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 .
Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial.
STUDY DESIGN R and omized clinical trial . OBJECTIVES To examine the effectiveness of cervical traction in addition to exercise for specific subgroups of patients with neck pain . BACKGROUND Cervical traction is frequently used , but its effectiveness has not been adequately examined . Existing studies have failed to target patients most likely to respond . Traction is typically recommended for patients with cervical radiculopathy . A prediction rule has been described to identify a narrower subgroup of patients likely to respond to cervical traction . METHODS Patients with neck pain and signs of radiculopathy were r and omized to 4 weeks of treatment with exercise , exercise with mechanical traction , or exercise with over-door traction . Baseline assessment included subgrouping-rule status . The primary outcome measure ( Neck Disability Index , scored 0 - 100 ) and secondary outcome measure ( neck and arm pain intensity ) were assessed at 4 weeks , 6 months , and 12 months after enrollment . The primary analyses examined 2-way treatment-by-time interactions . Secondary analyses examined validity of the subgrouping rule by adding 3-way interactions . RESULTS Eighty-six patients ( 53.5 % female ; mean age , 46.9 years ) were enrolled in the study . Intention-to-treat analysis found lower Neck Disability Index scores at 6 months in the mechanical traction group compared to the exercise group ( mean difference between groups , 13.3 ; 95 % confidence interval : 5.6 , 21.0 ) and over-door traction group ( mean difference between groups , 8.1 ; 95 % confidence interval : 0.8 , 15.3 ) , and at 12 months in the mechanical traction group compared to the exercise group ( mean difference between groups , 9.8 ; 95 % confidence interval : 0.2 , 19.4 ) . Secondary outcomes favored mechanical traction at several time points . The validity of the subgrouping rule was supported on the Neck Disability Index at the 6-month time point only . CONCLUSION Adding mechanical traction to exercise for patients with cervical radiculopathy result ed in lower disability and pain , particularly at long-term follow-ups . The study protocol was registered at http:// clinical trials.gov ( NCT00979108 )
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 .