Neck Pain Tool-kit: Step 4: Difference between revisions

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! scope="row" | Treatment (T) / Comparison (C)  
! scope="row" | Treatment (T) / Comparison (C)  
| T: Seated thoracic distraction manipulation + adjunct treatment<br>C: Adjunct treatment - electrothermal therapy (infrared therapy + TENS)
| T: Seated thoracic distraction manipulation + adjunct treatment <br>C: Adjunct treatment - electrothermal therapy (infrared therapy + TENS) <br>
|-
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! scope="row" | Frequency  
! scope="row" | Frequency  
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ETT: Electrothermal therapy.
ETT: Electrothermal therapy.  
 
*Click to return to Step 3: Inform your technique [[Neck Pain Tool-kit: Step 3#Gonzalez-Iglesias_2009|Gonzalez-Iglesias 2009]]


== Subacute/chronic neck pain  ==
== Subacute/chronic neck pain  ==


=== Manual therapy and exercise  ===
=== Manual therapy and exercise  ===
==== Bronfort 2001<ref name="Bronfort 2001" />  ====


{| width="700" border="1" cellpadding="1" cellspacing="1"
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
|-
! scope="col" | Study Year/Disorder Type  
! scope="row" | Disorder Type  
! scope="col" | Treatment (T) / Comparison (C)
| Chronic neck pain
! scope="col" | Frequency
! scope="col" | Dose
! scope="col" | Duration
! scope="col" | Follow-up
|-
|-
| Bronfort 2001<ref name="Bronfort 2001" /><br>Chronic neck pain
! scope="row" | Treatment (T) / Comparison (C)
| T: Spinal manipulation and massage to the cervical and thoracic spine and exercise therapy  
| T:&nbsp;Spinal manipulation and massage to the cervical and thoracic spine and exercise therapy <br>C: <br>
C:  
 
*(a) Exercise therapy using MedX equipment  
*(a) Exercise therapy using MedX equipment  
*(b) Spinal manipulation and massage + detuned microcurrent
*(b) Spinal manipulation and massage + detuned microcurrent


| 20 sessions over 11 weeks  
|-
| 15 minutes of manipulation and massage<br>45 minutes of exercise therapy<br>Dumbbell shoulder exercises: 2 x 15-30 repetitions with 2-10lbs<br>Pulley exercises: 1.25-10 lbs resistance<br>
! scope="row" | Frequency
| 11 weeks, <br>20 sessions  
| 20 sessions over 11 weeks
|-
! scope="row" | Dose
| 15 minutes of manipulation and massage<br>45 minutes of exercise therapy<br>Dumbbell shoulder exercises: 2 x 15-30 repetitions with 2-10lbs<br>Pulley exercises: 1.25-10 lbs resistance
|-
! scope="row" | Duration
| 11 weeks, <br>20 sessions
|-
! scope="row" | Follow-up
| 52 and 104 weeks
| 52 and 104 weeks
|}
*Click to return to Step 3: Inform your technique [[Neck Pain Tool-kit: Step 3#Bronfort_2001|Bronfort 2001]]
==== Hoving 2002<ref name="Bronfort 2001" />  ====
1 session/week
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
|-
| Hoving 2002<ref name="Hoving 2002" /><br>Neck pain of mixed duration with or without cervicogenic headache or radiculopathy  
! scope="row" | Disorder Type
| T: Muscular and articular mobilization techniques to the cervical spine, coordination and stabilization techniques  
| Neck pain of mixed duration with or without cervicogenic headache or radiculopathy
C:  
|-
 
! scope="row" | Treatment (T) / Comparison (C)
| T: Muscular and articular mobilization techniques to the cervical spine, coordination and stabilization techniques<br>C:  
*(a) Active exercise therapies: strengthening, stretching (ROM), postural/ relaxation/ functional exercise; optional modalities: manual traction, massage, interferential current, heat  
*(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
*(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, <br>3-6 sessions
| 52 weeks
|-
|-
| Jull 2002<ref name="Jull 2002" /><br>Chronic neck pain with cervicogenic headache
! scope="row" | Frequency
| T: Manipulation or mobilization and low load endurance exercise for cervicoscapular region
| 1 session/week
C:
|-
 
! scope="row" | Dose
*(a) Exercise alone
| 45 minute treatment sessions, exercise and manual therapy dosage not reported
*(b) Manual therapy alone
|-
*(c) No treatment
! scope="row" | Duration
 
| Max. 6 weeks, <br>3-6 session
| 1-2 sessions/week
| Treatment sessions: up to 30 minutes long<br>Deep neck flexor exercises: twice/day<br>Postural correction exercises: regularly throughout the day
| 6 weeks, <br>8-12 sessions
| 52 weeks
|-
|-
| Skargren 1998<ref name="Skargren 1998" /><br>Chronic neck pain
! scope="row" | Follow-up
| T&nbsp;: 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, <br>6-8 sessions
| 52 weeks
| 52 weeks
|-
|}
| Ylinen 2003 <ref name="Ylinen 2003" /><br>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
*Click to return to Step 3: Inform your technique [[Neck Pain Tool-kit: Step 3#Hoving_2002|Hoving 2002]]
*(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)
==== Jull 2002<ref name="Jull 2002" />  ====


| Exercises: 5 sessions/week for 2 weeks; <br>3 times/week for 1 year at home
1 session/week  
Physical therapy:<br>4 sessions over 2 weeks


| 45 minute exercise sessions
{| width="700" border="1" cellpadding="1" cellspacing="1"
*(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
! scope="row" | Disorder Type
| Chronic neck pain with cervicogenic headache
|-
! scope="row" | Treatment (T) / Comparison (C)
| T: Manipulation or mobilization and low load endurance exercise for cervicoscapular region<br>C:
*(a) Exercise alone
*(b) Manual therapy alone
*(c) No treatment


| 2 weeks, <br>10 sessions
| 12 months
|-
|-
| Allison 2002<ref name="Allison 2002" /><br>Neck pain with mechanically sensitive neural tissue
! scope="row" | Frequency
|
| 1-2 sessions/week
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<br>
 
| Not reported
| Active movements at home performed 10 repetitions, 1-3 times/day
| 8 weeks
| 0
|-
|-
| Brodin 1982<ref name="Brodin 1982" /><br>Chronic neck pain with or without radicular findings
! scope="row" | Dose
| T: Passive mobilizations, massage, manual traction, heat, analgesics, education
| Treatment sessions: up to 30 minutes long<br>Deep neck flexor exercises: twice/day<br>Postural correction exercises: regularly throughout the day
C:  
 
*(a) Mock therapy including massage, manual traction, electrical stimulation, analgesics, education
*(b) Analgesics<br>
 
| 3 sessions/week
| Not reported
| 9 sessions,<br>3 weeks
| 1 week
|-
|-
| Karlberg 1996<ref name="Karlberg 1996" /><br>Subacute neck pain with<br>dizziness
! scope="row" | Duration
| T: Cervical mobilization, soft tissue treatment, stabilization exercise, relaxation techniques, non-steroidal anti-inflammatory, education
| 6 weeks, <br>8-12 sessions
C: Delayed Treatment Group <br>  
 
| Median 13 sessions over median 13 weeks
| Not reported
| 5-23 sessions, 5-20 weeks
| 0
|-
|-
| Palmgren 2006<ref name="Palmgren 2006" /><br>Chronic neck pain<br>
! scope="row" | Follow-up
| T: Education, cervical manipulation, myofascial technique, exercise (spine stabilizing for cervical region and cervicothoracic junction)
| 52 weeks<br>
| 3-5 sessions over 5 weeks  
| Not reported
| 3-5 sessions, <br>5 weeks
| 0
|}
|}
*Click to return to Step 3: Inform your technique [[Neck Pain Tool-kit: Step 3#Jull_2002|Jull 2002]]


<br>  
<br>  


=== Manual therapy ===
*<span class="Apple-style-span" style="font-size: 18px; font-weight: bold; ">Manual therapy</span>


=== Exercise  ===
=== Exercise  ===

Revision as of 18:00, 3 April 2012

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

2.1 Neck pain alone (non-specific)[edit | edit source]

Acute/subacute neck pain[edit | edit source]

Thoracic manipulation[edit | edit source]

Cleland 2007[edit | edit source]

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
  • Click to return to Step 3: Inform your technique Cleland 2007

Gonzalez-Iglesias 2009
[edit | edit source]

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 3 weeks,
5 sessions
Follow-up 04 weeks

ETT: Electrothermal therapy.

Subacute/chronic neck pain[edit | edit source]

Manual therapy and exercise[edit | edit source]

Bronfort 2001[1][edit | edit source]

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[1][edit | edit source]

1 session/week

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
  • Click to return to Step 3: Inform your technique Hoving 2002

Jull 2002[2][edit | edit source]

1 session/week

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
  • Click to return to Step 3: Inform your technique Jull 2002


  • Manual therapy

Exercise[edit | edit source]

Unspecified/mixed duration neck pain[edit | edit source]

Exercise[edit | edit source]

Manual therapy[edit | edit source]

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.

  1. ↑ 1.0 1.1 Cite error: Invalid <ref> tag; no text was provided for refs named Bronfort 2001
  2. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Jull 2002
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