Neck Pain Tool-kit: Step 3
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 3 below to inform your technique.
The techniques utilized in the positive trials investigating the use of manual therapy and exercise for the treatment of neck pain are presented below, organized by patient characteristics
- 3.1 Neck pain alone
- 3.2 Neck pain with cervicogenic headache
- 3.3 Whiplash associated disorder
- 3.4 Neck pain with radiculopathy
Once you have found the techniques most applicable to your patient, click on Step 4: consider dosage to see the techniques utilized in the positive studies for that patient population
3.1 Neck pain alone (non-specific)[edit | edit source]
Acute/subacute neck pain[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence for acute/subacute neck pain
- Click to continue to Step 4: Consider dosage
Thoracic manipulation[edit | edit source]
Cleland 2007[edit | edit source]
Reference: Cleland 2007[1]
- upper thoracic spine thrust manipulation targeting T1-T4(a)
- patient laces hands behind his/her neck
- therapist uses the patients elbow to flex spine down to the upper thoracic levels
- therapist stabilizes the inferior vertebrae using his/her manipulative hand and uses his/her chest to provide the thrust manipulation. If no pop is heard, a second attempt is made
- middle thoracic spine thrust manipulation targeting T5-T8 (b)
- patient clasps hands on opposite shoulder
- therapist flexes spine down to the target levels using the patients arms
- therapist provides the thrust manipulation through his/her chest. If no pop is heard, a second attempt is made
- Advice to maintain usual activities within the limits of pain
- Advice to maintain current medications
- Adjunct exercise
- place fingers over manubrium and place chin on the fingers
- rotate the head and neck as far as possible to alternating sides
- start using 5 fingers and progress to 4, 3, 2, and 1 finger as mobility improves
- 10 repetitions to each side, 3-4 times/day
- Click to continue to Step 4: Consider dosage for Cleland 2007
- Click to go back to Step 2: Determine the evidence for acute/subacute neck pain
Gonzalez-Iglesias 2009[edit | edit source]
Reference: Gonzalez-Iglesias 2009[2]
- seated distraction manipulation (c)
- patient seated with arms crossed over the chest and one hand over opposite shoulder and one hand over rib cage
- therapist places his/her upper chest at the level of the patient’s middle thoracic spine
- therapist grasps the patient’s elbows and flexes the thoracic spine until tension is felt
- a distraction manipulation was applied in an upward direction
- if no pop was heard, a second attempt was made
- adjunct electrothermal therapy
- Click to continue to Step 4: Consider dosage for Gonzalez-Iglesias 2009
- Click to go back to Step 2: Determine the evidence for acute/subacute neck pain
Subacute/chronic neck pain[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Manual therapy and exercise[edit | edit source]
Bronfort 2001 ====
Reference: Bronfort 2001[3]
- Spinal manipulation to the cervical and thoracic spine (Haldeman 1991[4]) with light soft-tissue massage as indicated to facilitate the spinal manipulative therapy
- Warm-up on a stationary bike with arm levers
- Light stretching as part of warm-up (a-c)
- Upper-body strengthening exercises (Dyrssen 1989[5])
- Push-ups (d)
- Dumbbell shoulder exercises (e-k)
- Dynamic neck exercises lying on table with headgear attached to a simple pulley system
- extension (l)
- flexion (m)
- rotation (n)
- Click to continue to Step 4: Consider dosage for Bronfort 2001
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Hoving 2002 ====
Reference: Hoving 2002[6]
- An eclectic approach to manual therapy including several techniques used in western Europe, North America, and Australia, including those described by Cyriax, Kaltenborn, Maitland, and Mennel (Basmajian 1993[7]; Cookson 1979[8]; Gross 1996[9]).
- Techniques included:
- “hands-on” muscular mobilization techniques (aimed at improving soft tissue function)
- specific articular mobilization techniques (to improve overall joint function and decrease any restrictions in movement at single or multiple segmental levels in the cervical spine) (o-oo)
- coordination or stabilization techniques (to improve postural control, coordination, and movement patterns by using the stabilizing cervical musculature) (Van der 1993[10]) (pp-rr)
- Click to continue to Step 4: Consider dosage for Hoving 2002
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Jull 2002 ====
Reference: Jull 2002[11]
- Manipulative therapy at the therapist’s discretion (Maitland 2000[12])(y-kk)
- low-velocity cervical joint mobilization techniques (in which the cervical segment is moved passively with rhythmical movements)
- high-velocity manipulation techniques
- Low load endurance exercises to train muscle control of the cervicoscapular region (Jull 1997[13])
- The subjects were first taught to perform a slow and controlled craniocervical flexion action aimed to target the deep neck flexor muscles (pp)
- They then trained to be able to hold progressively increasing ranges of craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck (qq).
- The muscles of the scapula, particularly the serratus anterior and lower trapezius, were trained using inner range holding exercises of scapular adduction and retraction, practiced initially in the prone lying position (ss)
- Training of these neck and scapular muscles also was incorporated into postural correction exercises performed regularly throughout the day in the sitting position. The subjects were trained to sit with a natural lumbar lordosis while gently retracting and adducting their scapulas and gently elongating their cervical spine to facilitate the longus colli (tt)
- Subsequently, isometric exercises using a low level of rotatory resistance were used to train the cocontraction of the neck flexors and extensors (uu)
- They also could be taught muscle lengthening exercises to address any muscle tightness assessed to be present (a-c)
- Click to continue to Step 4: Consider dosage for Jull 2002
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Skargren 1998 ====
Reference: Skargren 1998[14]
- Each patient's treatment was at the discretion of the individual physiotherapist
- None of the physiotherapists was a specialist in manipulation.
- None of the physiotherapists was a specialist in manipulation.
- Click to continue to Step 4: Consider dosage for Skargren 1998
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Ylinen 2003 ====
Reference: Ylinen 2003[15]
Endurance training group
- Neck flexor exercise performed by lifting the head up from the supine position (qq)
- Dynamic exercises for shoulders and upper extremities using dumbbells(2 sets of 20 repetitions with 2kg dumbbells)
- presses (e)
- shrugs (f)
- flyes (h)
- curls (i)
- bent-over rows (j)
- pullovers (k)
- Exercises for trunk and leg muscles against body weight
- squats (vv)
- sit-ups (ww)
- back extensions (xx)
- Stretching for neck, shoulder, and upper limb muscles (a-c, yy-ccc)
- Advice to perform aerobic exercise 3 times a week for a half hour (ddd,eee)
- A common multimodal rehabilitation program, including aspects commonly associated with traditional treatment: relaxation training, aerobic training, behavioral support to reduce fear of pain and improve exercise motivation, and lectures and practical exercises in ergonomics
- 4 sessions of physical therapy, which consisted mainly of massage and mobilization to alleviate neck pain and to enable those with severe neck pain to perform active physical exercises
- Every other session was performed at only half intensity to avoid excessive loading
Strength training group
- Neck exercises with an elastic rubber band performed in a sitting position at 80% of maximum isometric strength recorded at baseline and follow-up visits
- directly forward (fff)
- obliquely toward right and left (ggg)
- directly backward (hhh)
- Dynamic exercises for shoulders and upper extremities using dumbbells (1set of 15 repetitions with highest load possible)
- presses (e)
- shrugs (f)
- flyes (h)
- curls (i)
- bent-over rows (j)
- pullovers (k)
- Exercises for trunk and leg muscles against body weight
- squats (vv)
- sit-ups (ww)
- back extensions (xx)
- Stretching for neck, shoulder, and upper limb muscles (a-c, yy-ccc)
- Advice to perform aerobic exercise 3 times a week for a half hour (ddd, eee)
- A common multimodal rehabilitation program, including aspects commonly associated with traditional treatment: relaxation training, aerobic training, behavioral support to reduce fear of pain and improve exercise motivation, and lectures and practical exercises in ergonomics
- 4 sessions of physical therapy, which consisted mainly of massage and mobilization to alleviate neck pain and to enable those with severe neck pain to perform active physical exercises
- Every other session was performed at only half intensity to avoid excessive loading
- Click to continue to Step 4: Consider dosage for Ylinen 2003
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Allison 2002 ====
Reference: Allison 2002[16]
Neural treatment (Elvey 1997[17]). The treating physiotherapist could use any or all of the following interventions at his/her discretion.
- Cervical lateral glide (iii)
- The subject was positioned in supine, the shoulder slightly abducted with a few degrees of medial rotation, and the elbow flexed to approximately 90 such that the hands were resting on the subject’s chest or abdomen
- The physiotherapist gently supported the shoulder over the acromial region with one hand while holding and supporting the head and neck
- The technique involved a gentle controlled lateral glide to the contralateral side of pain in a slow oscillating manner up to a point in range where the first perception of resistance was felt by the therapist (and before the onset of pain).
- Shoulder girdle oscillation (jjj)
- The subject was positioned prone with the involved arm comfortably supported by the physiotherapist towards a position of hand behind the back.
- The physiotherapist placed the other hand over the acromial area.
- The technique involved a gentle oscillation of the shoulder girdle in a caudad cephalad direction. The range of oscillation was governed by the onset of first resistance perceived by the therapist in the caudad direction.
- The technique was progressed by performing the oscillation in gradually increased amounts of hand behind the back position.
- Muscle re-education
- Contract-relax techniques were performed into shoulder abduction and external rotation.
- This was progressed from a shoulder position of flexion/ adduction towards a position of abduction/external rotation comparable to a quadrant position in the scapular plane (Elvey and Hall, 1997).
- Home mobilisation
- Cervical spine side flexion was performed contralateral to the painful side with the shoulder in a position of abduction, and elbow resting on a table in a flexed position
- Active movements of shoulder abduction and/or external rotation in the same starting position as above was carried out if appropriate (kkk)
- Click to continue to Step 4: Consider dosage for Allison 2002
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Brodin 1985 ====
Reference: Brodin 1985[18]
- superficial massage
- slight and relaxing traction (q)
- electrical stimulation
- 'cervical mobilization (Stoddard 1959[19]) (lll-rrr)
- ‘cervical school’
- education on anatomy and mechanical problems
- how to deal with practical problems such as lifting, carrying, and relaxation
- movements with the aim of improving muscular control of the cervical spine and shoulder girdle
- Click to continue to Step 4: Consider dosage for Brodin 1985
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Karlberg 1996 ====
Reference: Karlberg 1996[20]
- Physiotherapy methods were chosen by the therapist based on analysis of different functions such as mobility, stability, muscle tension and tone, postural alignment and body awareness (Feldenkrais, 1987; Jacobson, 1938; Kaltenborn, 1993; Lewit, 1991)
- The purpose of the treatment was to reduce cervical discomfort, and it included soft tissue treatment, stabilization exercises of the trunk and cervical spine (pp,qq), passive (u-ff) and active mobilization (sss-vvv), relaxation techniques (www), home training programs and minor ergonomic changes at work
- The majority of the patients underwent several treatment modalities, depending on findings from the analysis mentioned above
- Click to continue to Step 4: Consider dosage for Karlberg 1996
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Palmgren 2006 ====
Reference: Palmgren 2006[21]
- Patients received information regarding basic anatomy and physiology of the spine, principles of ergonomics for neck pain patients, and basic instructions on how to exercise and cope with the pain. The clinical findings were explained and potential causes of pain were clarified
- The patients were told that neck pain generally has a benign, self-limiting natural course and that the healing process could be accelerated by simple, regular exercises and by avoiding immobility
- The choice of therapy and modality was pragmatic and based on the analysis of different functions such as mobility, muscle tension and tone, and each patient’s symptoms, but might include:
- high-velocity and low-amplitude techniques
- myofascial techniques
- spine-stabilizing exercises targeted toward hypomobile zygapophyseal joints in the cervical region and the cervicothoracic junction
- The spine stabilizing exercises consisted of:
- 4-5 minutes of jogging for a warm-up was performed (eee)
- Stretching of cervical and shoulder region (a-c, yy-ccc)
- Cervical isometrics in supine and seated (xxx-ffff)
- Click to continue to Step 4: Consider dosage for Palmgren 2006
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Strengthening exercise[edit | edit source]
Chiu 2005[edit | edit source]
Chiu 2005[22]
- An intensive neck exercise program using the Multi Cervical Rehabilitation Unit (MCRU) (Pollock 1993[23]) and the exercise protocol of (Jull 1999[24])
- Activation of the deep neck muscles aimed to enhance their ability for active stabilization for warm-up (a)
- Flexion and extension of neck using the MCRU as a warm-up exercise for the superficial neck muscles using resistance equal to approximately 20% of the peak isometric muscle strength as warm-up (b)
- Full flexion and extension within pain tolerance (b)
- The dynamic weight load was calculated to be about 30% of the peak isometric muscle strength
- The weight load was increased by approximately 5%, when a set of 12 or more repetitions had been achieved.
- Activation of the deep neck flexor muscles (c)
- the patient lay down in the supine position with the weight of the head and the cervical spine supported by towels under the occiput in a neutral position
- An air-filled pressure sensor (Stablizer, Chattanooga South Pacific, Australia) was used to monitor the subtle flattening of the cervical lordosis that was expected to occur with contraction of deep neck flexors.
- The sensor was placed suboccipitally behind the neck and inflated to 20 mmHg
- The patient was instructed to slowly nod the head in an action indicating 'yes', so as to raise the pressure to a level that could be held steadily for 10 seconds
- A 15 second break was given between each 10 second hold and this pattern was repeated for 10 minutes or until patient was unable to hold the contraction
- Click to continue to Step 4: Consider dosage for Chiu 2005
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Bronfort 2001[edit | edit source]
Reference: Bronfort 2001[3]
- Stretching for warm-up (d-f)
- Aerobic exercise using dual action stationary bike for warm-up
- Strengthening of shoulders and upper back using MedX variable resistance equipment (g)
- Patients were stabilized with torso restraints to isolate and specifically exercise the cervical musculature.
- They were encouraged to perform repetitions to volitional muscle fatigue (maximum 20 reps) even if pain was exacerbated, and resistance was increased periodically (Highland 1992[25]; Nelson 1999[26]).
- Click to continue to Step 4: Consider dosage for Bronfort 2001
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Franca 2008[edit | edit source]
Reference: Franca 2008[27]
Strengthening exercise (Hall 1999[28])
- Stretching exercise of the muscles of the neck and upper limbs regions (d-f, h-l)
- Recruitment exercise of the deep cervical flexion muscles (wave movement of the head) (a)
- Strengthening exercise of the deep cervical flexion muscles (c)
- Strengthening of upper limbs (o-r)
- Click to continue to Step 4: Consider dosage for Franca 2008
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Martel 2011[edit | edit source]
Reference: Martel 2011[29]
- Advised to perform a home exercise program 3 times/week
- All participants were instructed in the same routine
- Exercise volume was tailored to each participant’s strength, flexibility and ability to complete the routine with minimal neck pain
- Each patient received a written copy of the program and exercises were checked every 2 months by a kinesiologist
- Exercises included
- Range of motion exercises (Manual therapy and exercise figures sss-vvv)
- 4 stretching/mobilisation exercises (d-f)
- 4 strengthening exercises (concentric and isometric contractions) of the cervical and upper thoracic spine (primarily flexion, extension, lateral flexion and rotation of the cervical spine) (Manual therapy and exercise figures xxx-bbbb).
- Click to continue to Step 4: Consider dosage for Martel 2011
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Qigong exercises[edit | edit source]
Rendant 2011[edit | edit source]
Reference: Rendant 2011[30]
- 12 neck exercises including ROM and imagery
- Turn head (a)
- Tilt head (b)
- Bow head (c)
- Roll head gently (or rotate head)(d)
- Bend neck like an immortal crane
- Gently rock head like an old sage
- While nodding turn head from side to side (e)
- Imagine a huge dragon was twisting your neck
- Rub the base of your skill (described as gallbladder 20) (f)
- Rub your neck (g)
- Knead your neck (h)
- Let your arms hang loose and swing (i)
- 7 Shoulder exercises
- Massage shoulders(j)
- Move shoulders in a circular motion (k)
- Move shoulders as if you were rowing(l)
- Raise shoulders (m)
- Open and close shoulders (Expander-exercises) (n-o)
- Tap on shoulders, tap the kidneys(p-q)
- Jia Ji Gong
- 7 moving exercises
- Uplift clear thoughts, let troubled thoughts subside
- Push the boot against the current
- Be at one with the universe from within
- The spring breeze caresses the weeping willow
- The older the tree, the deeper the roots
- Stretch up toward the sky
- Stand on one leg like a golden hen
- Click to continue to Step 4: Consider dosage for Rendant 2011
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Von Trott 2009[edit | edit source]
Reference: von Trott 2009[31]
- 10 minutes of typical qigong "opening" exercises with 10-12 specific exercises: hip, legs, shoulders, arms and the head are moved in a qigong specific way (Wiedemann 2008[32])
- Up to 4 exercises of Dantian Qigong (Wiedemann 2008[32])
- Opening and closing of the Dantian(r-t)
- Embracing the waterpot (u-w)
- Bringing fire below the waterpot (x-aa)
- Uniting the three Dantian (bb-hh)
- 10 minutes of "closing" exercises (e.g. striking the meridians, circles over the lower Dantian and rubbing the kidney region (Wiedemann 2008[33])
- Click to continue to Step 4: Consider dosage for Von Trott 2009
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Cervical range of motion and strengthening exercises[edit | edit source]
Rendant 2011[edit | edit source]
Reference: Rendant 2011[30]
- Warming up with a soft ball
- Practice standing upright
- Pass the ball around the body at shoulder height
- Throw and catch the ball
- Main exercises with theraband
- Stretch the theraband (a)
- Rowing movements with theraband (b)
- Move as if climbing a ladder (c)
- Hold band in front of body (d)
- Hold band behind your head (e)
- With your arms above your head, grip your hands (as if picking fruit) (f)
- With arms stretched out at shoulder height, turn head (g)
- Swing arms (h)
- With head bowed, stretch out arms (i)
- Place band under your feet and pull it tight (j)
- Standing opposite a partner with two bands stretched out beween each pair, pull it backwards and forwards (like a train piston) (k)
- Closing exercises
- Move head slowly from left to right (l)
- Move head backwards and forwards (m-n)
- Bow head and stretch arms to the floor (o)
- With arms outstretched, turn head (p)
- Swing arms (q)
- While sitting, roll your body into a ball and then straighten out (r-s)
Click to continue to Step 4: Consider dosage for Rendant 2011
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Von Trott 2009[edit | edit source]
Reference: von Trott 2009[34]
- Exercise therapy was based on a standardized program for computer and workplace related neck pain (Wiedemann 2008[32])
- Mobilizing and stabilizing the whole vertebrae (s-t)
- Strengthening the dorsal neck muscles (u)
- Softening the atlanto-axial and upper vertebra joints (v-w)
- Strengthening the lateral neck muscles (x)
- Strengthening the ventral neck muscles (y)
- Click to continue to Step 4: Consider dosage for Von Trott 2009
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Isometric strengthening exercise[edit | edit source]
Helewa 2007[edit | edit source]
Reference: Helewa 2007[35]
- Adjunct moist hot or cold pack according to patient preference, applied for 20 minutes to the neck and upper scapular area and instruction for home use
- Adjunct effleurage massage consisted of soothing rhythmic superficial strokes lasting 5 minutes.
- Adjunct neck support pillow to be used during sleep
- Participants received a neck support pillow to be used during sleep
- Two types of pillows were randomly assigned equally in each arm: Shape of Sleep and the Sissel Design AB Swedish foam pillow (Sissel Design AB, Svedala, Sweden)
- Sitting posture taught and reinforced by mirror feedback, was a relaxed mid-position, with the shoulders neither retracted nor protracted. Viewed from the side, the head is held with the ear above the shoulder (a)
- Manually resisted isometric exercises involved muscle groups acting on the head, neck, and shoulder girdles. Contraction of one muscle group was followed slowly and rhythmically by a contraction of its antagonist (b-e)
- Click to continue to Step 4: Consider dosage for Helewa 2007
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Goldie 1970[edit | edit source]
Reference: Goldie 1970[36]
- different cervical movments against the physiotherapist’s gentle pressure to the maximum ability under the pain threshold (b-e)
- 10 minutes rest in supine on a low pillow following treatment
- Click to continue to Step 4: Consider dosage for Goldie 1970
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Eye-neck coordination exercises[edit | edit source]
Revel 1994[edit | edit source]
Reference: Revel 1994[37]
- slow passive motions of head in supine while patient maintains gaze on a fixed target (a)
- active head movement (mainly rotation) in standing with restricted gaze (0.5mm) following a mobile target (b)
- gaze on a fixed target with restricted gaze while the physiotherapist passively moves the trunk (c)
- fix a target for a few seconds, remember the position, then close eyes and maximally rotate the head and try to find the initial position (d)
- following a mobile target with free eye neck coupling alternating between slow pursuits and saccadic movement (e)
- Click to continue to Step 4: Consider dosage for Revel 1994
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Cervical Manipulation[edit | edit source]
Bitterli 1977[edit | edit source]
Reference: Bitterli 1977[38]
- Click to continue to Step 4: Consider dosage for Bitterli 1977
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Howe 1983[edit | edit source]
Reference: Howe 1983[42]
- Manipulation (Bourdillon 1975[43]) (e-g)
- Move the joint as far as comfortably possible and then apply a quick thrust of moderate force in the same direction
- Injection of either methylprednisonlone or mixture of lignocaine and hydrocortisone to the dorsum of the appropriate apophyseal joint in two patients whose necks were too painful to manipulate
- Click to continue to Step 4: Consider dosage for Howe 1983
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Martinez-Segura 2006[edit | edit source]
Reference: Martinez-Segura 2006[44]
- Manipulation (Gibbons 2000[45]) (g)
- The patient was supine with the cervical spine in a neutral position
- The index finger of the therapist applied contact over the posterior lateral aspect of the articular pillar at the dysfunctional side of the identified vertebra (assessed by the lateral gliding test).
- The therapist’s other hand cradled the patient’s head
- Gentle ipsilateral side flexion and contralateral rotation were introduced from the restricted side until slight tension was palpated in the tissues at the contact point
- A high velocity, low amplitude thrust was directed upward and medially in the direction of the patient’s contralateral eye
- Click to continue to Step 4: Consider dosage for Martinez-Segura 2006
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Sloop 1982[edit | edit source]
Reference: Sloop 1982[46]
Manipulation performed by a rheumatologist (Cyriax 1971[47]; Maigne 1972a,b,c[39][40][41]; Maitland 1968[48]; Matthews 1972[49]) (a-d), h-s)
- Click to continue to Step 4: Consider dosage forSloop 1982
- Click to go back to Step 2: Determine the evidence forsubacute/chronic neck pain
Vernon 1990[edit | edit source]
Reference: Vernon 1990[50]
Rotational thrust manipulation (g)
- Click to continue to Step 4: Consider dosage for Vernon 1990
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Thoracic manipulation[edit | edit source]
Cleland 2005[edit | edit source]
Reference: Cleland 2005[51]
- Thoracic thrust manipulation to each level with an identified segmental mobility restriction (a-b)
- The stabilizing hand was placed at the level immediately caudal to the restricted segment using a ‘‘pistol grip’’
- Once the pre-manipulative position was achieved the patient was instructed to take a deep inhalation and exhale
- During the exhalation the treating clinician performed a high velocity, small amplitude thrust in a direction to facilitate relative closing or opening of the respective facet joint as indicated by the segmental examination
- If an audible cavitation was heard during the first manipulation attempt, the treating clinician proceeded to the next segment
- If no audible cavitation was heard, the patient was repositioned, and the manipulation intervention was repeated
- If no audible cavitation was noted after two attempts, the physical therapist manipulated the next segmental restriction
- Click to continue to Step 4: Consider dosage for Cleland 2005
- Click to go back to Step 2: Determine the evidence for subacute/chronic neck pain
Unspecified/mixed duration neck pain[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Strengthening exercise
[edit | edit source]
Andersen 2008[edit | edit source]
Reference: Andersen 2008[52]
- High intensity strength training for neck and shoulder muscles
- Arm row (a)
- Shoulder abduction (b)
- Shoulder elevation (c)
- Reverse flies (d)
- Upright row (e)
- Click to continue to Step 4: Consider dosage for Andersen 2008
- Click to go back to Step 2: Determine the evidence for unspecified/mixed duration neck pain
3.2 Neck pain with cervicogenic headache[edit | edit source]
Acute/subacute neck pain with cervicogenic headache[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Manual therapy and exercise
Exercise
Manual therapy
Chronic neck pain with cervicogenic headache[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Manual therapy and exercise
Exercise
Manual therapy
3.3 Whiplash associated disorder[edit | edit source]
Acute/subacute whiplash associated disorder[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Manual therapy and exercise
Exercise
Manual therapy
Chronic whiplash associated disorder[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Manual therapy and exercise
3.4 Neck pain with radiculopathy[edit | edit source]
Acute neck pain with radiculopathy
[edit | edit source]
- Click to go back to Step 1: Identify your patient
- Click to go back to Step 2: Determine the evidence
- Click to continue to Step 4: Consider dosage
Exercise
Manual therapy
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Cleland 2007
- ↑ 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 There 2009;39(1):20–7.
- ↑ 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.
- ↑ Haldeman S, Phillips RB. Spinal manipulative therapy in the management of low back pain. In: Frymoyer JW, Ducker TB, Hadler NM, et al, eds. The Adult Spine: Principles and Practice. New York: Raven Press, 1991:1581-605.
- ↑ Dyrssen T, Svedenkrans M, Paasikivi J. Muskeltraning vid besvar i nacke och skuldror effektiv behandling for att minska smartan. Lakartidningen 1989;86:2116-20.
- ↑ Cite error: Invalid
<ref>
tag; no text was provided for refs namedHoving 2002
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