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:&nbsp;Spinal manipulation and massage to the cervical and thoracic spine and exercise therapy <br>C: <br>  
|  
*(a) Exercise therapy using MedX equipment
T:  
*(b) Spinal manipulation and massage + detuned microcurrent
 
*(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)<br>  
 
<br>


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! scope="row" | Frequency  
! scope="row" | Frequency  
| 20 sessions over 11 weeks
|  
*Exercises:
**5 sessions/week for 2 weeks;
**3 times/week for 1 year at home
 
*Physical therapy:
**4 sessions over 2 weeks
 
|-
|-
! scope="row" | Dose  
! 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
| 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
 
|-
|-
! scope="row" | Duration  
! scope="row" | Duration  
| 11 weeks, <br>20 sessions
| 2 weeks, <br>10 sessions<br>
|-
|-
! scope="row" | Follow-up  
! scope="row" | Follow-up  
| 52 and 104 weeks
| 12 months
|}
|}


Revision as of 10:32, 11 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

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

Acute/subacute neck pain[edit | edit source]

Thoracic manipulation[edit | edit source]

Cleland 2007[1][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

Gonzalez-Iglesias 2009[2][edit | edit source]

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[edit | edit source]

Manual therapy and exercise[edit | edit source]

Bronfort 2001[3][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[4][edit | edit source]

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]
[edit | edit source]

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][edit | edit source]

Disorder Type Chronic neck pain

Treatment (T)

Comparison (C)

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

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

Ylinen 2003 [3][edit | edit source]

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[3][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

Brodin 1982[3][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

Karlberg 1996[3][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

Palmgren 2006[3][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


  • Manual therapy

Exercise[edit | edit source]

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

Exercise[edit | edit source]

Manual therapy[edit | edit source]

4.2 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]

4.3 Whiplash associated disorder[edit | edit source]

Acute/subacute whiplash associated disorder[edit | edit source]

==== Manual therapy and exercise ====*Click to continue to Step 5: Individualize treatment

Exercise[edit | edit source]

Manual therapy[edit | edit source]

Chronic whiplash associated disorder[edit | edit source]

Manual therapy and exercise
[edit | edit source]

4.4 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. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Cleland 2007
  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 3.2 3.3 3.4 3.5 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. ↑ 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.
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