The Canadian C-Spine Rule Project


To optimize care of acute traumatic neck pain patients by BC physiotherapists, specifically with respect to appropriate referral for medical imaging.

Phase 1: An online survey to determine current awareness, knowledge, and use of the Canadian Cervical Spine Rule (C-Spine Rule) by BC physical therapists was undertaken January 28-May 15 2013.

Phase 2: The results of the survey informed the need for and subsequent design of learning resources and tools to increase awareness and use of the C-Spine Rule in clinical practice.

Phase 3: The resources to support knowledge and use of the C-Spine Rule will be disseminated to BC PTs .


Each year in BC, there are more than 60,000 motor vehicle accident related whiplash injures of the neck and an unknown number of sport, fall and other traumatic neck injuries. Given that physiotherapists are primary care practitioners, it is important that they are able to identify neck pain patients with potentially serious injuries, such as traumatic fractures, dislocations and significant ligamentous injuries in order to refer them to a physician for imaging and appropriate medical management.

Appropriate referrals for xray prevent unnecessary radiation, patient inconvenience and unnecessary burden on health care resources, as well as preventing complications associated with missed fractures and other serious neck injuries. The C-Spine Rule is a reliable and sensitive tool designed to determine the need for medical imaging in acute traumatic neck pain patients. It has been validated with emergency physicians, emergency room nurses, and paramedics but there is no research regarding its use by physical therapists.

C-Spine Rule Advisory Group (CRAG):

Marj Belot (Chair), Carol Kennedy, Guido Wisotzki, Bill Lyons, John Howick, Antonio Zenone, Melina Kurtakis, Peter Francis, Sarah Hrabi, Hisae Nakamura, Dr. Linda Li, Alison Hoens

Current Status (January 2014):

The survey has been completed and analyzed. A manuscript is currently being prepared for submission for publication. A number of resources and supporting materials have been developed by the members of CRAG to enhance adoption of the C Spine Rule. A PABC webinar on this topic was presented March 11 2014.


A video on how to use the C Spine Rule is available at:

C spine rule & FAQs

C spine rule

C-Spine FAQ’s

C-Spine Rule Physician Follow-up Letter Template

C-Spine Rule Physician LetterTemplate

How to use the C-Spine Rule Physician’s Letter Templates


*This project has been informed through participation in the CIHR /VCHRI sponsored Foundations of Knowledge Translation Course