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 manipulative therapy and exercise for seniors with chronic neck pain.
BACKGROUND CONTEXT Neck pain , common among the elderly population , has considerable implication s on health and quality of life . Evidence supports the use of spinal manipulative therapy ( SMT ) and exercise to treat neck pain ; however , no studies to date have evaluated the effectiveness of these therapies specifically in seniors . PURPOSE To assess the relative effectiveness of SMT and supervised rehabilitative exercise , both in combination with and compared to home exercise ( HE ) alone for neck pain in individuals ages 65 years or older . STUDY DESIGN / SETTING R and omized clinical trial . PATIENT SAMPLE Individuals 65 years of age or older with a primary complaint of mechanical neck pain , rated ≥3 ( 0 - 10 ) for 12 weeks or longer in duration . OUTCOME MEASURES Patient self-report outcomes were collected at baseline and 4 , 12 , 26 , and 52 weeks after r and omization . The primary outcome was pain , measured by an 11-box numerical rating scale . Secondary outcomes included disability ( Neck Disability Index ) , general health status ( Medical Outcomes Study Short Form-36 ) , satisfaction ( 7-point scale ) , improvement ( 9-point scale ) , and medication use ( days per week ) . METHODS This study was funded by the US Department of Health and Human Services , Health Re sources and Services Administration . Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses . Blinded evaluations of objective outcomes were performed at baseline and 12 weeks . Adverse event data were collected at each treatment visit . RESULTS A total of 241 participants were r and omized , with 95 % reporting primary outcome data at all time points . After 12 weeks of treatment , the SMT with home exercise group demonstrated a 10 % greater decrease in pain compared with the HE-alone group , and 5 % change over supervised plus home exercise . A decrease in pain  favoring supervised plus HE over HE alone did not reach statistical significance . Compared with the HE group , both combination groups reported greater improvement at week 12 and more satisfaction at all time points . Multivariate longitudinal analysis incorporating primary and secondary patient-rated outcomes showed that the SMT with HE group was superior to the HE-alone group in both the short- and long-term . No serious adverse events were observed as a result of the study treatments . CONCLUSIONS SMT with HE result ed in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone . Supervised exercise sessions added little benefit to the HE-alone program
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 .