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 .
Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes.
BACKGROUND CONTEXT This is the first study to systematic ally evaluate the value of a longer treatment period for massage . We provide a framework of how to conceptualize an optimal dose in this challenging setting of nonpharmacologic treatments . PURPOSE The aim was to determine the optimal dose of massage for neck pain . STUDY DESIGN / SETTING Two-phase r and omized trial for persons with chronic nonspecific neck pain . Primary r and omization to one of five groups receiving 4 weeks of massage ( 30 minutes 2x/or 3x/wk or 60 minutes 1x , 2x , or 3x/wk ) . Booster r and omization of participants to receive an additional six massages , 60 minutes 1x/wk , or no additional massage . PATIENT SAMPLE A total of 179 participants from Group Health and the general population of Seattle , WA , USA recruited between June 2010 and August 2011 were included . OUTCOME MEASURES Primary outcomes self-reported neck-related dysfunction ( Neck Disability Index ) and pain ( 0 - 10 scale ) were assessed at baseline , 12 , and 26 weeks . Clinical ly meaningful improvement was defined as greater than or equal to 5-point decrease in dysfunction and greater than or equal to 30 % decrease in pain from baseline . METHODS Clinical ly meaningful improvement for each primary outcome with both follow-up times was analyzed using adjusted modified Poisson generalized estimating equations ( GEEs ) . Secondary analyses for the continuous outcomes used linear GEEs . RESULTS There were no observed differences by primary treatment group at 12 or 26 weeks . Those receiving booster dose had improvements in both dysfunction and pain at 12 weeks ( dysfunction : relative risk [RR]=1.56 [ 1.08 - 2.25 ] , p=.018 ; pain : RR=1.25 [ 0.98 - 1.61 ] , p=.077 ) , but those were nonsignificant at 26 weeks ( dysfunction : RR=1.22 [ 0.85 - 1.74 ] ; pain : RR=1.09 [ 0.82 - 1.43 ] ) . Subgroup analysis by primary and booster treatments found the booster dose only effective among those initially r and omized to one of the 60-minute massage groups . CONCLUSIONS " Booster " doses for those initially receiving 60 minutes of massage should be incorporated into future trials of massage for chronic neck pain
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 .