Neck Pain Tool-kit: Step 4

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 4 below to consider dosage.


NeckPainToolkit Step4 Logo.png

  • The dosage corresponding to the techniques selected in step 3 is presented below, organized by patient characteristics

4.1 Neck pain alone
4.2 Neck pain with cervicogenic headache
4.3 Whiplash associated disorder
4.4 Neck pain with radiculopathy

  • Once you have found the evidence most applicable to your patient, click on ‘Step 5- Individualize your treatment’ for other considerations in applying the evidence to your patient

Contents

4.1 Neck pain alone (non-specific)

Acute/subacute neck pain

Thoracic manipulation

Cleland 2005[1]

Disorder Type Acute/subacute neck pain

Treatment (T)

Comparison (C)

T: Thoracic distraction manipulation + adjunct exercise

C: Prone thoracic mobilization + adjunct exercise

Frequency 1 session
Dose 1-2 manipulations
Duration 1 session
Follow-up 0

Gonzalez-Iglesias 2009[2]

Disorder Type Acute neck pain

Treatment (T)

Comparison (C)

T: Seated thoracic distraction manipulation + adjunct treatment

C: Adjunct treatment - ETT (infrared therapy + TENS)

Frequency

1 session/week of manipulation

5 sessions over 3 weeks of ETT

Dose 1-2 manipulations
Duration 3 weeks,
5 sessions
Follow-up 4 weeks

ETT: Electrothermal therapy; TENS: Transelectrical nerve stimulation.

Subacute/chronic neck pain

Manual therapy and exercise

Bronfort 2001[3]

Disorder Type Chronic neck pain
Treatment (T) / Comparison (C) T: Spinal manipulation and massage to the cervical and thoracic spine and exercise therapy
C:
  • (a) Exercise therapy using MedX equipment
  • (b) Spinal manipulation and massage + detuned microcurrent
Frequency 20 sessions over 11 weeks
Dose 15 minutes of manipulation and massage
45 minutes of exercise therapy
Dumbbell shoulder exercises: 2 x 15-30 repetitions with 2-10lbs
Pulley exercises: 1.25-10 lbs resistance
Duration 11 weeks,
20 sessions
Follow-up 52 and 104 weeks

Hoving 2002[4]

Disorder Type Neck pain of mixed duration with or without cervicogenic headache or radiculopathy
Treatment (T) / Comparison (C) T: Muscular and articular mobilization techniques to the cervical spine, coordination and stabilization techniques
C:
  • (a) Active exercise therapies: strengthening, stretching (ROM), postural/ relaxation/ functional exercise; optional modalities: manual traction, massage, interferential current, heat
  • (b) Continued care by a general practitioner including advice on prognosis, psychosocial issues, self-care, ergonomics and awaiting further recovery; an educational booklet on ergonomics and exercise; medication including paracetamol or nonsteroidal anti-inflammatory if necessary
Frequency 1 session/week
Dose 45 minute treatment sessions, exercise and manual therapy dosage not reported
Duration Max. 6 weeks,
3-6 session
Follow-up 52 weeks

Jull 2002[5]

Disorder Type Chronic neck pain with cervicogenic headache
Treatment (T) / Comparison (C) T: Manipulation or mobilization and low load endurance exercise for cervicoscapular region
C:
  • (a) Exercise alone
  • (b) Manual therapy alone
  • (c) No treatment
Frequency 1-2 sessions/week
Dose Treatment sessions: up to 30 minutes long
Deep neck flexor exercises: twice/day
Postural correction exercises: regularly throughout the day
Duration 6 weeks,
8-12 sessions
Follow-up 52 weeks

Skargren 1998[6]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: PT: technique: 1% manipulation, 25% mobilization, 15% traction, 25% soft tissue treatment, 33% McKenzie treatment, 21% individual training, 15% transcutaneous electrical nerve stimulation/ ultrasound/ cold, 15% individual program, 6% relaxation training, 4% acupuncture, 1% instruction on individual training

C: Chiro technique: 97% manipulation, 11% mobilization, 2% traction, 2% soft tissue treatment, 1% individual training, frequency: mean 5.6 sessions over mean 4.9 weeks; dose: NR; route: cervical spine

Frequency Mean 7.5 sessions over 6.4 weeks
Dose Not reported
Duration 5-6 weeks,
6-8 sessions
Follow-up 52 weeks

Chiro: Chiropractic; PT: Physiotherapy.

Ylinen 2003[7]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T:

  • (a) Endurance training group: neck flexion by lifting head up from supine; upper extremity exercises using dumbbells; lower extremity exercises using body weight; aerobic exercise 3 times/week; multimodal rehabilitation program including: relaxation, aerobic training, behavioural support, ergonomics, 4 sessions of physiotherapy including mobilization and massage
  • (b) Strength training group: using elastic resistance to flexion and oblique flexion/side flexion; upper extremity exercises using dumbbells; lower extremity exercises using body weight; aerobic exercise 3 times/week; multimodal rehabilitation program including: relaxation, aerobic training, behavioural support, ergonomics, 4 sessions of physiotherapy including mobilization and massage

C: Control (aerobics and stretching)

Frequency
  • Exercises:
    • 5 sessions/week for 2 weeks;
    • 3 times/week for 1 year at home
  • Physical therapy:
    • 4 sessions over 2 weeks
Dose 45 minute exercise sessions
  • (a) Endurance training group: 3 sets of 20 repetitions; using 2kg dumbbells for upper extremity exercises
  • (b) Strength training group: 1 set of 15 repetitions; using 80% maximum isometric strength for band exercises; using individualized resistance for dumbbell exercises using the highest load possible for 15 repetitions
Duration 2 weeks,
10 sessions
Follow-up 12 months

Allison 2002[8]

Disorder Type Neck pain with mechanically sensitive neural tissue

Treatment (T)

Comparison (C)

T:
  • (a) Neural treatment including cervical lateral glide, shoulder girdle oscillation, contract/relax techniques, and active movements at home
  • (b) Articular treatment including glenohumeral mobilization, thoracic mobilization, home exercises

C: Wait-list control

Frequency Not reported
Dose Active movements at home performed 10 repetitions, 1-3 times/day
Duration 8 weeks
Follow-up 0

Brodin 1984[9]

Disorder Type Chronic neck pain with or without radicular findings

Treatment (T)

Comparison (C)

T: Passive mobilizations, massage, manual traction, heat, analgesics, education

C:

  • (a) Mock therapy including massage, manual traction, electrical stimulation, analgesics, education
  • (b) Analgesics
Frequency 3 sessions/week
Dose Not reported
Duration 9 sessions,
3 weeks
Follow-up 1 week

Karlberg 1996[10]

Disorder Type Subacute neck pain with dizziness

Treatment (T)

Comparison (C)

T: Cervical mobilization, soft tissue treatment, stabilization exercise, relaxation techniques, non-steroidal anti-inflammatory, education

C: Delayed Treatment Group

Frequency Median 13 sessions over median 13 weeks
Dose Not reported
Duration 5-23 sessions, 5-20 weeks
Follow-up 0

Palmgren 2006[11]

Disorder Type Chronic neck pain

Treatment (T) 

Comparison (C)

T: Education, cervical manipulation, myofascial technique, exercise (spine stabilizing for cervical region and cervicothoracic junction)

C: Advice on simple regular exercise, done at own volition over 5 weeks

Frequency 3-5 sessions over 5 weeks
Dose Not reported
Duration 3-5 sessions,
5 weeks
Follow-up 0

Strengthening exercise

Chiu 2005[12]

Disorder Type Subacute neck pain

Treatment (T)

Comparison (C)

T: DNF with pressure sensor, C spine MRU at 30% max isometric strength, increased by 5% when able to do 12 reps, and infrared radiation and advice on neck care

C:

  • (a) Infrared radiation and advice on neck care
  • (b) TENS and infrared radiation and advice on neck care


Frequency 2 sessions/week
Dose Warm-up : one set (10 minutes) of deep neck flexor activation and one set of 15 repetitions at 20% on
Deep neck flexor activation: 10s hold, 15 s rest for 10 min
MRU: 3 sets of 8 to 12 reps of flexion and extension progressive starting at 30% isometric maximum
Each session lasted 35 minutes
Duration 6 weeks,
12 sessions
Follow-up 6 months

MRU: Multicervical rehab unit; TENS: Transelectrical nerve stimulation

Bronfort 2001[3]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: Exercise therapy using MedX equipment

C:

  • (a) Spinal manipulation and massage to the cervical and thoracic spine and exercise therapy
  • (b) Spinal manipulation and massage + detuned microcurrent


Frequency 20 sessions over 11 weeks
Dose Warm-up: aerobic exercise for 15-20 minutes, stretching and upper body strengthening
Progressive exercises: performed on the MedX equipment to volitional fatigue up to 20 repetitions
Duration 11 weeks,
20 sessions  
Follow-up 52 and 104 weeks

Franca 2008[13]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: Physiotherapy protocol consisting of muscle stretching of neck and upper limbs regions, recruitment exercise of the deep neck flexors and strengthening exercise of deep neck flexors

C: Acupuncture based on Traditional Chinese Medicine theory of biao-li (symptom/root) treatment

Frequency 1-2 sessions/week
Dose 20 minute treatment sessions
Duration 10 weeks,
20 sessions
Follow-up 6 months

Martel 2011[14]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: Cervical/upper thoracic manipulation and exercise

C:

  • (a) Cervical/upper thoracic manipulation alone
  • (b) Attention control


Frequency 1 session/month
Dose 10-15 minute treatment. Maximum 4 manipulations. Advised to perform a home exercise program 3 times/week. 3 series of each exercises with a 30-60 second rest between series were performed during each training session. A training session lasted 20-30 minutes. All participants were instructed in the same routine, exerise volume was tailored to each participant's strength, flexibility and ability to complete the routine with minimal neck pain. Each patient received a written copy of the program. Exercise checked every 2 months by a kinesiologist.
Duration 10 months, 10 sessions 
Follow-up 0

Qigong exercises

Rendant 2011[15]

Treatment (T)

Comparison (C)

T: Qigong exercises

C: No treatment control

Frequency 18 sessions over 6 months
Dose 90 minute sessions
Duration 6 months,
18 sessions
 
Follow-up 0

von Trott 2009[16]

Treatment (T)

Comparison (C)

T: Qigong lessons

C: Wait-list control

Frequency 2 sessions/week
Dose 45 minute sessions
  • 10 minsutes of typical qigong ‘opening’ exercises
  • 25 minutes to perform up to 4 Dantian qigong exercises
  • 10 minutes of typical qigong ‘closing’ exercises
Duration 3 months,
24 sessions
Follow-up 0

Cervical range of motion and strengthening exercise

Rendant 2011[15]

Treatment (T)

Comparison (C)

T: Exercise
C: No treatment control
Frequency 18 sessions over 6 months
Dose 90 minute sessions
Duration 6 months,
18 sessions
Follow-up 0

von Trott 2009[16]

Treatment (T)

Comparison (C)

T: Exercise therapy based on a standardized program for computer and workplace related neck pain
C: Wait-list control


Frequency 2 sessions/week
Dose

45 minute sessions

  • Mobilizing and stabilizing the whole vertebrae is repeated 10-15 times
  • Strengthening the dorsal neck muscles is held for a few seconds and repeated 5 to 6 times
  • Softening the atlanto-axial and upper vertebral joints is held for a few seconds and repeated 3-4 times each side
  • Strengthening the lateral neck muscles is repeated 3-4 times
  • Strengthening the ventral neck muscles is repeated 3-4 times
Duration 3 months,
24 sessions
Follow-up 0

Isometric strengthening

Helewa 2007[17]

Disorder Type Subacute, chronic neck pain

Treatment (T)

Comparison (C)

T: Active neck and postural exercises, neck support pillow, heat or cold and superficial massage

C:

  • (a) Heat or cold and superficial massage
  • (b) Neck support pillow; Heat or cold and superficial massage
Frequency 2 sessions/week for 3 weeks;
1 session/week for 3 weeks;
1 final session at 10 weeks;
Dose Exercises were performed twice/day for 5-10 minutes
Duration 10 weeks;
7-10 sessions
Follow-up 2 weeks

Goldie 1970[18]

Disorder Type Chronic Neck pain with possible radiculopathy

Treatment (T)

Comparison (C)

T: Maximal pain free isometric strengthening of the cervical spine in sitting and supine against PT manual resistance

C:

  • (a) No treatment
  • (b) Traction


Frequency 3 sessions/week
Dose 20 minute treatment sessions
Duration 3 weeks,
10 sessions
Follow-up 3 weeks, 24 week by letter

Eye-neck coordination exercises

Revel 1994[19]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: Eye-head coordination training and adjunct treatment

C: Adjunct non-steroidal anti-inflammatory and/or analgesic medications as necessary

Frequency 2 sessions/week
Dose 30-40 minute treatment sessions
Duration 8 weeks,
15 sessions
Follow-up 10 weeks

Cervical manipulation

Bitterli 1997[20]

Disorder Type Chronic neck pain with headache or degenerative changes

Treatment (T)

Comparison (C)

T: Cervical manipulation

C: Wait list control

Frequency 1 session/week
Dose Mean 6.2 manipulations over 3.2 sessions
Duration 3 weeks,
3 sessions
Follow-up 12 weeks

Howe 1983[21]

Disorder Type Subacute/chronic neck pain with radicular findings and cervicogenic headache

Treatment (T)

Comparison (C)

T: Cervical manipulation

C: Azapropazone


Frequency 1 session
Dose 17/26 patients received 1 manipulation
4/26 received 2 manipulations
2/26 received 3 manipulations
1/26 received manipulation of the neck and low back
2/26 received injection of either methylprednisone or lignocaine and hydrocortisone to the dorsum of the appropriate apophyseal joint and manipulation
Duration 1 session
Follow-up 3 weeks

Martinez-Segura 2006[22]

Disorder Type Subacute, chronic neck pain

Treatment (T)

Comparison (C)

T: Cervical manipulation: ipsilateral side flexion, contralateral rotation

C: Sham: neck positioned into ipsilateral side flexion, contralateral rotation, position held for 30 second, the side of manual contact was randomised


Frequency 1 session
Dose 1 manipulation
Duration 1 session
Follow-up 0

Sloop 1982[23]

Disorder Type Subacute, chronic neck pain

Treatment (T)

Comparison (C)

T: Cervical manipulation and adjunct treatment

C: Adjunct diazepam


Frequency 1 session
Dose 1 manipulation
Duration 1 session
Follow-up 3 weeks

Vernon 1990[24]

Disorder Type Neck pain of mixed duration

Treatment (T)

Comparison (C)

T: Cervical rotational manipulation

C: Rotational mobilization with gentle oscillations into
elastic barrier


Frequency 1 session
Dose Not reported
Duration 1 session
Follow-up 0

Thoracic manipulation

Cleland 2007[25]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

T: thoracic distraction manipulation

C: Placebo manipulation


Frequency 1 session
Dose 1-2 manipulations per segment identified
average 3.7 manipulations/subject
Duration 1 session
Follow-up 0

Unspecified/mixed duration neck pain

Strengthening exercise

Andersen 2008[26]

Treatment (T)

Comparison (C)

T: Strengthening of the neck and shoulders

C: Health counseling

Frequency 3 sessions/week for 10 weeks
Dose Progressive increases in load from 12 repetitions maximum (RM) (~70% of 1RM) to 8 repetitions maximum (~80% of 1RM). Training load was doubled by the end of 10 weeks.

Exercises were performed using consecutive concentric and eccentric muscle contractions in a controlled manner without pause, each set lasting 25-30 seconds.

30 repetitions of 5 different exercises were performed during each session.

Duration 10 weeks, Mean 26 sessions
Follow-up 10 weeks

4.2 Neck pain with cervicogenic headache

Acute neck pain with cervicogenic headache

Manual therapy and relaxation and eye-fixation exercises

Provinciali 1996[27]

Disorder type Acute, subacute neck pain with cervicogenic headache

Treatment (T)

Comparison (C)

T: Cervical mobilization, massage, eye fixation exercise, neck school, relaxation using diaphragmatic breathing, psychological support
C: Transcutaneous electrical nerve stimulation, pulsed electromagnetic field, ultrasound

Frequency 5 sessions/week
Dose 1 hour sessions
Duration 2 weeks,
10 sessions
Follow-up 24 weeks

Self SNAG exercise

Hall 2007[28]

Disorder type Acute/subacute cervicogenic headache

Treatment (T)

Comparison (C)

T: C1/2 Self SNAG

C: Sham: forward pressure on Self SNAG strap

Frequency 1 training session,
2 sessions/day for 1 year at home
Dose 2 repetitions, twice daily
Duration 1 session
Follow-up 4 weeks, 12 months

Chronic neck pain with cervicogenic headache

Manual therapy and exercise

Jull 2002[5]

Disorder type Chronic neck pain with cervicogenic headache

Treatment (T)

Comparison (C)

T: Manipulation or mobilization and low load endurance exercise for cervicoscapular region
C:

  • (a) Exercise alone
  • (b) Manual therapy alone
  • (c) No treatment
Frequency 1-2 sessions/week
Dose Treatment sessions: up to 30 minutes long
Manipulation or mobilization: not reported
Deep neck flexor exercises: twice/day
Scapulothoracic endurance exercises: twice/day
Postural correction exercises: regularly throughout the day
Duration 6 weeks,
8-12 sessions
Follow-up 52 weeks

Exercise

Jull 2002[5]

Disorder type Chronic neck pain with cervicogenic headache

Treatment (T)

Comparison (C)

T: Low load endurance for cervicoscapular region
Including deep neck flexor activation with pressure sensor, scapula retraction/adduction, postural correction, isometric resisted neck rotation, stretching
C:

  • (a) Manual therapy alone
  • (b) No treatment
Frequency 1-2 sessions/week
Dose Treatment sessions: up to 30 minutes long
Deep neck flexor exercises: twice/day
Scapulothoracic endurance exercises: twice/day
Postural correction exercises: regularly throughout the day
Duration 6 weeks,
8-12 sessions
Follow-up 52 weeks

Cervical manipulation

Haas 2004[29]

Disorder type Chronic neck pain with cervicogenic headache

Treatment (T)

Comparison (C)

T:

  • (a) 12 sessions of manipulation, heat, soft tissue therapy with massage, trigger point therapy, education (modification of ADL), rehabilitation exercises
  • (b) 9 sessions of manipulation, heat, soft tissue therapy with massage, trigger point therapy, education (modification of ADL), rehabilitation exercises

C:

  • (c) 3 sessions of manipulation, heat, soft tissue therapy with massage, trigger point therapy, education (modification ofADL), rehabilitation exercises
Frequency
  • (a) 4 sessions/week
  • (b) 3 sessions/week
  • (c) 1 session/week
Dose Not reported
Duration 3 weeks,
  • (a) 12 sessions
  • (b) 9 sessions
  • (c) 3 sessions
Follow-up 1 week,
11 weeks

Chen 2007[30]

Disorder type

Chronic neck pain with cervicogenic headache

Treatment (T)

Comparison (C)

T: Cervical manipulation
C: TENS

Frequency 10 sessions over 20 days
Dose 20-30 minute treatment sessions
Duration 3 weeks,
10 sessions
Follow-up 1 week

4.3 Whiplash associated disorder

Acute/subacute whiplash associated disorder

Manual therapy and exercise

Giebel 1997[31]

Disorder type Acute WAD with cervicogenic headache

Treatment (T)

Comparison (C)

T: Cervical mobilization, passive movements under light traction; active, hold-relax/contract-relax technique to scaleni, levator scapula and trapezius in sitting; exercise; analgesic; anti-inflammatory
C: Collar: worn continuously, taken off at night; advised no exercise; analgesic; anti-inflammatory

Frequency Not reported
Dose Not reported
Duration 3 weeks
Follow-up 9 weeks

Mealy 1986[32]

Disorder type Acute WAD

Treatment (T)

Comparison (C)

T: Cervical mobilization, exercise within the limits of pain, heat, ice, analgesics

C: Soft cervical collar, worn for two weeks; rest for two weeks before beginning gradual mobilization, analgesics

Frequency Exercises performed daily, every hour at home
Dose Not reported
Duration 8 weeks
Follow-up 0

Bonk 2000[33]

Disorder type Acute WAD

Treatment (T)

Comparison (C)

T: Cervical mobilization, isometric strengthening, inter scapular muscle strengthening, postural exercise, advice
C: Collar worn during day for 3 weeks, no physiotherapy, activity, exercise or mobilization

Frequency 3 sessions in first week,
2 sessions in second and third weeks
Dose Not reported
Duration 3 weeks,
7 sessions
Follow-up 12 weeks

McKinney 1994[34]

Disorder type Acute WAD

Treatment (T)

Comparison (C)

T: Cervical mobilization, active and passive movements, heat/cold application, short wave diathermy, hydrotherapy, traction, education - posture and exercise to perform at home, standard analgesic, soft collar to be used intermittently

C: (a) Education on mobilization after an initial 10-14 day rest period, general advice; analgesics; soft collar used continuously
(b) Education on posture correction, use of analgesics, use of collar when neck was vulnerable to sudden jolting, exercise performed after collar use, heat, muscle relaxation, encouraged to perform demonstrated mobilization exercises, analgesics

Frequency 3 sessions/week
Dose 40 minute sessions
Duration 6 weeks,
24 sessions
Follow-up 2 weeks

Thoracic manipulation

Fernandez-de-las-Penas 2004[35]

Disorder type Acute, subacute WAD II or WAD III

Treatment (T)

Comparison (C)

T: Thoracic manipulation and adjunct treatment

C: Adjunct treatment: Ultrasound, active exercise, muscle stretching, massage, electrotherapies, manual therapy

Frequency 2 manipulations over 2 weeks
Dose 2 manipulations
Duration 3 weeks,
15 sessions, manipulation at first two sessions
Follow-up 0

Chronic whiplash associated disorder

Manual therapy and exercise

Jull 2007[36]

Disorder type Chronic WAD II

Treatment (T)

Comparison (C)

T: Exercise, mobilizations, education, assurance

C: Self management program including education on exercise, staying active, recovery process following WAD, ergonomic advice

Frequency 1-2 sessions/week
Dose Treatment sessions: up to 30 minutes long
Manipulation or mobilization: not reported
Deep neck flexor exercises: twice/day
Scapulothoracic endurance exercises: twice/day
Postural correction exercises: regularly throughout the day
Duration 10 weeks,
10-15 sessions
Follow-up 0

4.4 Neck pain with radiculopathy

Acute neck pain with radiculopathy

Mobilizing and stabilizing exercises

Kuijper 2009[37]

Disorder type Acute neck pain with radiculopathy

Treatment (T)

Comparison (C)

T: Mobilizing and stabilizing exercise
C: Wait list control and collar group

Frequency 2 sessions/week
Dose Chest press in sitting: 2 x 10 repetitions with 5 kg.
Lateral Pull-down in sitting: 2 x 10 repetitions with 20 kg
Low-back flies: 2 x 10 repetitions with 1 kg
Neck-press: 2 x 10 repetitions with 1 kg
Front-raises: 2 x 10 repetitions with 1 kg
Upright row: 2 x 10 repetitions with 7.5 kg
Weight rotation: 3 repetitions: 5 repetitions to left and right with 7.5 kg
Home exercises: 2 sets of 10 repetitions each
Duration 6 weeks,
12 sessions
Follow-up 6 months

References

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

  1. Cleland JA, Childs Maj JD, McRae M, Palmer JA, Stowell T. Immediate effects of a thoracic manipulation in patients with neck pain: A randomized clinical trial. Manual Therapy 2005;10: 127–35.
  2. Gonzalez-Iglesias J, Fernandez-De-Las-Penas C, Cleland JA, Del Rosario Gutierrez-Vega M. Thoracic spine manipulation for the management of paitents with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2009;39(1):20–7.
  3. 3.0 3.1 Bronfort G, Evan R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001;26(7):788-99.
  4. Hoving JL, Koes BW, de Vet HCW, van der Windt DAWM, Assendelft WJJ, van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized controlled trial. Ann Int Med 2002;136:713-22.
  5. 5.0 5.1 5.2 Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27(17):1835-43.
  6. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Spine 1998;23(17):1875-84.
  7. Ylinen J, Takala EP, Nykanen M, Hakkinen A, Malkia E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women. JAMA 2003;289(19):2509-16.
  8. Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico-brachial pain syndrome e a pilot study. Man Ther 2002;7 (2):95-102.
  9. Brodin H. Cervical pain and mobilization. Int J Rehabil Res 1984;7(2):190-1.
  10. Karlberg M, Magnusson M, Eva-Maj M, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil 1996;77:874-82.
  11. Palmgren PJ, Sandstrom PJ, Lundqvist FJ, Heikkila H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther 2006;29:100-6.
  12. Chiu T, Huiu-Chan C, and Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil 2005;19:850-60.
  13. Franca DLM., Senna-Fernades V., Martins Cortez C., Jackson MN., Bernardo-Filho M., and Guimaraes MAM. Tension neck syndrome treated by acupuncture combined with physiotherapy: A comparative clinical trial (pilot study). Complementary Therapies in Medicine 2008;16:268-277.
  14. Martel J., Dugas C., Dubois JD., Descarreaux M.. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain. BMC Musculoskeletal Disorders 2011;12:41-54.
  15. 15.0 15.1 Rendant D, Pach D, Ludtke R, Reishauer A, Mietzner A, Willich SN, Witt CM. Qigong versus exercise versus no therapy for patients with chronic neck pain. Spine 2011;36(6):419-29.
  16. 16.0 16.1 von Trott P., Wiedemann A, Ludtke R., reibhauer A., Willich ST., and Witt CM.. Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): A randomized controlled study. J Pain 2009;10(5):501-508.
  17. Helewa A, Goldsmith C, Smythe H, Lee P, Obright K. Effect of Therapuetic esercise and Sleeping Neck Support on Patients with Chronic Neck Pain: A Randomized Clinical Trial. J Rheumatol 2007;34(1):151-58.
  18. Goldie I, Landquist A. Evaluation of the effects of different forms of physiotherapy in cervical pain. Scand J Rehab Med 1970;2-3:117-21.
  19. Revel M, Minguet M, Gergoy P, Vaillant J, Manuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck apin: a randomized controlled study. Arch Phys Med Rehabil 1994;75:895-9.
  20. Bitterli J, Graf R, Robert F, Adler R, Mumenthaler M. Zur objectivierung der manualtherapeutischen beeinflussbarkeit des spondylogenen kopfschmerzes. Nervenarzt 1977;48:259–62.
  21. Howe DH, Newcombe RG, Wade MT. Manipulation of the cervical spine - a pilot study. Journal of the Royal College of General Practitioners 1983;33:574–9.
  22. Martinez-Segura R, Fernandez-de-las-Penas C, Ruiz-Saez M, Lopez-Jimenez C, Rodriguez-Blanco C. Immedicate effects on neck pain and active range of motion after a single cervical high-velocity low amplitude manipulation in subjects presenting with mechanical neck pain: A randomized controlled trial. J Manipulative Phyiol Ther 2006;29:511–7.
  23. Sloop PR, Smith DS, Goldenberg E, Dore C. Manipulation for chronic neck pain: A double-blind controlled study. Spine 1982;7 (6):532–5.
  24. Vernon HT, Aker P, Burns S, Viljakaanen S, Short L. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: A pilot study. J Manipulative Physiol Ther 1990;13(1):13–6.
  25. Cleland 2007
  26. Andersen L, Kjaer M, Sogaard K, Hansen L, Kryger A and Sjogaard G. Effect of Two Contrasting Types of Physical Exercise on Chronic Neck Muscle Pain. Arthritis and Rheumatism 2008;59(1):84-91.
  27. Provinciali L, Baroni M, Illuminati L, Ceravolo MG. Multimodal treatment to prevent the late whiplash syndrome. Scand J Rehabil Med 1996;28:105-11
  28. Hall T, Chan H, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache. J Orthop Sports Phys Ther 2007;37(3):100-7.
  29. Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, et al.Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: A randomized pilot study. J Manipulative Physiol Ther 2004;27:547–53.
  30. Chen L, Zhang XL, Ding H, Tao YQ, Zhan HS. Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache. Journal of Chinese Integrative Medicine 2007;5(4):403–6.
  31. Giebel GD, Edelmann M, Huser R. Die distorsion der halswirbelsaule: Fruhfunktionalle vs. ruhigstellende behandlung. Zentralbibliotak Chiropractic 1997;122:517-21.
  32. Mealy K, Brennan H, Fenelon GC. Early mobilization of acute whiplash injuries. Br Med J 1986;92:656-7.
  33. Bonk AD, Ferrari R, Giebel GD, Edelmann M, Huser R. Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany. J Musculoskelet Pain 2000;8(1/2):123-32.
  34. McKinney MB. Behandlung der HWS-Distorsionen bei sog. Schleuderverletzungen. Orthopade 1994;23:287-90.
  35. Fernandez-de-las-Penas C, Fernandez-Carnero J, Plaza Fernandez A, Lomas-Vega R, Miangolarra-Page JC. Dorsal manipulation in whiplash injury treatment: A randomized controlled trial. Journal of Whiplash & Related Disorders 2004;3:55–71.
  36. Jull G, Sterling M, Kenardy J, Beller E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? A preliminary RCT. Pain 2007;129:28-34.
  37. Kuijper B., Tans JT, Beelen A., Nollet F. and de Visser M.. Cervical collar or physiotherpay versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ 2009;339(b3883).