For workers with persistent neck and shoulder pain , evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone ( grade s I-III NAD ) .
A multimodal approach including manual therapy , self-management advice , and exercise is an effective treatment strategy for both recent-onset and persistent neck pain
OBJECTIVE The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders ( NADs ) and whiplash-associated disorders ( WADs ) .
This guideline replaces 2 prior chiropractic guidelines on NADs and WADs .
The addition of cervical thrust manipulations to a manual physical therapy approach in patients treated for mechanical neck pain: a secondary analysis.
STUDY DESIGN Secondary analysis of a r and omized clinical trial ( RCT ) . OBJECTIVES To perform a secondary analysis on the treatment arm of a larger RCT to determine differences in treatment outcomes , adverse reactions , and effect sizes between patients who received cervical thrust manipulation  and those who received only nonthrust manipulation  as part of an impairment-based , multimodal treatment program of manual physical therapy ( MPT ) and exercise for patients with mechanical neck pain . BACKGROUND A treatment regimen of MPT and exercise has been effective in patients with mechanical neck pain . Limited research has compared the effectiveness of cervical thrust manipulations and nonthrust mobilizations for this patient population , and no studies have investigated the added benefit of cervical thrust manipulations as part of an overall MPT treatment plan . METHODS Treatment outcomes from 47 patients in the treatment arm of a larger RCT , with a primary complaint of mechanical neck pain , were analyzed . Twenty-three patients ( 49 % ) received cervical thrust manipulations as part of their MPT treatment , and 24 patients ( 51 % ) received only cervical nonthrust mobilizations . All patients received up to 6 clinic sessions , twice weekly for 3 weeks , and a home exercise program . Primary outcome measures were the Neck Disability Index ( NDI ) , 2 visual analog scales for cervical and upper extremity pain , and a 15-point global rating of change scale . Blinded outcome measurements were collected at baseline and at 3- , 6- and 52-week follow-ups . RESULTS Consistent with the larger RCT , both subgroups in this secondary analysis demonstrated improvement in short- and long-term pain and disability scores . Low statistical power ( beta < or = .28 ) and the result ant small effect size indices ( -0.21 to 0.17 ) preclude the identification of any between-group differences . No serious adverse reactions were reported by patients in either subgroup . CONCLUSIONS Clinical ly meaningful and statistically significant improvements in both subgroups of patients over time suggest that cervical thrust manipulation , as part of the MPT treatment plan , did not influence the results of the treatment arm of the larger RCT from which this study was drawn . Although no between-group differences can be identified , the small observed effect sizes in this study may benefit future studies with sample size estimation for larger RCTs and indicate the need to incorporate clinical prediction rule criteria as a means to improve statistical power . LEVEL OF EVIDENCE Therapy , level 4
For workers with persistent neck and shoulder pain , evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone ( grade s I-III NAD ) .
A multimodal approach including manual therapy , self-management advice , and exercise is an effective treatment strategy for both recent-onset and persistent neck pain
OBJECTIVE The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders ( NADs ) and whiplash-associated disorders ( WADs ) .
This guideline replaces 2 prior chiropractic guidelines on NADs and WADs .