Not All Neck Pain Is the Same: Machine Learning Finds Distinct Subtypes in a 2026 Study

By Dr. Jason Forward, DC. Practicing chiropractor in Tulsa, Oklahoma. Posted April 17, 2026.

Why This Matters for Anyone With Neck Pain

If you have chronic neck pain that has not improved despite treatment, this study might explain why.

Most treatment protocols for neck pain are generic. Stretch this. Strengthen that. Take this medication. Apply heat. The assumption is that all neck pain has the same underlying mechanism. This study shows that assumption is wrong.

Consider two patients who both report "my neck hurts":

• Patient A: Has reduced cervical range of motion. Cannot turn their head past 45 degrees. The joints are restricted, the muscles are tight, and the primary problem is mobility. This patient needs joint mobilization and manual treatment to restore range of motion.
• Patient B: Has full cervical range of motion. Can turn their head 80 degrees in each direction. But their head wobbles. Their movements are jerky and imprecise. The primary problem is not range. It is control. This patient needs motor control retraining, deep neck flexor exercises, and proprioceptive training.

Treating Patient A with motor control exercises wastes time because the range is not there to control yet. Treating Patient B with aggressive joint mobilization wastes time because the range is already there. The problem is that they cannot control what they have.

The machine learning algorithm in this study sorted patients into these kinds of distinct groups automatically, using objective movement data rather than subjective pain reports. That is the value of this research.

Two people can both have "neck pain" and have completely different problems. If the treatment does not match the subtype, the treatment fails. Not because it was wrong, but because it was wrong for that patient.

What the Subtypes Look Like in My Practice

I have not run machine learning algorithms on my patients. But I do a thorough movement assessment on every neck pain case at Vanguard Chiropractic, and the patterns this study describes are the same patterns I see daily.

The Stiff Neck

This patient has lost range of motion. They cannot turn their head far enough to check a blind spot while driving. Looking up is painful. Cervical extension is the most restricted direction. The facet joints are restricted, the paraspinal muscles are guarding, and the deep stabilizers have shortened to match the reduced range. This is the classic pattern I see in desk workers and patients with desk-related neck pain.

Treatment: cervical and upper thoracic adjustment to restore segmental motion, soft tissue work on the suboccipital and upper trapezius muscles, and home range of motion exercises. This responds well to chiropractic care, usually within three to six visits.

The Unstable Neck

This patient has full range of motion but poor control. They can move through a large range, but the movement is not smooth. There may be clicking, catching, or a feeling that the head is "too heavy." The deep neck flexors (longus colli, longus capitis) are weak or inhibited, and the superficial muscles (SCM, upper traps) are doing the stabilizing work they are not designed for.

Treatment: gentle adjustment to address any specific segmental restrictions, but the primary focus is motor control. Deep neck flexor activation drills, craniocervical flexion training, and proprioceptive exercises. This takes longer to resolve because it requires neuromuscular retraining, not just joint motion restoration.

The Sensitized Neck

This patient may have near-normal range and decent control, but everything hurts. Light touch on the neck is painful. Pressure that would be normal on any other patient produces a pain response. This is central sensitization. The nervous system has turned up the volume on pain signals from the cervical spine. The mechanical problem may be minor, but the pain experience is major.

Treatment: very gentle, graded mobilization. No high-velocity adjusting initially. The goal is to give the nervous system positive movement input without triggering the sensitized pain response. This patient also benefits from education about pain science, stress management, and often from concurrent care with a mental health professional or pain specialist.

Why Generic Neck Pain Treatment Fails

Here is the clinical reality that this study supports with data.

If you go to a provider who treats every neck pain patient the same way, whether that is always doing the same adjustment, always prescribing the same exercises, or always giving the same medication, you have a roughly one-in-three chance that their approach matches your subtype. For the other two-thirds, the treatment is mismatched, and the result is partial improvement or no improvement.

This is why neck pain keeps coming back for so many people. It is not that treatment does not work. It is that the wrong treatment was applied to the wrong subtype. The patient concludes "nothing helps my neck pain" when the reality is "the specific thing I needed was never identified."

The exam matters more than the treatment. If the assessment correctly identifies which subtype of neck pain you have, the treatment becomes obvious. The challenge is doing the assessment carefully enough to make that distinction.

How I Assess Neck Pain at Vanguard Chiropractic

When you walk into Vanguard Chiropractic with neck pain, I do not just check where it hurts and start adjusting. Here is the assessment process:

1. Active range of motion: I watch you move your head in all six directions. I am looking at how much you move, but also how smoothly you move. Jerky, hesitant, or inconsistent motion patterns tell me as much as the range itself.
2. Segmental motion testing: I palpate each cervical segment individually to find which specific joints are restricted. Not all neck pain comes from the same level. C1-C2 restriction produces a different pattern than C5-C6 restriction.
3. Muscle function: I test the deep neck flexors and the superficial muscles separately. If the deep stabilizers are not firing, it changes the treatment plan.
4. Neurological screen: Checking reflexes, sensation, and strength in the arms to rule out nerve root compression. If a pinched nerve is involved, the approach is different.
5. Provocation testing: Spurling's test for radiculopathy, vertebral artery screening if cervical rotation or extension is planned, and upper limb tension testing if arm symptoms are present.
6. Functional assessment: Can you check a blind spot? Can you look up at a shelf? Can you hold your head still while your eyes track a moving target? These functional tests tell me whether the problem is range, control, or both.

The assessment takes a few minutes more than a generic "where does it hurt?" approach. But it identifies the subtype, and that drives a treatment plan that actually matches your problem.

The Future of Neck Pain Treatment

Studies like this one are pointing toward a future where neck pain treatment is subtyped from the first visit. Instead of a generic diagnosis of "cervicalgia" or "neck strain," patients would be classified into specific mechanical subtypes, and treatment would be matched accordingly.

We are not there yet in a formal clinical algorithm. But good clinicians have been doing this informally for years. The machine learning study simply validates the clinical observation that neck pain is not one thing, and confirms that movement-based classification outperforms pain-based classification for predicting treatment needs.

For Tulsa patients dealing with chronic neck pain that has not responded to previous treatment, the takeaway is this: find a provider who assesses how you move, not just where you hurt. The movement tells the story the pain cannot.

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