The following points should be considered during the history taking process:
- Age: spondylosis occurs more often with increasing age.
- Severity of symptoms: (clinimetrics: severity scales).
- Mechanism of injury: trauma, stretching or overuse; such as sustained posture.
- Patient’s usual activity: activities, movements, positions or postures that bother the patient. What kind of work and hobbies does the patient do?
- Blow to the head or loss of consciousness during trauma.
- Onset and duration of symptoms: sudden pain onset or slow progression of symptoms.
- Sites and boundaries of pain: location, unilateral or bilateral, involvement of dermatomes and myotomes.
- Radiation of pain: dermatomes and sensory peripheral nerve involvement.
- Laughing, coughing, sneezing, straining affect pain behavior (increase in intra thoracic or abdominal pressure).
- Headaches: occurrence, frequency, location and intensity.
- Positions that change the pain or headache: alleviation or aggrevation of symptoms.
- Presence of paresthesia “pins and needles”: might indicate increased pressure on nerve root.
- Experience of tingling sensation in extremities.
- Symptoms in lower limbs.
- Difficulties with walking or balance: might indicate cervical myelopathy.
- Experience of dizziness, fatigue, seizures.
- Presence of sympathetic symptoms: sympathetic hypertonia, tinnitus, dizziness, blurred vision, photophobia, rhinorrhea, sweating, lacrimation, loss of strength.
- Progression of symptoms: improving, worsening, staying the same.
- Activities that aggravate and ease the problem: certain head or neck positions.
- Restriction of movements.
- Breathing technique: mouth breathing encourages forward head posture.
- Difficulties with swallowing or voice changes: might indicate neurological problems, mechanical pressure or muscle incoordination.
- Patients sleeping position: type of pillow and mattress.
- Cognitive dysfunctions.
Always be aware of red and yellow flags!