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 .
Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain
BACKGROUND Mechanical neck pain is a common condition that affects an estimated 70 % of persons at some point in their lives . Little research exists to guide the choice of therapy for acute and subacute neck pain . OBJECTIVE To determine the relative efficacy of spinal manipulation therapy ( SMT ) , medication , and home exercise with advice ( HEA ) for acute and subacute neck pain in both the short and long term . DESIGN R and omized , controlled trial . ( Clinical Trials.gov registration number : NCT00029770 ) SETTING 1 university research center and 1 pain management clinic in Minnesota . PARTICIPANTS 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks . INTERVENTION 12 weeks of SMT , medication , or HEA . MEASUREMENTS The primary outcome was participant-rated pain , measured at 2 , 4 , 8 , 12 , 26 , and 52 weeks after r and omization . Secondary measures were self-reported disability , global improvement , medication use , satisfaction , general health status ( Short Form-36 Health Survey physical and mental health scales ) , and adverse events . Blinded evaluation of neck motion was performed at 4 and 12 weeks . RESULTS For pain  , SMT had a statistically significant advantage over medication after 8 , 12 , 26 , and 52 weeks ( P ≤ 0.010 ) , and HEA was superior to medication at 26 weeks ( P = 0.02 ) . No important differences in pain were found between SMT and HEA at any time point . Results for most of the secondary outcomes were similar to those of the primary outcome . LIMITATIONS Participants and providers could not be blinded . No specific criteria for defining clinical ly important group differences were prespecified or available from the literature . CONCLUSION For participants with acute and subacute neck pain  , SMT was more effective than medication in both the short and long term . However , a few instructional sessions of HEA result ed in similar outcomes at most time points . PRIMARY FUNDING SOURCE National Center for Complementary and Alternative Medicine , National Institutes of Health
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 .