How Chiropractors Diagnose Neck Pain: A Step‑by‑Step Guide to Identifying Common Cervical Conditions

Introduction

Neck pain affects as many as two-thirds of all adults annually, both here, in Anchorage, Alaska and around the globe. It is also a leading cause of disability and can really throw a damper on one’s lifestyle. Chiropractors are often the first line of defense for treatment of spine-related conditions like neck pain. Trained in all parts of the musculoskeletal system, chiropractors use a systematic approach to identify the root cause of neck pain and, often, a step-by-step means of treating it. 

This blog post outlines how chiropractors diagnose the different types of neck pain. It also discusses some of the more common types of cervical spinal conditions and how they can be effectively treated according to current clinical research.

I. The Chiropractic Diagnostic Workflow

1. Comprehensive Patient History & Red-Flag Screening

Typically, on a patient’s first visit, chiropractors will begin with a face-to-face evaluation of the patient to get a handle on their pain: where it’s located, how it onset, and how long it has been occurring. From there, the chiropractor will inquire about the history of any trauma that may be responsible, and he/she will look for and examine any neurological symptoms.

Throughout the whole diagnostic process, the chiropractor will be on the lookout for certain red flags. Red flag screening can help rule out serious pathologies like fractures, cancer, or infections.

One tool chiropractors can use to help in their assessment are decision guides. The BMC developed and published in 2011, a Diagnosis Based Clinical Decision Guide for patients with neck pain.. It is a manual designed to help private offices systematically deal with neck pain cases.¹

2. Physical Examination

The next step in the diagnosis would entail a complete physical examination. This typically involves a great deal of observation combined with an assessment of the patient’s posture. The chiropractor will also perform a number of range of motion (ROM) tests. This will be followed by neurological screening that tests reflexes as well as dermatomes(nerves ending at the skin) and myotomes (nerves ending in muscles). 

In many situations, a chiropractor may perform certain physical tests. One such option is known as Spurling’s Test – where the patient bends their neck to the side of the body where pain, numbness, or weakness is being experienced. Then, the chiropractor applies a limited amount of pressure on the patient’s neck. If pain radiates down the arm, that is regarded as a positive test, and suggests the presence of a compressed nerve in the neck.

Another test available, is the Shoulder Abduction Relief Test, where a patient lifts her arm and places her hand on top of her head. If her arm pain recedes, it is considered a positive test that is indicative of a compressed nerve in her neck.

3. Imaging & Electrodiagnostics

Imaging and electrodiagnostics are used to get a better look at the problem area. They are typically only used after neurologic symptoms have persisted for more than 6 weeks or if there are any red flags that might suggest their use.

MRI’s and EMG’s, for example, can confirm conditions like cervical disc herniation or myelopathy. 

II. Diagnosing Common Cervical Conditions

1. Mechanical Neck Pain / Cervical Strain

When it comes to neck pain there are a number of common cervical conditions that chiropractors look out for. Two significant ones are mechanical neck pain and cervical strain. These are closely related issues: the first refers to pain arising from a problem with various cervical structures. The latter specifically deals with an injury to the muscles and tendons of the neck.

Signs for either condition include: local pain, muscle tightness, and decreased ROM. Common treatments for such are spinal manipulation and mobilization – two techniques common to chiropractic care.

2. Cervical Radiculopathy

Another common problem related to neck pain is cervical radiculopathy. This refers to pain, tingling, or numbness that radiates to a location distant from the actual injury. In the case of cervical radiculopathy, this usually means the pain or other symptoms are felt in the arm as opposed to the neck.

Two effective chiropractic tools here are Spurling’s test (discussed above) and neurologic screening. Neurologic screening entails a number of different tests that the chiropractor uses to determine the health of the nervous system (brain, spinal cord, etc…). These tests run the gamut from evaluating motor function, coordination, sensory function, and more.

Should cervical radiculopathy be confirmed, the chiropractor can treat the condition with flexion-distraction and spinal mobilization.

Although there has been controversy over chiropractic care in the past, this study on PubMed concludes that “existing literature does provide support for the cautious application of HVLA procedures in cases of confirmed or suspected CR.”² 

3. Cervical Spondylosis & Degenerative Stenosis

Two more conditions chiropractors look for are cervical spondylosis and degenerative stenosis. Cervical spondylosis is a common condition that develops as the patient ages. The disks dehydrate, and bony projections in the spine may appear. Degenerative stenosis is another age-related condition. Here, it involves a narrowing of the spine that can compress the spinal cord.

Signs of these conditions include a stiff neck, mild neurological deficits, and age-related degeneration. They are typically diagnosed with a clinical exam combined with the use of an MRI to determine if there is disc space narrowing or signs of osteophytes.

A case study on Science Direct detailed the successful treatment of cervical spinal stenosis through chiropractic means.³ 

4. Cervical Myelopathy

Another condition of concern  for chiropractors is cervical myelopathy. This refers to a situation where the spinal cord is compressed and that compression has led to dysfunction. Signs of the condition include difficulty walking, a general clumsiness, bowel/bladder dysfunction, and hyperreflexia (a condition where reflexes over-react).

In situations like these, the chiropractor will often screen the patient and then refer them for a surgical consultation as needed. A study on Cureus highlights a case where a chiropractor referred a 62-year-old woman with degenerative cervical myelopathy to a surgeon.⁴ 

5. Headache-Related Neck Pain (Cervicogenic or Tension-Type)

Another issue commonly diagnosed by chiropractors is headache-related neck pain. That is, pain in the neck that originates from a headache – either a cervicogenic headache (secondary) or a tension-type headache (primary)).

This type of neck pain is indicated by a worsening of the headache with neck movement and muscular tightness. Treatment is usually through spinal manipulation, soft-tissue work, and posture correction. 

III. Clinical Tools & Guidelines

• Chiropractors use evidence-based protocols like Clinical Practice Guidelines (CPGs) and decision aids.

At the heart of chiropractic care is a reliance on science and the scientific method. Chiropractors, like Dr. Brent Wells of Better Health Alaska in Anchorage, use evidence-based protocols as well as Clinical Practice Guidelines (CPGs)⁵  and other decision aids, to provide conservative, non-invasive healthcare. The care provided is reliable, systematic, and effective.

More and more evidence continues to bear out the effectiveness of chiropractic care and support its safety. One study on Nature.com, for example, that looked into chiropractic safety found that “severe SMT-related AEs(Adverse Events) were reassuringly very rare.”⁶  

IV. Where to Go for Chiropractic Neck Pain Diagnosis

Conclusion

Chiropractors are well-equipped to diagnose and manage most neck pain conditions. They typically use a combination of detailed assessment and evidence-based practice. Their skills are usually sufficient for many common conditions like mechanical pain, radiculopathy, and cervicogenic headache – all of which can be treated conservatively. Of course, when red-flags are noted, chiropractors can and do refer patients to other healthcare specialists as needed.

Here, at Better Health Alaska in Anchorage, AK, our team, headed by Dr. Brent Wells, includes a team of highly trained chiropractors, physical therapists, and more. We have well over 20 years experience dealing with neck pain cases, and we can help you with yours. Contact us today, and we’ll get you in and seen as soon as we can.

1. Murphy, D. R., Hurwitz, L. E., “Application of a diagnosis-based clinical decision guide in patients with neck pain,” BMC (Part of Springer Nature), Chiropractic & Manual Therapies, 19, 19 (2011),
   https://chiromt.biomedcentral.com/articles/10.1186/2045-709X-19-19. 
2. Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. J Can Chiropr Assoc. 2012 Mar;56(1):18-28. PMID: 22457538; PMCID: PMC3280115.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC3280115/
3. Kukurin, G. W. DC, “The Amelioration of Symptoms in Cervical Spinal Stenosis with Spinal Cord Deformation Through Specific Chiropractic Manipulation: A Case Report with Long-Term Follow-Up,” Science Direct: Journal of Manipulative and Physiological Therapeutics, Vol. 27, Iss. 5, June 2004, Page 366
   https://www.sciencedirect.com/science/article/abs/pii/S0161475404000521 
4. Trajer, R.J., et al, “Identification of Degenerative Cervical Myelopathy in the Chiropractic Office: Case Report and a Review of the Literature,” Cureus, 2022 
   https://assets.cureus.com/uploads/case_report/pdf/119688/20221119-9191-1pevf1g.pdf
5. Practice Management and Research Clinical Guidelines, North American Spine Society, 2025,
   https://www.spine.org/Research/Clinical-Guidelines 
6. Chu, E.CP., Trager, R.J., Lee, L.YK. et al. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep13, 1254 (2023).
   https://www.nature.com/articles/s41598-023-28520-4