Neck Pain Patient Decision Aid: Step 2
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 2 below to understand the evidence.
Neck pain alone for less than 6 weeks
There is low quality evidence available. Definitive recommendations cannot be made from this research.
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
Neck pain with headache for less than 6 weeks
There is low quality evidence available. Definitive recommendations cannot be made from this research.
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
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.[1][2]
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to analgesic medication and collar treatment | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Short-term |   
[1 out of 4 to 5] |
|
 |
 |
 |
 |
 |
 |
 |
 |
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
Neck pain alone for more than 6 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:
- Greater short-term pain relief than exercise alone, but no long-term difference in pain, function, or quality of life (QoL)[3][4][5].
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to exercise alone | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Short-term |
[1 out of 6] |
Small moderate large |
| Pain | Long-term |
|
Small moderate large |
| Function | Long-term |
|
Small moderate large |
| Quality of life | Long-term |
|
Small moderate large |
- 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]
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to manual therapy alone | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Long-term |
[1 out of 8 to 9] |
|
| Quality of life | Long-term |
[1 out of 9 to 52] |
Small moderate large |
- Greater long-term improvements in pain and function in comparison to advice[7]
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to advice | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Long-term |
[1 out of 18] |
|
| Function | Long-term |
[1 out of 4] |
|
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to general practitioner care | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Long-term |
|
Small moderate large |
| Function | Long-term |
|
Small moderate large |
 |
 |
 |
 |
 |
 |
 |
 |
Manipulation and mobilization appear to have similar effects for improving pain and function in the intermediate-term[9] |
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to general practitioner care | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Intermediate-term |
|
Small moderate large |
| Function | Intermediate-term |
|
Small moderate large |
 |
 |
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]
| Outcome | Follow-up | Number of people experiencing greater change with exercise in comparison to other treatments | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Intermediate-term |
[1 out of 6 to 18] |
Small moderate large |
| Function | Intermediate-term |
[1 out of 4 to 13] |
Small moderate large |
| Quality of life | Long-term |
|
Small moderate large |
- Upper extremity stretching, strengthening and endurance training do not provide any additional benefit to normal activities in terms of neck pain and function[13]
| Outcome | Follow-up | Number of people experiencing greater change with upper extremity exercise in comparison to a control group | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Short-term |
|
Small moderate large |
| Function | Short-term |
|
Small moderate large |
| Outcome | Follow-up | Number of people experiencing greater change with upper extremity exercise in comparison to a control group | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Immediately following treatment period |
1 out of 4 to 6 |
Small moderate large |
| Function | Immediately following treatment |
1 out of 5 to 19 |
Small moderate large |
| Quality of life | Immediately following treatment |
1 out of 7 to 10 |
Small moderate large |
 |
 |
 |
 |
 |
 |
 |
 |
- Click to continue to [[Neck_Pain_Patient_Decision_Aid:_Step_3|Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
Neck pain with headache for more than 6 weeks
Manual therapy and exercise provide greater short and long-term improvements in pain and function compared to no treatment[5]
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to no treatment | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Long-term |
[1 out of 5] |
Small moderate large |
| Function | Long-term |
[1 out of 6] |
Small moderate large |
 |
 |
 |
 |
|
|
 |
 |
Exercise also provides greater short and long-term improvements in pain and function compared to no treatment[5]
| Outcome | Follow-up | Number of people experiencing greater change with manual therapy and exercise in comparison to no treatment | Average difference in improvement between groups |
|---|---|---|---|
| Pain | Long-term |
[1 out of 6] |
Small moderate large |
| Function | Long-term |
[1 out of 6] |
Small moderate large |
|
|
|
|
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
Neck pain after whiplash injury for more than 6 weeks
There is low quality evidence available. Definitive recommendations cannot be made from this research.
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
Neck pain with pain numbness and tingling down your arm
There is low quality evidence available. Definitive recommendations cannot be made from this research.
- Click to continue to Step 3: Recognize the risks
- Click to return to Step 1: Describe your neck pain
References
- ↑ Giebel GD, Edelmann M, Huser R. Diedistorsionderhalswirbelsaule: Fruhfunk-tionalle vs.ruhigstellendebehandlung. Zentralbibliotak Chiropractic 1997;122:517-21.
- ↑ Mealy K, Brennan H, Fenelon GC. Early mobilisation of acute whiplash injuries. Br Med J 1986;92:656-7.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 5.2 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.