In most patients with neck pain there is some improvement within 6 weeks of symptom onset. Failure to improve or a worsening of symptoms after 6 weeks may be referred to as a deviant recovery. The causes of a deviant course are reported by the KNGF (Joninklijk Nederlands Genootschap voor Fysiotherapie or Royal Dutch Society for Physical Therapy).
Worsening of neck pain or failure to improve raises the possibility of serious structural pathology (fracture, vertebral dislocation, infection, neoplasm, inflammatory arthropathy, etc).
Causes of a deviant recovery in a patient without a serious structural problem include:
(1) advanced age
(2) psychosocial stress
(3) anxiety or depression
(4) history of other musculoskeletal disorders
(5) catastrophic thinking
(6) hyperalgesia or hypersensitivity to cold
(7) post-traumatic stress symptoms at onset
(8) passive coping style
(9) previous episodes of neck pain
(10) work or activities related neck trauma
