Managing Claims Involving Neck Pain

Neck claims can be a pain in the neck. They are the third most costly lost-time workers’ compensation claims, when ranking the cost of claims by body part. The most expensive ones involve the head or central nervous system, and the second most costly claims involve multiple body parts, according to National Safety Council’s Injury Fact sheet, which compiled these statistics using the National Council on Compensation Insurance (NCCI) Workers Compensation Statistical Plan database.

Also known as the cervical spine, the neck is composed of seven vertebrae that are stacked on top of each other and separated by discs providing cushion and shock absorption. The muscles, tendons and ligament of the neck help support the head and allow for safe bending and twisting of the head.

Trauma, such as a sprain, whiplash, or fracture, is the most common cause of neck pain. However, less obvious damage comes from slumping over smartphones (text neck), using ergonomically incorrect workstations, persistently grinding teeth, and back and shoulder injuries.

A physical exam is used to assess neck issues. The provider will have the patient move their head forward, backward, and side-to-side and probe for symptoms of tenderness, numbness, and muscle weakness. In some cases, imaging tests such as CT scans, x-rays or MRIs may be ordered to determine the root cause of the pain.  

After diagnosing the case, the provider will often refer the patient to a physical therapist, and studies have found that this type of conservative therapy reduces the chance of opioid prescriptions. Early on, patients may receive heat, ice, and electrical stimulation to relieve pain and inflammation and possibly traction to stretch the neck and address nerve root irritation. Then physical therapists help injured workers regain neck function by normalizing alignment and teaching them exercises to correct muscle flexibility and strengthen deficits. Therapists also educate patients on proper posture, self-care, and self-management.

Many injured workers benefit from a pre-treatment consultation with a physical therapist, who discusses the injury, treatment, and concerns.  Therapists also identify psychosocial factors and note these for adjusters to consider.  Patients need to feel heard and realize their concerns will be taken into consideration in the treatment plan.

The fear of pain and reinjury is common. When the patient understands that the exercises are safe and connects the biomechanical reason for why stretching their neck a certain way will increase mobility or holding the phone differently will reduce pain, they are more motivated to do them. 

The rise of telerehabilitation during the pandemic promoted patient education and self-management strategies among injured workers. While in-clinic therapy is frequently necessary and often preferred, delivering therapy virtually emboldened patients to help themselves.  A physical therapist could demonstrate an exercise, watch the patient perform it, correct posture, if necessary, but the patient had to do it by themselves without hands-on assistance.

Patient education is part of self-management, but self-management is much more than providing information and exercises.  It means helping patients express their own recovery goals, identify their own barriers to achieving those goals, problem-solve ways to find time for home exercises, and pinpoint which stretches reduce their pain.

Another phase of patient empowerment is working, preferably in their pre-injury position.  Many people don’t understand the therapeutic value of remaining at work when possible and returning to work as soon as possible. Engaging with colleagues and customers, moving around safely, and concentrating on projects can take a person’s mind off their injury, reduce pain, and facilitate healing. 

It’s important to talk to injured workers and their employers about returning to work right from the beginning and to tailor rehabilitation around the job’s physical demands.  A worker might feel some pain when returning to the workplace and should be prepared with stretches, exercises, and ergonomic solutions to manage it.  

Naturally, the likelihood of an employee developing chronic neck pain depends on the nature of the injury, but expectations play a role. Conservative care and patient self-management along with return-to-work mindset are important components to recovery.   

By Brian Peers

Brian Peers is a licensed physical therapist serving as MedRisk’s Vice President of Clinical Services and Provider Management.  He is responsible for overseeing and ensuring the quality of MedRisk’s centralized telerehabilitation services, as well as MedRisk’s platinum grade clinical review and peer-to peer provider coaching program. He is board certified as an orthopedic clinical specialist and is recognized as an expert in rehabilitation of the injured worker.  Prior to joining MedRisk, Dr. Peers was the owner and operator of an interdisciplinary rehab practice and has held faculty appointments at multiple physical therapy education programs.  He has also served as an injury prevention consultant for multiple large corporations and the United States Department of Defense.  He holds Bachelor of Science and Master of Physical Therapy degrees from St. Francis University in Loretto, Pennsylvania, an MBA from Louisiana State University in Baton Rouge, Louisiana, and a Doctorate in Physical Therapy from the University of St. Augustine, in St. Augustine, Florida.

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