Neck Pain Tool-kit: Step 2

This page is part of the 'Manual Therapy & Exercise for Neck Pain: Clinical Treatment Tool-kit' resource for clinical decision making, which provides evidence, techniques, and dosages for the use of manual therapy and exercise in the treatment of neck pain. Please see the main project page for further information, or to return to Step 1 to identify your patient. Otherwise, proceed to Step 2 below to determine the evidence.

NeckPainToolkit Step2 Logo.png

  • Once you have found the evidence most applicable to your patient, click on ‘Step 3-inform your technique’ to see the techniques utilized in the positive studies for that patient population

2.1 Neck pain alone (non-specific)

Acute/subacute neck pain

Manual therapy

Author, year of original studies Participant characteristics Intervention Comparison Pain Function/ Disability GPE Patient Satisfaction QoL
Cleland 2005[1] Acute/subacute neck pain Thoracic manipulation + adjunct treatment Thoracic mobilization + adjunct exercise ▲▲ ▲▲ ▲▲
Gonzalez-Iglesias 2009[2]
Acute neck pain Thoracic manipulation + adjunct treatment Adjunct electrothermal therapy ▲, ▲▲ ▲, ▲▲
Eqwu 2008[3] Acute/subacute neck pain Ipsilateral PA or AP mobilization Rotation or transverse mobilization

AP: Anterior-posterior; GPE: Global perceived effect; QoL: Quality of life; PA: Posterior-anterior.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Subacute/chronic neck pain

Manual Therapy and Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Bronfort 2001[4], Hoving 2002[5], Jull 2002[6] Subacute/chronic neck pain with or without CGH Manipulation or mobilization and exercise Primarily exercise alone ♦♦, ◊◊◊◊
◊◊, ◊◊◊◊
◊◊, ◊◊◊◊
◊◊, ◊◊◊◊
Bronfort 2001[4], Skargren 1998[7] Chronic neck pain Manipulation or mobilization and exercise Primarily manipulation or mobilization alone ●●●●

●●●●
Ylinen 2003[8] Chronic neck pain Manipulation, mobilization, and exercise Adjunct advice including general exercise ●●●● ●●●●
Allison 2002[9], Brodin 1985[10], Jull 2002[6], Karlberg 1996[11] Subacute/chronic neck pain with or without CGH or Radiculopathy Manipulation or mobilization and exercise No treatment ▲, ▲▲, ▲▲▲▲
Palmgren 2006[12] Chronic neck pain Manipulation or mobilization and exercise Advice
Hoving 2002[5], Walker 2008[13] Chronic or mixed duration neck pain Manipulation or mobilization and exercise Traditional care ○○○○
Persson 2001[14] Chronic neck pain with radicular symptoms Manipulation or mobilization and exercise Collar therapy or surgery
Vasseljen 1995[15] Chronic neck pain Manipulation or mobilization and exercise Exercise ∆∆∆

AP: Anterior-posterior; CGH: Cervicogenic headache; GPE: Global perceived effect; QoL: Quality of life; PA: Posterior-anterior.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Chiu 2005[16], Evans 2002[17], Franca 2008[18], Martel 2011[19] Chronic neck pain
Combined cervical and scapulothoracic stretching and strengthening + adjunct treatment
Adjunct treatment (varied)
♦, ●●, ♦♦♦, ○○○○
♦, ●●, ♦♦♦, ●●●●
●, ○○, ○○○, ○○○○
●, ●●, ●●●, ●●●●
○, ○○, ○○○, ○○○○
Von Trott 2009[20], Rendent 2011[21] Chronic neck pain Qigong exercises (Dantian Qigong)
Wait list control
●, ●●
●, ●●
○, ○○

●, ●●
Von Trott 2009[20], Rendent 2011[21] Chronic neck pain
Cervical range of motion and strengthening exercise
Wait list control
▲, ▲▲
▲, ▲▲
∆, ∆∆ ∆, ∆∆
Helewa 2007[22] Chronic neck pain Isometric neck exercises + adjunct treatment
Adjunct pillow
▲, ▲▲
▲, ▲▲ ▲, ▲▲
Goldie 1970[23], Helewa 2007[22] Chronic neck pain
Isometric neck exercises
No treatment
∆, ∆∆
∆, ∆∆ ∆, ∆∆
Revel 1994[24] Chronic neck pain
Eye neck coordination exercises + adjunct treatment
Adjunct medication
▲▲
▲▲
Viljanen 2003[25] Chronic neck pain with/without WAD
Upper extremity stretching and endurance training
Normal activities
○, ○○, ○○○○
○, ○○, ○○○○
Kjellman 2002[26] Chronic neck pain
Neck and upper extremity stretch and strengthening program
Sham ultrasound
∆, ∆∆, ∆∆∆, ∆∆∆∆
∆, ∆∆, ∆∆∆, ∆∆∆∆
Kjellman 2002[26] Chronic neck pain
Cervical movement exercises (McKenzie)
Sham ultrasound
∆, ∆∆, ∆∆∆, ∆∆∆∆
∆, ∆∆, ∆∆∆, ∆∆∆∆
Allan 2003[27] Chronic neck pain
Stretching exercises either before or after a manipulation
That same manipulation

Lundblad 1999[28]
Chronic neck pain
Stabilization of the low back and pelvis, posture awareness, ergonomic training, and strength, coordination, endurance, flexibility/smoothness and rhythm exercises
No treatment
∆∆

GPE: Global perceived effect; QoL: Quality of life; WAD: Whiplash-associated disorder.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Manual therapy

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Bitterli 1977[29], Howe 1983[30], Martinez-Segura 2006[31], Sloop 1982[32], Vernon 1990[33] Subacute/chronic neck pain
Cervical manipulation
Various controls
▲, ▲▲




Cleland 2005[1] Chronic neck pain
Thoracic manipulation
Sham manipulation





Kanlayanaphotporn 2010[34] Chronic neck pain
Central PA mobilization
One of three random mobilizations





Hurwitz 2002[35] Subacute to chronic neck pain with or without CGH or radiculopathy
Cervical manipulation
Cervical mobilization
○○○
○○○



Kanlayanaphotporn 2009[36] Chronic neck pain
Ipsilateral PA mobilization
Randomly selected ipsilateral/central/ contralateral PA mobilization





Strunk 2008[37] Subacute or chronic neck pain
Cervical mobilization
Manipulation to various spinal regions


Giles 1999[38], Muller 2005[39] Chronic neck pain
Cervical manipulation
medication


Giles 1999[38], Muller 2005[39] Chronic neck pain
Cervical manipulation
Acupuncture or electroacupuncture


Yurkiw 1996[40], Wood 2001[41] Subacute neck pain
Manual cervical manipulation
Activator instrumental manipulation
∆, ∆∆

David 1998[42] Chronic neck pain with or without WAD
Cervical mobilization
Acupuncture
∆∆∆∆
∆∆∆∆
Bitterli 1977[29] Chronic neck pain with or without CGH Cervical mobilization
Adjunct cervical manipulation

CGH: Cervicogenic headache; GPE: Global perceived effect; QoL: Quality of life; PA: Posterior-anterior; WAD: Whiplash-associated disorder.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Unspecified/mixed duration neck pain

Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Andersen 2008[43]
Neck pain of mixed duration Specific scapulothoracic and upper extremity strengthening
Health counseling
▲, ▲▲




Andersen 2008[43]
Neck pain of mixed duration
General aerobic fitness training
Health counseling
∆, ∆∆




Coppieters 2003[44]
Neck pain of mixed duration
Neurodynamic mobilizations
Pulsed ultrasound





Takala 1994[45]
Neck pain of unspecified duration
Group exercise program combining extensibility exercises, coordination exercises, and cardiovascular training
No treatment





GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Manual therapy

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Cassidy 1992[46] Neck pain of mixed duration
Cervical manipulation
Muscle energy technique





Van Schalkwyk 2000[47]
Neck pain of unspecified duration
Rotary break manipulation
Lateral break manipulation
∆∆




Krauss 2008[48] Neck pain of unspecified duration
Thoracic manipulation
No treatment





Savolainen 2004[49] Neck pain of unspecified duration
Thoracic manipulation
Exercise





Parkin-Smith 1998[50] Neck pain of unspecified duration
Thoracic manipulation + adjunct treatment
Adjunct cervical manipulation





GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


  2.2 Neck pain with cervicogenic headache

 Acute/subacute neck pain with cervicogenic headache

Manual therapy and exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Provinciali 1996[51] Acute, subacute neck pain with CGH
Manipulation or mobilization and exercise
TENS





GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Hall 2007[52] Acute neck pain with CGH
C1/2 self sustained neurophysiological apophyseal glide (SNAG) exercise
Placebo
▲▲, ▲▲▲▲




GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Chronic neck pain with cervicogenic headache

Manual therapy and exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Jull 2002[6] Chronic neck pain with cervicogenic headache (CGH)
Cervical mobilizations, scapulothoracic endurance strengthening and low load cervical endurance exercises with pressure biofeedback
No treatment
●●,●●●●
●●,●●●●
●●●●


GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Jull 2002[6] Chronic neck pain with cervicogenic headache (CGH)
Scapulothoracic endurance strengthening and low load cervical endurance exercises with pressure biofeedback
No treatment
●●,●●●●
●●,●●●●
●●●●

GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Manual therapy

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Haas 2004[53] Chronic neck pain with CGH
9 sessions of manipulation
3 sessions of manipulation
▲,▲▲




Chen 2007[54]
Chronic neck pain with CGH
Cervical manipulation
TENS
▲▲




Nilsson 1997[55] Chronic neck pain with CGH
Cervical manipulation
Soft tissue work




GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


2.3 Whiplash associated disorder

Acute/subacute whiplash associated disorder

Manual therapy and exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Giebel 1997[56], Mealy 1986[57] Acute WAD
Manipulation or mobilization and exercise
Traditional care
●,●●




Bonk 2000[58]
Acute WAD
Manipulation or mobilization and exercise
Collar therapy
▲▲




Krauss 2008[48] Acute WAD
Manipulation or mobilization and exercise
Education or advice
▲▲




GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Manual therapy

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Fernandez-de-las-Penas 2004[59] Acute/subacute WAD 2 or 3
Thoracic manipulation + adjunct treatment
Adjunct physiotherapy care





GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


Chronic whiplash associated disorder

Manual therapy and exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Jull 2007[60] Chronic WAD II
Manipulation or mobilization and exercise
Self management





GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


2.4 Neck pain with radiculopathy

Acute neck pain with radiculopathy

Exercise

Author, year of original studies Participant characteristics Intervention Comparison
Pain Function/ Disability GPE Patient Satisfaction QoL
Kuijper 2009[61] Acute neck pain with radiculopathy
Cervical mobilizing and stabilizing exercise
Wait list control
▲, ∆∆∆
∆, ∆∆∆



GPE: Global perceived effect; QoL: Quality of life.

Legend:

  • Quality of evidence: Low or very low ▲, moderate ●, high ♦
  • Duration of follow-up: immediate = one symbol, short-term = two symbols, intermediate-term = three symbols, long-term = four symbols
  • Evidence of positive benefit = filled symbol, evidence of no difference = open symbol


References

References will automatically be added here, see adding references tutorial.

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