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.
[edit | edit source]
- The evidence regarding the use of manual therapy and exercise for the treatment of neck pain is presented below, organized by patient characteristics
- 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)[edit | edit source]
Acute/subacute neck pain
[edit | edit source]
Manual therapy
| Author, year of original studies | Participant characteristics | Intervention | Comparison | Pain | Function/ Disability | GPE | Patient Satisfaction | QoL |
|---|---|---|---|---|---|---|---|---|
| Cleland 2007 | Acute/subacute neck pain | Thoracic manipulation + adjunct treatment | Thoracic mobilization + adjunct exercise | ▲▲ | ▲▲ | ▲▲ | ||
| Gonzalez-Iglesias 2009[1] |
Acute neck pain | Thoracic manipulation + adjunct treatment | Adjunct electrothermal therapy | ▲, ▲▲ | ▲, ▲▲ | |||
| Egwu 2008[2] | 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.
- Now go back to Step 1: Identify your patient, or continue to Step 3: Inform your technique.
Subacute/chronic neck pain
[edit | edit source]
Manual Therapy and Exercise
| Author, year of original studies | Participant characteristics | Intervention | Comparison |
Pain | Function/ Disability | GPE | Patient Satisfaction | QoL |
|---|---|---|---|---|---|---|---|---|
| Bronfort 2001[3], Hoving 2002[4], Jull 2002[5] | Subacute/chronic neck pain with or without CGH | Manipulation or mobilization and exercise | Primarily exercise alone | ♦♦, ◊◊◊◊ |
◊◊, ◊◊◊◊ |
◊◊, ◊◊◊◊ |
◊◊, ◊◊◊◊ | |
| Bronfort 2001[3], Skargren 1998[6] | Chronic neck pain | Manipulation or mobilization and exercise | Primarily manipulation or mobilization alone | ●●●● |
●●●● | |||
| Ylinen 2003 | Chronic neck pain | Manipulation, mobilization, and exercise | Adjunct advice including general exercise | ●●●● | ●●●● | |||
| Allison 2002, Brodin 1985, Jull 2002, Karlberg 1996 | Subacute/chronic neck pain with or without CGH or Radiculopathy | Manipulation or mobilization and exercise | No treatment | ▲, ▲▲, ▲▲▲▲ | ||||
| Palmgren 2006 | Chronic neck pain | Manipulation or mobilization and exercise | Advice | ▲ | ||||
| Hoving 2002, Walker 2008 | Chronic or mixed duration neck pain | Manipulation or mobilization and exercise | Traditional care | ○○○○ | ||||
| Persson 2001 | Chronic neck pain with radicular symptoms | Manipulation or mobilization and exercise | Collar therapy or surgery | ∆ | ||||
| Vasseljen 1995 | 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.
- Now go back to Step 1: Identify your patient, or continue to Step 3: Inform your technique.
Exercise
| Author, year of original studies | Participant characteristics | Intervention | Comparison |
Pain | Function/ Disability | GPE | Patient Satisfaction | QoL |
|---|---|---|---|---|---|---|---|---|
| Chiu 2005, Evans 2002, Franca 2008, Martel 2011 | Chronic neck pain |
Combined cervical and scapulothoracic stretching and strengthening + adjunct treatment |
Adjunct treatment (varied) |
♦, ●●, ♦♦♦, ○○○○ |
♦, ●●, ♦♦♦, ●●●● |
●, ○○, ○○○, ○○○○ |
●, ●●, ●●●, ●●●● |
○, ○○, ○○○, ○○○○ |
| Von Trott 2009, Rendent 2011 | Chronic neck pain | Qigong exercises (Dantian Qigong) |
Wait list control |
●, ●● |
●, ●● |
○, ○○ |
●, ●● | |
| Von Trott 2009, Rendent 2011 | Chronic neck pain |
Cervical range of motion and strengthening exercise |
Wait list control |
▲, ▲▲ |
▲, ▲▲ |
∆, ∆∆ | ∆, ∆∆ | |
| Helewa 2007 | Chronic neck pain | Isometric neck exercises + adjunct treatment |
Adjunct pillow |
▲, ▲▲ |
▲, ▲▲ | ▲, ▲▲ | ||
| Goldie 1970, Helewa 2007 | Chronic neck pain |
Isometric neck exercises |
No treatment |
∆, ∆∆ |
∆, ∆∆ | ▲ | ∆, ∆∆ | |
| Revel 1994 | Chronic neck pain |
Eye neck coordination exercises + adjunct treatment |
Adjunct medication |
▲▲ |
▲▲ | |||
| Viljanen 2006 | Chronic neck pain with/without WAD |
Upper extremity stretching and endurance training |
Normal activities |
○, ○○, ○○○○ |
○, ○○, ○○○○ | |||
| Kjellman 2002 | Chronic neck pain |
Neck and upper extremity stretch and strengthening program |
Sham ultrasound |
∆, ∆∆, ∆∆∆, ∆∆∆∆ |
∆, ∆∆, ∆∆∆, ∆∆∆∆ | |||
| Kjellman 2002 | Chronic neck pain |
Cervical movement exercises (McKenzie) |
Sham ultrasound |
∆, ∆∆, ∆∆∆, ∆∆∆∆ |
∆, ∆∆, ∆∆∆, ∆∆∆∆ | |||
| Allan 2003 | Chronic neck pain |
Stretching exercises either before or after a manipulation |
That same manipulation |
∆ |
∆ | |||
| Lundblad 1999 |
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.
- Now go back to Step 1: Identify your patient, or continue to Step 3: Inform your technique.
Manual therapy
| Author, year of original studies | Participant characteristics | Intervention | Comparison |
Pain | Function/ Disability | GPE | Patient Satisfaction | QoL |
|---|---|---|---|---|---|---|---|---|
| Bitterli 1977, Howe 1983, Martinez- Segura 2006, Sloop 1982, Vernon 1990 | Subacute/chronic neck pain |
Cervical manipulation |
Various controls |
▲, ▲▲ |
||||
| Cleland 2005 | Chronic neck pain |
Thoracic manipulation |
Sham manipulation |
▲ |
||||
| Kanlayanaphotporn 2009 | Chronic neck pain |
Central PA mobilization |
One of three random mobilizations |
▲ |
∆ |
|||
| Hurwitz 2002 | Subacute to chronic neck pain with or without CGH or radiculopathy |
Cervical manipulation |
Cervical mobilization |
○○○ |
○○○ |
|||
| Kanlayanaphotporn 2009 | Chronic neck pain |
Ipsilateral PA mobilization |
Randomly selected ipsilateral/central/ contralateral PA mobilization |
∆ |
∆ |
|||
| Strunk 2008 | Subacute or chronic neck pain |
Cervical mobilization |
Manipulation to various spinal regions |
∆ |
||||
| Giles 1999, Muller 2005 | Chronic neck pain |
Cervical manipulation |
medication |
∆ |
∆ |
|||
| Giles 1999, Muller 2005 | Chronic neck pain |
Cervical manipulation |
Acupuncture or electroacupuncture |
∆ |
∆ |
|||
| Yurkiw 1996, Wood 2001 | Subacute neck pain |
Manual cervical manipulation |
Activator instrumental manipulation |
∆, ∆∆ |
∆, ∆∆ |
|||
| David 1998 | Chronic neck pain with or without WAD |
Cervical mobilization |
Acupuncture |
∆∆∆∆ |
∆∆∆∆ |
|||
| Bitterli 1977 | 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.
- Now go back to Step 1: Identify your patient, or continue to Step 3: Inform your technique.
Unspecified/mixed duration neck pain[edit | edit source]
Exercise
Manual therapy
2.2 Neck pain with cervicogenic headache[edit | edit source]
Acute/subacute neck pain with cervicogenic headache[edit | edit source]
Manual therapy and exercise[edit | edit source]
Exercise[edit | edit source]
Manual therapy[edit | edit source]
Chronic neck pain with cervicogenic headache[edit | edit source]
Manual therapy and exercise[edit | edit source]
Exercise[edit | edit source]
Manual therapy[edit | edit source]
2.3 Whiplash associated disorder[edit | edit source]
Acute/subacute whiplash associated disorder[edit | edit source]
Manual therapy and exercise[edit | edit source]
Exercise[edit | edit source]
Manual therapy[edit | edit source]
Chronic whiplash associated disorder[edit | edit source]
Manual therapy and exercise
[edit | edit source]
2.4 Neck pain with radiculopathy[edit | edit source]
Acute neck pain with radiculopathy
[edit | edit source]
Exercise[edit | edit source]
Manual therapy
[edit | edit source]
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 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.
- ↑ Eqwu MO. Relative therapeutic efficacy of some vertebral mobolization techniques in the management of unilateral cervical spondylosis: a comparitive study. J Phys Ther Sci 2008;20:103-8.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
