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 .
Supervised Exercise With and Without Spinal Manipulation Performs Similarly and Better Than Home Exercise for Chronic Neck Pain: A Randomized Controlled Trial
Study Design . R and omized controlled trial using mixed methods . Objective . To evaluate the relative effectiveness of high-dose supervised exercise with and without spinal manipulation and low-dose home exercise for  chronic neck pain .  Summary of Background Data . Neck pain is a common global health care complaint with considerable social and economic impact . Systematic review s have found exercise therapy ( ET ) to be effective for neck pain , either alone or in combination with spinal manipulation . However , it is unclear to what extent spinal manipulation adds to supervised exercise or how supervised high-dose exercise compares with low-dose home exercise . Methods . Two hundred and seventy patients with chronic neck pain were studied at an outpatient clinic . Patients were r and omly assigned one of the following interventions : ( 1 ) high-dose supervised strengthening exercise with spinal manipulation ( exercise therapy combined with spinal manipulation therapy [ ET + SMT ] ) , ( 2 ) high-dose supervised strengthening exercise ( ET ) alone , or ( 3 ) low-dose home exercise and advice ( HEA ) . The primary outcome was patient-rated pain at baseline and at 4 , 12 , 26 , and 52 weeks . Secondary measures were disability , health status , global perceived effect , medication use , and satisfaction . Results . At 12 weeks , there was a significant difference in patient-rated pain between ET + SMT and HEA ( 1.3 points , P < 0.001 ) and ET and HEA ( 1.1 points , P = 0.001 ) . Although there were smaller group differences in patient-rated pain at 52 weeks ( ET + SMT vs. HEA , 0.2 points , P > 0.05 ; ET vs. HEA , 0.3 points , P > 0.05 ) , linear mixed model analyses incorporating all time points yielded a significant advantage for the 2 supervised exercise groups ( ET + SMT vs. HEA , P = 0.03 ; ET vs. HEA , P = 0.02 ) . Similar results were observed for global perceived effect and satisfaction . Conclusion . Supervised strengthening exercise with and without spinal manipulation performed similarly , yielding better outcomes than home exercise particularly in the short term . Various stakeholders ' perspectives should be considered carefully when making recommendations regarding these therapies , taking into account side effects , preferences , and costs
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 .