I understand that very typical activities, so typical that people might not even think about them, such as:

  • Walking primarily or only with shoes instead "flipflops" and alike
  • Using proper shoe inserts with shoes
  • Wearing what I can name "orthopedic sock devices" instead regular socks (I don't know the professional term)
  • Working half day or one day with a standing stance and another half day or one day in sitting (or in other, better intervals)
  • Changing a chair to one whom gives better support
  • Having a 90 minutes massage in an authorized massage entity with skilled, moral/ethical workers
  • Changing rest/sleep pillows, maybe per ergonomics expert (objective) advice
  • Sleep hygiene changes (permitting longer sleep and/or preventing nightmares in case of nightmare disorder)
  • Dietary changes

Could save many orthopedic and radiologic tests, rare(?) cases of misdiagnosis and pharmaceutical intervention as well as surgery.

I never came across an orthopedic system with the above or similar guidelines.

Are there standardized first line treatments in neck and/or shoulder and/or back pain for an otherwise healthy person? (someone that actually has no condition or disease at the time of pain)
There is no understanding-problem to solve here; I don't ask this about a personal medical condition but just of curiosity to expand general knowledge about different guidelines in different systems.

  • Hi ! Sorry for being inaccurate ! I mean someone who is actually totally healthy otherwise; any check such as an X-ray or MRI, correctly interpreted, won't show any damage.
    – user8225
    Commented Feb 4, 2020 at 12:25
  • Question edited to clarify for future readers if comments get deleted.
    – user8225
    Commented Feb 4, 2020 at 12:26
  • A human or animal without any condition limiting function (in general) or disease or carrying any violent bacteria/fungi/protist/virus/viroid/any-other-molecular-mechanism that can make damage is and that has no significant disability to function, I guess is a nice definition. I personally believe that if there are so many definitions for what is a human or animal (or plant) with a condition or disease, there should be a definition for healthy, probably doing with homeostasis as well.
    – user8225
    Commented Feb 4, 2020 at 12:35
  • Your usage of "otherwise healthy person" is actually quite official and you used it just fine. I was checking if this healthy person would be still considered healthy after investigations. You said yes, so it's all clear to me now.
    – Jan
    Commented Feb 4, 2020 at 12:41
  • 1/2 I suffered from that for several years, did 2 RMI, I saw several physios, which made it even worst. I tried every stretch possible. I finally discover that physiotherapy isn't currently a scientific field (evidence-based), but much like psychanalysis. There is currently a huge paradigm shift in physiotherapy, but few physios know it. To make it short painful muscle must not be stretched but strengthened (stretching is a waste of time). They feel tight but they aren't. They don't need to be relaxed, on the opposite:
    – JinSnow
    Commented Dec 1, 2021 at 9:05

1 Answer 1


Pain without a known organic cause can be called "non-specific" or "functional" or "stress-related" or "idiopathic" and can result from:

  • Mechanical stress by improper posture at desk or during sleeping or walking or by forced repeated moves at physical work or exercise, carrying a heavy backpack or bag and such
  • Psychological stress associated with increased tension in the muscles, which becomes a mechanical problem (a psychosomatic condition)

Neck Pain (BMJ Clinical Evidence, 2008):

Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people.

"Standarized first line treatments" are usually recommended for actual organic diseases, so there may be no such standards for "otherwise healthy people with neck pain" and it all depends on the case.

A reasonable initial approach is to identify the cause/trigger of pain and make appropriate changes (it may take several days to observe the improvement). It's on the "patient" to identify the cause and remove it - this part may not need any doctor's intervention and may include any change mentioned in the question and more.

The systematic review about Neck Pain linked above mentions that stretching and strengthening exercises may also help. Anyway, if the cause is identified and removed, such exercises may not be needed. They also say:

Analgesics, NSAIDs, antidepressants, and muscle relaxants are widely used to treat chronic neck pain, but we don't know whether they are effective.

We don't know whether traction, PEMF treatment, TENS, heat or cold, biofeedback, spray and stretch, multimodal treatment, patient education, soft collars, or special pillows are better or worse than other treatments at reducing chronic neck pain.

Anyway, without removing the cause, the mentioned active treatments may just mask the original problem.

If the cause is psychological (anxiety, anger, frustration, lack of goal...), an appropriate approach is to discuss the problems with an experienced person one can trust.

  • Thanks, regarding the last paragraph --- I would add checking pillow hygiene, sleep hygiene and footwear hygiene (including utilizing proper shoe inserts); from my last experience people neglecting these and these can very often be a root cause of "common" neck and back pain, possibly effecting shoulder. Of course, unfit chairs can have a similar effect.
    – user8225
    Commented Feb 5, 2020 at 1:30

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