Neck Pain Patient Decision Aid: Step 2: Difference between revisions

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= Neck pain alone for less than 6 weeks =
= Neck pain alone for less than 6 weeks =


There is low quality evidence available. Definitive recommendations cannot be made from this research.  
There is low quality evidence available. Definitive recommendations cannot be made from this research.  
Neck pain with headache for less than 6 weeks =


= Neck pain after whiplash injury for less than 6 weeks =
There is low quality evidence available. Definitive recommendations cannot be made from this research.
 
= Neck pain after whiplash injury for less than 6 weeks =
 
Neck mobilizations and range of motion exercises performed frequently within your limits of pain provide greater pain relief in the short-term when compared to using analgesic medication and collar<ref name="Giebel 1997">Giebel GD, Edelmann M, Huser R. Diedistorsionderhalswirbelsaule: Fruhfunk-tionalle vs.ruhigstellendebehandlung. Zentralbibliotak Chiropractic 1997;122:517-21.</ref><ref name="Mealy 1986">Mealy K, Brennan H, Fenelon GC. Early mobilisation of acute whiplash injuries. Br Med J 1986;92:656-7.</ref>.


Neck mobilizations and range of motion exercises performed frequently within your limits of pain provide greater pain relief in the short-term when compared to using analgesic medication and collar<ref name="Giebel 1997">Giebel GD, Edelmann M, Huser R. Diedistorsionderhalswirbelsaule: Fruhfunk-tionalle vs.ruhigstellendebehandlung. Zentralbibliotak Chiropractic 1997;122:517-21.</ref><ref name="Mealy 1986">Mealy K, Brennan H, Fenelon GC. Early mobilisation of acute whiplash injuries. Br Med J 1986;92:656-7.</ref>.
= Neck pain alone for more than 12 weeks =
Neck pain alone for more than 12 weeks =


Neck exercises plus mobilization with or without manipulations or massage can help you in the short- and long-term. Moderate to high quality evidence suggests:
Neck exercises plus mobilization with or without manipulations or massage can help you in the short- and long-term. Moderate to high quality evidence suggests:  


*Greater short-term pain relief than exercise alone, but no long-term difference in pain, function, or quality of life (QoL)<ref name="Bronfort 2001">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.</ref><ref name="Hoving 2002">Hoving JL, Koes BW, deVet HCW,vanderWindt 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.</ref><ref name="Jull 2001">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 2001;27(17):1835-43.</ref>.
*Greater short-term pain relief than exercise alone, but no long-term difference in pain, function, or quality of life (QoL)<ref name="Bronfort 2001">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.</ref><ref name="Hoving 2002">Hoving JL, Koes BW, deVet HCW,vanderWindt 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.</ref><ref name="Jull 2001">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 2001;27(17):1835-43.</ref>.  
**Greater short- and long-term improvements in pain and quality of life with manual therapy and exercise in comparison to manual therapy alone<ref name="Bronfort 2001" /><ref name="Skargren 1998">Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-7.</ref>
**Greater short- and long-term improvements in pain and quality of life with manual therapy and exercise in comparison to manual therapy alone<ref name="Bronfort 2001" /><ref name="Skargren 1998">Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-7.</ref>  
*Greater long-term improvements in pain and function in comparison to advice<ref name="Ylinen 2003">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.</ref>
*Greater long-term improvements in pain and function in comparison to advice<ref name="Ylinen 2003">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.</ref>  
*Similar benefit to advice and care from your doctor a year after the pain is started<ref name="Hoving 2002" /><ref name="Walker 2008">Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine 2008;33(22):2371-8.</ref>
*Similar benefit to advice and care from your doctor a year after the pain is started<ref name="Hoving 2002" /><ref name="Walker 2008">Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine 2008;33(22):2371-8.</ref>  
*Manipulation and mobilization appear to have similar effects for improving pain and function in the intermediate-term<ref name="Hurwitz 2002">Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Research and Practice 2002;92(10):1634-41.</ref>
*Manipulation and mobilization appear to have similar effects for improving pain and function in the intermediate-term<ref name="Hurwitz 2002">Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Research and Practice 2002;92(10):1634-41.</ref>  
*
*
Exercise alone is also effective in the short- and long-term  
Exercise alone is also effective in the short- and long-term  


*Neck and upper back range of motion and low-load strengthening exercises provide reductions in pain, improvements in function, and patient satisfaction. There is no difference in global perceived effect or quality of life<ref name="Bronfort 2001" /><ref name="Chiu 2005">Chiu TTW, Hui-chan CWY, Cheing G.  A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil 2005;19:850-60.</ref><ref name="Franca 2008">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.</ref><ref name="Martel 2011">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.</ref>
*Neck and upper back range of motion and low-load strengthening exercises provide reductions in pain, improvements in function, and patient satisfaction. There is no difference in global perceived effect or quality of life<ref name="Bronfort 2001" /><ref name="Chiu 2005">Chiu TTW, Hui-chan CWY, Cheing G.  A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil 2005;19:850-60.</ref><ref name="Franca 2008">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.</ref><ref name="Martel 2011">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.</ref>


<br>


Upper extremity stretching, strengthening and endurance training do not provide any additional benefit to normal activities in terms of neck pain and function<ref name="Viljanen 2003">Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trial. BMJ. 2003;327:475-479.</ref>


Upper extremity stretching, strengthening and endurance training do not provide any additional benefit to normal activities in terms of neck pain and function<ref name="Viljanen 2003">Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trial. BMJ. 2003;327:475-479.</ref>
**Qigong exercises are more effective than being on a wait-list for that treatment<ref name="von Trott 2009">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.</ref><ref name="Rendant 2011">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.</ref>
**Qigong exercises are more effective than being on a wait-list for that treatment<ref name="von Trott 2009">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.</ref><ref name="Rendant 2011">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.</ref>


= <br>Neck pain with headache for more than 12 weeks =
= <br>Neck pain with headache for more than 12 weeks =
 
Manual therapy and exercise provide greater short and long-term improvements in pain and function compared to no treatment<ref>Jull 2001</ref>
 


Manual therapy and exercise provide greater short and long-term improvements in pain and function compared to no treatment<ref>Jull 2001</ref>


Exercise also provides greater short and long-term improvements in pain and function compared to no treatment<ref>Jull 2001</ref>
<br>  


Exercise also provides greater short and long-term improvements in pain and function compared to no treatment<ref>Jull 2001</ref>


<br>


= Neck pain after whiplash injury for more than 12 weeks =
= Neck pain after whiplash injury for more than 12 weeks =


There is low quality evidence available. Definitive recommendations cannot be made from this research.  
There is low quality evidence available. Definitive recommendations cannot be made from this research.  


<br>


= Neck pain with pain numbness and tingling down your arm  =


= Neck pain with pain numbness and tingling down your arm =
There is low quality evidence available. Definitive recommendations cannot be made from this research.  
 
There is low quality evidence available. Definitive recommendations cannot be made from this research.


<references /><br><br>
<references /><br><br>

Revision as of 00:20, 27 April 2012

This page is part of the 'Should I receive manual therapy and exercise for my neck pain?: A patient decision aid' resource for patients. Please see the main project page for further information, or proceed to Step 1 below to describe your neck pain.


NeckPainPatientAid Step2 Logo.png

Neck pain alone for less than 6 weeks[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research. Neck pain with headache for less than 6 weeks =

There is low quality evidence available. Definitive recommendations cannot be made from this research.

Neck pain after whiplash injury for less than 6 weeks[edit | edit source]

Neck mobilizations and range of motion exercises performed frequently within your limits of pain provide greater pain relief in the short-term when compared to using analgesic medication and collar[1][2].

Neck pain alone for more than 12 weeks[edit | edit source]

Neck exercises plus mobilization with or without manipulations or massage can help you in the short- and long-term. Moderate to high quality evidence suggests:

  • Greater short-term pain relief than exercise alone, but no long-term difference in pain, function, or quality of life (QoL)[3][4][5].
    • Greater short- and long-term improvements in pain and quality of life with manual therapy and exercise in comparison to manual therapy alone[3][6]
  • Greater long-term improvements in pain and function in comparison to advice[7]
  • Similar benefit to advice and care from your doctor a year after the pain is started[4][8]
  • Manipulation and mobilization appear to have similar effects for improving pain and function in the intermediate-term[9]

Exercise alone is also effective in the short- and long-term

  • Neck and upper back range of motion and low-load strengthening exercises provide reductions in pain, improvements in function, and patient satisfaction. There is no difference in global perceived effect or quality of life[3][10][11][12]


Upper extremity stretching, strengthening and endurance training do not provide any additional benefit to normal activities in terms of neck pain and function[13]

    • Qigong exercises are more effective than being on a wait-list for that treatment[14][15]


Neck pain with headache for more than 12 weeks[edit | edit source]

Manual therapy and exercise provide greater short and long-term improvements in pain and function compared to no treatment[16]


Exercise also provides greater short and long-term improvements in pain and function compared to no treatment[17]


Neck pain after whiplash injury for more than 12 weeks[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research.


Neck pain with pain numbness and tingling down your arm[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research.

  1. ↑ Giebel GD, Edelmann M, Huser R. Diedistorsionderhalswirbelsaule: Fruhfunk-tionalle vs.ruhigstellendebehandlung. Zentralbibliotak Chiropractic 1997;122:517-21.
  2. ↑ Mealy K, Brennan H, Fenelon GC. Early mobilisation of acute whiplash injuries. Br Med J 1986;92:656-7.
  3. ↑ 3.0 3.1 3.2 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. ↑ 4.0 4.1 Hoving JL, Koes BW, deVet HCW,vanderWindt 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. ↑ 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 2001;27(17):1835-43.
  6. ↑ Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-7.
  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. ↑ Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine 2008;33(22):2371-8.
  9. ↑ Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Research and Practice 2002;92(10):1634-41.
  10. ↑ Chiu TTW, Hui-chan CWY, Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil 2005;19:850-60.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trial. BMJ. 2003;327:475-479.
  14. ↑ 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.
  15. ↑ 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. ↑ Jull 2001
  17. ↑ Jull 2001



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