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.

• 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

2.1 Neck pain alone (non-specific)

Acute/subacute neck pain

Thoracic manipulation

Cleland 2007

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

3 weeks,
5 sessions

Disorder Type	Acute neck pain
Treatment (T) / Comparison (C)	T: Seated thoracic distraction manipulation + adjunct treatment C: Adjunct treatment - electrothermal therapy (infrared therapy + TENS)
Frequency	1 session/week of manipulation, 5 sessions over 3 weeks of ETT
Dose	1-2 manipulations
Duration
Follow-up	04 weeks

Study Year/		Frequency	Dose	Duration	Follow-up
Cleland 2007 Acute/subacute neck pain				1 session	0

ETT: Electrothermal therapy.

Subacute/chronic neck pain

Manual therapy and exercise

Study Year/Disorder Type	Treatment (T) / Comparison (C)	Frequency	Dose	Duration	Follow-up
Bronfort 2001 Chronic neck pain	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	20 sessions over 11 weeks	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	11 weeks, 20 sessions	52 and 104 weeks
Hoving 2002 Neck pain of mixed duration with or without cervicogenic headache or radiculopathy	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	1 session/week	45 minute treatment sessions, exercise and manual therapy dosage not reported	Max. 6 weeks, 3-6 sessions	52 weeks
Jull 2002 Chronic neck pain with cervicogenic headache	T: Manipulation or mobilization and low load endurance exercise for cervicoscapular region C: (a) Exercise alone (b) Manual therapy alone (c) No treatment	1-2 sessions/week	Treatment sessions: up to 30 minutes long Deep neck flexor exercises: twice/day Postural correction exercises: regularly throughout the day	6 weeks, 8-12 sessions	52 weeks
Skargren 1998 Chronic neck pain	T : Physiotherapy (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: Chiropractic (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	Mean 7.5 sessions over 6.4 weeks	Not reported	5-6 weeks, 6-8 sessions	52 weeks
Ylinen 2003 Chronic neck pain	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)	Exercises: 5 sessions/week for 2 weeks; 3 times/week for 1 year at home Physical therapy: 4 sessions over 2 weeks	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	2 weeks, 10 sessions	12 months
Allison 2002 Neck pain with mechanically sensitive neural tissue	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	Not reported	Active movements at home performed 10 repetitions, 1-3 times/day	8 weeks	0
Brodin 1982 Chronic neck pain with or without radicular findings	T: Passive mobilizations, massage, manual traction, heat, analgesics, education C: (a) Mock therapy including massage, manual traction, electrical stimulation, analgesics, education (b) Analgesics	3 sessions/week	Not reported	9 sessions, 3 weeks	1 week
Karlberg 1996 Subacute neck pain with dizziness	T: Cervical mobilization, soft tissue treatment, stabilization exercise, relaxation techniques, non-steroidal anti-inflammatory, education C: Delayed Treatment Group	Median 13 sessions over median 13 weeks	Not reported	5-23 sessions, 5-20 weeks	0
Palmgren 2006 Chronic neck pain	T: Education, cervical manipulation, myofascial technique, exercise (spine stabilizing for cervical region and cervicothoracic junction)	3-5 sessions over 5 weeks	Not reported	3-5 sessions, 5 weeks	0

References

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