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 .
Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain.
STUDY DESIGN R and omized controlled trial . Objective To determine if force magnitude during posterior-to-anterior mobilization affects immediate and short-term outcomes in patients with chronic , nonspecific neck pain . BACKGROUND The optimal dose of mobilization to effectively treat patients with neck pain is not known . METHODS Patients with neck pain of at least 3 months in duration ( n = 64 ) were r and omized to receive a single treatment of posterior-to-anterior mobilization applied with 30 N or 90 N of mean peak force ( 3 sets of 30 seconds ) or a placebo ( detuned laser ) on the spinous process at the painful spinal level . Pressure pain threshold , pain measured with a visual analog scale ( range , 0 - 100 mm ) , cervical range of motion , and spinal stiffness at the painful spinal level ( measured with a custom device and normalized as a percentage of C7 stiffness ) were assessed before , immediately after , and at a mean ± SD follow-up of 4.0 ± 1.8 days following treatment . Repeated- measures analysis of covariance and Bonferroni-adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow-up . RESULTS At follow-up , the 90-N group had less pain than the 30-N group ( mean difference , 11.3 mm ; 95 % confidence interval : 0.1 , 22.6 mm ; P = .048 ) and lower stiffness than the placebo group ( mean difference , 17.5 % ; 95 % confidence interval : 4.2 % , 30.9 % ; P = .006 ) . These differences were not present immediately after treatment . There were no significant between-group differences in pressure pain threshold or range of motion after treatment or at follow-up . CONCLUSION A specific dose of mobilization , in terms of applied force , appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain . Changes were not observed immediately after mobilization , suggesting that its effects are not directly mechanical . TRIAL REGISTRATION Australian and New Zeal and Clinical Trials Registry ( http://www.anzctr.org.au/ ) : ACTRN12611000374965 . 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 .