Dr. Hamilton Hall, MD, FRCSC, is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.
Greg McIntosh, MSc, completed his Masters in Epidemiology from the University of Toronto's Faculty of Medicine. He is currently the Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.
Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.
Dr. Pierre Côté, DC, PhD, Canada Research Chair in Disability Prevention and Rehabilitation; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation.

Abstract
Neck pain is common and disabling. Associated with poor posture, sedentary work and stress it is long lasting and recurrent. Most neck pain is mechanical from the structural elements within the cervical spine and can be referred to a number of remote locations. Radicular arm dominant pain is infrequent. Neck pain is diagnosed on history and confirmed with the physical examination. Routine imaging is inappropriate and the Canadian C-spine rules are recommended. Management focuses on education, range of movement exercises with associated postural improvement and strengthening exercises; neck braces should not be used.
Key Words: cervical spine, neck pain, Canadian C-spine rules, range of movement, exercise.

Neck pain is the fourth leading cause of disability worldwide.¹ With a lifetime prevalence of 71%, most adults can expect to experience an attack at some point during their lifetime.^2,3 During any six-month period, 54% of adults suffer from neck pain and 4.6% experience important activity limitations.² The prevalence of neck pain peaks in middle age and it is more common in women.^2,3 Every year, 213 per 1000 persons develop neck pain and 6 per 100,000 will experience a cervical spine disc herniation with radiculopathy.^2,3 The risk factors for neck pain include genetics, poor psychological health and previous musculoskeletal pain.³ Neck pain is also more likely to develop in individuals with high job demands, low social support at work, job insecurity, low physical capacity and sedentary work positions with poor work posture accentuated by poor ergonomic workplace design.⁴ There is no evidence that disc degeneration is a risk factor for neck pain.^3,4

The course of neck pain is marked by periods of remission and exacerbation.^5,6 Contrary to common belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability within the subsequent 12 months. The evidence suggest that if we follow a group of individuals with neck pain for one year, 36.6% will report complete resolution of their pain and disability and 32.7% will report marked improvement.⁵ However, 37.3% will report no change in their symptoms and 9.9% will experience an aggravation. In addition 23% of who completely recover from their pain and disability will experience a recurrence of their symptoms.⁵ A cervical disc herniation with radiculopathy is relatively uncommon and most patients can expect substantial recovery within the first 4 to 6 months post-onset.⁷ Over time symptoms generally resolve completely without surgical intervention. Factors associated with a poor prognosis include older age, passive coping strategies and overall poor psychosocial health.⁶