Orthopaedic & Sports Physical Therapy (in English). 46 (10): 894ā€“901. doi:10.2519/jospt.2016.6588. ISSN 0190-6011. Check date values in: |date= (help)
  12. ā†‘ 12.0 12.1 Sarrami, Pooria; Armstrong, Elizabeth; Naylor, Justine M.; Harris, Ian A. (2016 Oct 13). "Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors". Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology (in English). 18 (1): 9. doi:10.1007/s10195-016-0431-x. PMID 27738773. Check date values in: |date= (help)
  13. ā†‘ 13.0 13.1 Sterling, Michele (2009-05). "Neck Pain: Much More Than a Psychosocial Condition". Journal of Orthopaedic & Sports Physical Therapy (in English). 39 (5): 309ā€“311. doi:10.2519/jospt.2009.0113. ISSN 0190-6011. Check date values in: |date= (help)
  14. ā†‘ 14.0 14.1 Yadla, Sanjay; Ratliff, John K.; Harrop, James S. (2007 Nov 6). "Whiplash: diagnosis, treatment, and associated injuries". Current Reviews in Musculoskeletal Medicine (in English). 1 (1): 65. doi:10.1007/s12178-007-9008-x. PMID 19468901. Check date values in: |date= (help)
  15. ā†‘ Gabriela Macias, Erika; Georgopoulos, Vasileios; Taylor, Alan (2018-05-17). "Do maladaptive beliefs delay whiplash associated disorders (WAD): A systematic review". Edorium Journal of Disability and Rehabilitation. 4 (1): 1ā€“14. doi:10.5348/100040d05em2018ra. ISSN 2456-8392.
  16. ā†‘ Binder, Allan I. (2008 Aug 4). "Neck pain". BMJ Clinical Evidence (in English). 2008: 1103. PMID 19445809. Check date values in: |date= (help)
  17. ā†‘ Pastakia; Kumar, Saravana (2011-04). "Acute whiplash associated disorders (WAD)". Open Access Emergency Medicine (in English): 29. doi:10.2147/OAEM.S17853. ISSN 1179-1500. PMC 4753964. PMID 27147849. Check date values in: |date= (help)CS1 maint: PMC format (link)
  18. ā†‘ Blanpied, Peter R.; Gross, Anita R.; Elliott, James M.; Devaney, Laurie Lee; Clewley, Derek; Walton, David M.; Sparks, Cheryl; Robertson, Eric K. (2017-07). "Neck Pain: Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association". Journal of Orthopaedic & Sports Physical Therapy (in English). 47 (7): A1ā€“A83. doi:10.2519/jospt.2017.0302. ISSN 0190-6011. Check date values in: |date= (help)
  19. ā†‘ Alalawi, Ahmed; Gallina, Alessio; Sterling, Michele; Falla, Deborah (2019-11). "Are physical factors associated with poor prognosis following a whiplash trauma?: a protocol for a systematic review and data synthesis". BMJ Open (in English). 9 (11): e033298. doi:10.1136/bmjopen-2019-033298. ISSN 2044-6055. PMC 6887082. PMID 31748312. Check date values in: |date= (help)CS1 maint: PMC format (link)
  20. ā†‘ Carroll, Linda J.; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Haldeman, Scott; Holm, Lena W.; Carragee, Eugene J.; Hurwitz, Eric L.; CĆ“tĆ©, Pierre; Nordin, Margareta; Peloso, Paul M.; Guzman, Jaime (2008-02). "Course and Prognostic Factors for Neck Pain in the General Population". Spine. 33 (Supplement): S75ā€“S82. doi:10.1097/brs.0b013e31816445be. ISSN 0362-2436. Check date values in: |date= (help)
  21. ā†‘ Sterling, Michele; Hendrikz, Joan; Kenardy, Justin (2010-07). "Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study". Pain. 150 (1): 22ā€“28. doi:10.1016/j.pain.2010.02.013. ISSN 0304-3959. Check date values in: |date= (help)

Literature Review

Literature Review

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