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 .
Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial.
STUDY DESIGN R and omized clinical trial . OBJECTIVE To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude ( HVLA ) thrust manipulation to nonthrust mobilization in patients with neck pain . BACKGROUND Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain , no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain . METHODS Patients completed the Neck Disability Index , the numeric pain rating scale , the flexion-rotation test for measurement of C1 - 2 passive rotation range of motion , and the craniocervical flexion test for measurement of deep cervical flexor motor performance . Following the baseline evaluation , patients were r and omized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical ( C1 - 2 ) and upper thoracic ( T1 - 2 ) spines . Patients were reexamined 48-hours after the initial examination and again completed the outcome measures . The effects of treatment on disability , pain , C1 - 2 passive rotation range of motion , and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance ( ANOVA ) . RESULTS One hundred seven patients satisfied the eligibility criteria , agreed to participate , and were r and omized into the HVLA thrust manipulation  ( n = 56 ) and  nonthrust mobilization  ( n = 51 ) groups . The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly ( P<.001 ) greater reductions in disability ( 50.5 % ) and pain ( 58.5 % ) than those of the nonthrust mobilization group ( 12.8 % and 12.6 % , respectively ) following treatment . In addition , the HVLA thrust manipulation group had significantly ( P<.001 ) greater improvement in both passive C1 - 2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization . The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up , using the global rating of change and Neck Disability Index cut scores , respectively . CONCLUSION The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain . LEVEL OF EVIDENCE Therapy , level 1b
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 .