Management Of Non-specific Neck Pain Research Articles

Osteopathic management of non-specific neck pain: Preliminary findings from a cross sectional study of Australian osteopaths

ObjectiveNeck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP. MethodsCross sectional design. Via an online survey. ResultsAll participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP. ConclusionThis study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines. Implications for clinical practice•All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.•Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.•Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.

Evidence-based work up and management of non-specific neck pain in the emergency department

Neck pain has become a commonly encountered complaint in the emergency department and primary care office. A large proportion of the population, ranging from a fifth (⅕) to a third (⅓) of the total, will experience non-specific neck pain in their lifetime. Because of the difficulty to quickly parse out the differential and the severity of several of these diagnoses, it is imperative for physicians in the emergency department to establish a systematic and effective approach for evaluating nonspecific neck pain. This article will present a standardized case of a patient presenting with nonspecific neck pain, critically analyze current evidence and guidelines from major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, examine major statements released by the Choosing Wisely Campaign, and propose a new diagnostic decision tree for the management of nonspecific neck pain.

Psychosocial correlates of pain intensity and neck disability index among people with non-specific neck pain in a low-resource setting: a cross-sectional study

Background Psychosocial factors such as pain catastrophising (PC), kinesiophobia, and pain self-efficacy (PSE) complicate disease burden among people with chronic pain and disability. Purpose To investigate the psychosocial correlates of neck pain intensity and disability among Nigerians with non-specific neck pain (NSNP). Methods We conducted a cross-sectional study of Nigerians with NSNP through hospitals-based consecutive sampling. Numeric Pain Rating Scale and the Neck Disability Index questionnaire were used to assess participants’ pain intensity (PI) and neck disability (ND), respectively. Kinesiophobia, PC, and PSE were assessed using Tampa Scale for Kinesiophobia (TSK), Pain Catastrophising Scale, and Pain Self-efficacy Questionnaire, respectively. Data analyses were completed using descriptive statistics, independent samples t-test, Pearson’s correlation coefficient, and multiple linear regression at p ≤ 0.05. Results Participants were (24 males, 48 females) aged 51.56 ± 14.31 years. The average PI (5.28 ± 1.80) and ND (35.03 ± 17.85) were moderate. There were significant correlations between PC and PI (r = 0.350, p = 0.003), and ND (r = 0.339, p = 0.004); kinesiophobia and ND (r = 0.314, p = 0.007); and PSE and ND (r = − 0.561, p < 0.001). Multiple linear regression analysis showed that PC (β = 0.270, p = 0.026) and ND (β = 0.494, p = 0.001) significantly predicts PI, while age (β = 0.197, p = 0.038), PI (β = 0.344, p = 0.001), and PSE (β= −0.474, p < 0.001) predicts ND. There were no statistically significant gender differences in PC, kinesiophobia and PSE. Conclusion Non-specific neck pain and ND correlates with psychosocial factors such as PC and PSE, respectively. There were no gendered differences in psychosocial responses to NSNP, however, older individuals tend to have more severe ND. Assessment of age and psychosocial factors should be included in management of NSNP.

Effect of post-isometric relaxation versus myofascial release therapy on pain, functional disability, rom and qol in the management of non-specific neck pain: a randomized controlled trial

BackgroundNon-specific neck pain is the most prevailing musculoskeletal disorder which has a large socioeconomic burden worldwide. It is associated with poor posture and neck strain which may lead to pain and restricted mobility. Physical therapists treat such patients through several means. Post isometric relaxation and Myofascial release therapy are used in clinical practice with little evidence to be firmed appropriately. So, this study was conducted to explore the effect of Post-isometric relaxation in comparison to Myofascial release therapy for patients having non-specific neck pain.MethodologySixty patients were randomly allocated to Post isometric group and the Myofascial group. The treatment period was of 2 weeks. All the patients were evaluated using the Visual analogue scale (VAS), Neck disability index (NDI), Universal Goniometer, and WHO BREF Quality of life-100 in the 1st and 6th sessions. Recorded data was entered on SPSS 21. Data were examined using two-way repeated ANOVA to measure the variance of analysis (group x time).ResultsAnalysis of the baseline characteristics revealed that both groups were homogenous in terms of age and gender i.e. a total of 60 participants were included in this research study 30 in each group. Out of 60 patients, there were 20(33.3%) males and 40(66.7%) females with a mean age of 32.4(5.0) years. Participants in the Post Isometric group demonstrated significant improvements (p < 0.025) in VAS, NDI, Cervical Extension, left side rotation ranges, and QoL (Social Domain) at the 2-week follow-up compared with those in the Myofascial group. In addition, the Myofascial group indicated significantly better improvement in the mean score of CROM (flexion and right and left side bending).ConclusionThe study demonstrated patients with nonspecific neck pain can benefit from the post isometric relaxation with significant improvement in pain, disability, cervical ROM, and Quality of life compared with myofascial release therapy.Trial registrationClinical Trial registered on clinicaltrial.gov (NCT number) NCT04638062, 20/11/2020 (prospectively registered).

Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial.

Therapeutic exercise (TE) is highly recommended for the management of non-specific neck pain (NSNP) and has shown promising results combined with interferential current therapy. Yet, the clinical relevance of the pooled effect of these approaches remains uncertain. To investigate the immediate clinical effect size of combining TE and interferential therapy, compared with the isolated use of TE, in adults with chronic NSNP. Randomized, single-blinded, controlled, superiority trial. Outpatients, primary care center. Forty-nine adults with chronic NSNP. Participants with neck pain (grades I or II) lasting for more than 12 weeks were allocated to a TE plus interferential currents group (N.=25) or to a TE only group (N.=24). All individuals underwent treatment 5 times a week for 2 weeks. The primary outcome was current neck pain intensity (11-point Numeric Pain Rating Scale). Secondary outcomes included neck disability (Neck Disability Index) and active cervical range-of-movement (CROM device). Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat (NNT) were calculated. A significant time*group effect was found for pain intensity, disability, and neck flexion and right rotation (all, P<0.05). In the analysis for treatment benefit, the NNT was 2 (95% CI: 2 to 4, P<0.001) for neck pain and disability, and 3 (95% CI: 2 to 11, P=0.029) for neck flexion. Adding interferential therapy to TE is clinically more effective than TE alone to immediately improve neck pain and disability, but not active cervical range-of-movement, in adults with persistent neck pain. Our results suggest that this multimodal intervention can be a useful strategy for rehabilitation of patients with NSNP. This is the first study on this topic reporting findings in terms of clinical relevance, which is key to transfer research evidence into practice.

Utilisation of outcome measures in the management of non-specific neck pain: A national survey of current physiotherapy practice in the UK

BackgroundRoutine utilisation of outcome measures (OMs) is an integral part of physiotherapy rehabilitation when managing non-specific neck pain (NSNP). Numerous relevant OMs exist; however, the extent to which OMs are used by physiotherapists in the UK for NSNP is unknown. ObjectiveTo determine current utilisation patterns of OMs in UK physiotherapy practice when managing NSNP. MethodsAn online web-based survey instrument was developed and physiotherapists were invited to participate if they were currently practicing in the UK and had some experience of managing patients with neck pain. Logistic regression analyses using the generalised linear models was carried out to identify characteristics associated with OMs utilisation. ResultsA total of 2101 surveys were completed. One-third of the respondents reported not using OMs when managing NSNP. Lack of time and clear guidance about the suitability of available OMs were the most commonly reported reasons. A majority of the two-thirds of those who reported using OMs were consistently using pain and range of motion rating measures. Physical/functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NSNP, were rarely measured. Years of practice (p = 0.000), nation (p = 0.019) and proportion of patients with neck pain (p = 0.034) variables were found to be independently associated with frequent use of OMs. ConclusionThis survey established the poor integration of OMs in the UK when managing NSNP. Further attention is required to identify or develop OMs which are feasible for use in busy clinical practice and to market them more effectively to physiotherapists.

Addition of Myofascial Release Therapy to Therapeutic Exercise for Management of Nonspecific Neck Pain

Purpose : It is necessary to demonstrate the effect of non-invasive and non-pharmacological interventions such as manual therapy and therapeutic exercise for the management of nonspecific neck pain. In the present study, we aimed to investigate the efficacy of myofascial release therapy plus therapeutic exercise for disability owing to neck pain and quality of life in individuals with nonspecific neck pain. Methods : Eighteen participants with nonspecific neck pain were randomly allocated to intervention (n=9) and control groups (n=9). The intervention group received a myofascial release therapy for 20 min and performed neck stabilization exercises for 30 min twice a week for 4 weeks. The control group performed neck stabilization exercises for 30 min twice a week for 4 weeks at the same time points as the intervention group. Disability owing to neck pain and quality of life were quantified using the neck disability index (NDI) and the Korean version of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), respectively. NDI and WHOQOL-BREF were assessed before and after intervention. Results : The disability owing to neck pain significantly changed between the groups over time (total score of NDI, p=.049). There were significant time and group interactions in pain (pain intensity of NDI, p=.035) and concentration (concentration of NDI, p=.049). Personal care, lifting, reading, headaches, work, driving, sleeping, and recreation did not show significant improvement between the groups over time. Total score, overall quality of life and general health, physical health domain, psychological domain, social relationships domain, and environmental domain quantified by WHOQOL-BREF did not show significant improvements between the groups over time. Conclusion : These results suggest the clinical use of myofascial release therapy in addition to therapeutic exercise for the management of nonspecific neck pain. Further studies are needed to generalize the findings of this study.

The Effectiveness of Isometric Strengthening with Static Stretching vs. Static Stretching in Nonspecific Chronic Neck Pain

Background: The objective was to compare the effectiveness of Isometric neck strengthening exercises with static stretching vs. static stretching alone in the management of nonspecific chronic neck pain. Materials and methods: This study was a randomized controlled trial. 52 patients with non-specific chronic neck pain were randomly assigned through simple random sampling technique, into experimental (group 1) received Isometric training with static stretching and control group (group 2) received Static stretching alone. While aerobic training was initiated by both groups prior their main interventions. Therapeutic session was 3 days per week for 1 month. Neck pain and Disability was assessed by using outcome measures, numeric pain rating scale (NPRS) and neck disability index (NDI). Treadmill machine, Stationary Cycle and Stop watch were used during treatment session. Results: Both groups showed improvements; the baseline mean NDI score was 34.46 ± 11.80 and the final session score was 23.26 ± 17.46 which was significantly (p<0.001) whilst the baseline mean NPRS score was 5.38 ± 1.60 and the final session mean score was 2.65 ± 1.59 which was significantly (p<0.001) in experimental group (Group 1). In control group (Group 2), the baseline mean NDI score was 30.88 ± 10.75 and the final session mean score was 28.44 ± 10.43 which was significantly (p=0.002) whilst the baseline mean NPRS score was 5.00 ± 1.64 and the final session mean score was 3.80 ± 1.87 which was significantly (p=0.001). Conclusion: Both treatment regimens are effective in the management of chronic nonspecific neck pain; however Isometric strengthening exercises training with static stretching appears more valuable as compared with Static stretching training alone.

COMPARISON BETWEEN MCKENZIE EXTENSION AND NECK ISOMETRIC EXERCISES IN THE MANAGEMENT OF NONSPECIFIC NECK PAIN: A RANDOMIZED CONTROLLED TRIAL

OBJECTIVE: To compare the effects of neck exercises (McKenzie extension and isometric exercises) in the management of non-specific neck pain and range of motion in patients with neck pain.METHODS: This randomized controlled trial was conducted in physiotherapy departments of Dr. Akbar Niazi Teaching Hospital, Islamabad. Forty consecutive patients with acute to sub-acute cases of neck pain (<3 month) were enrolled. Based on lottery method two groups (n=20 in each group) were differentiated, Group-I (control) received isometric neck exercises and Group-II (treatment) received McKenzie extension exercises for 4-weeks along with hot packs therapy. Neck pain was measured using numeric pain rating scale (NPRS). All patients were tested on baseline, at 2nd and 4th week.RESULTS: Mean age of the sample was 33.85±4.80 and 33.50±5.20 years in group-I and group-II respectively. Male to female ratio was 4:1 in both groups. Mean body mass index was 24.54±1.50kg/m2. NPRS at baseline was 5.80±0.41 in group-I while 6.10±0.64 in group-II (p-value=0.001). NPRS decreased to 3.75±0.72 in group-I and 3.00±0.73 in group-II after 4-weeks (p-value=0.001). Neck flexion (degrees) at baseline was 31±2.05 in group-I and 35.75±1.83 in group-II (p-value=0.001) while after 4weeks increased to 35.50±4.26 in group-I and 40±4.29 in group-II (p-value=0.002). Neck extension (degrees) at baseline was 44±2.05 in group-I and 40.75±1.83 in group-II (p-value=0.001) while after 4-weeks increased to 48.5±4.01 in group-I and 45±4.29 in group-II (p-value=0.011).CONCLUSION: McKenzie exercises are more significant and show more improvement in reduction of pain and associated symptoms of neck and increased movements quicker than isometric exercises.

Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain; a randomized controlled trial.

To compare the effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain. The randomized controlled trial was conducted at 3 different hospitals in Peshawar, Pakistan, from October 2016 to January 2017, and comprised patients suffering from non-specific neck pain aged 25-60 years. The control group received cervical manual therapy alone while the experimental group received cervical along with thoracic manual therapy for 2 weeks. Data was analysed using SPSS 20. Of the 37 subjects, 20(54%) were cases and 17(46%) were controls.The overall mean age was 35.9±9.6 years. There was no significant difference between the groups at baseline in terms of the levels of pain (p=0.125) and disability (p=0.392). The experimental group showed greater reduction in pain (p=0.02) and disability (p=0.03) compared to the control group. Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone.

Comparison of CPG\u2019s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review

BackgroundNeck pain (NP) is a very common musculoskeletal condition with potential for a high burden in disability and length of disorder. Clinical practice guidelines (CPG) give recommendations to clinicians for providing optimal care for patients however best practice recommendations are often contradictory. The purpose for this review was to conduct a SR of CPGs to assess the management recommendations for NP (diagnosis, treatment, prognosis, imaging).MethodsStandard SR methodology was employed including a grey literature search (including the National Guideline Clearing House). Medline, Cinahl, Embase, ILC, Cochrane, Central, and Lilacs were searched from 1995-to March 2018. Two raters evaluated all citations and a third rater resolved any disagreements. The AGREE II was used to assess risk of bias of each CPG. Data was extracted and included CPG purpose, type of NP problem and clinical recommendations. The AGREE II critical appraisal tool was used to assess risk of bias of each CPG.ResultsFrom 640 articles, 241 were available for screening. A total of 46 guidelines were selected. CPG’s were categorized by the NP population (General NP, whiplash, interventional, headache and risk for vertebral insufficiency) and type of clinical aim (diagnosis, prognosis, treatment, imaging). Each clinical NP population had a large overlap of clinical aims presented. The CPGs were directed to a variety of clinicians that included physicians, physiotherapists and chiropractors. Results suggest heterogeneity in CPG recommendations within each clinical aim. CPG characteristics accounting for these differences are outlined.ConclusionThe majority of CPGs were developed for general NP that focused on treatment recommendations, with fewer number aimed at recommendations for diagnosis, prognosis, and outcomes. Heterogeneity of recommendations within the categories were noted as were potential factors associated with these differences, including CPG quality as assessed by the AGREE II.

Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial.

Non-specific neck pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented, but it is not clear which exercise regimen is more effective in alleviating its associated pain, depression and anxiety. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, depression and anxiety among patients with NsNP. Eighty-nine consenting individuals with NsNP participated in this single-blind, randomised controlled trial. They were recruited from the outpatient physiotherapy clinics of the National Orthopaedic Hospital in Dala, Kano State, Nigeria. Participants were randomly assigned into one of three intervention groups: neck stabilisation exercise group (NSEG; n=30), neck dynamic exercise group (NDEG; n=28) and neck stabilisation and dynamic exercise group (NSDEG; n=31). Treatment was administered thrice weekly for 8 consecutive weeks. Variables were assessed at baseline, at the end of the fourth and eighth weeks. Pain intensity was assessed through the use of a visual analogue scale, while depression and anxiety were evaluated using both the Beck Depression Inventory and Beck Anxiety Inventory. The data was analysed using descriptive statistics, multivariate analysis of variance (MANOVA) and post hoc tests with Bonferroni adjustment at the p=0.05 significant level. Ages of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. The comparison for NSEG, NSDEG and NDEG within groups revealed that there was significant difference in pain intensity, depression and anxiety scores from baseline, in the fourth and eighth weeks of the study - (F=62.40, p=0.001, F=13.91, p=0.001 and F=20.93, p=0.001); (F=11.92, p=0.001, F=8.75, p=0.004 and F=9.70, p=0.001) and (F=36.63, p=0.001, F=11.99, p=0.001 and F=6.59, p=0.001), respectively. A group comparison of the pain intensity, depression and anxiety scores of participants in the NSEG, NSDEG and NDEG at the baseline of the study revealed that there were no significant differences in the pain intensity and depression and anxiety scores among the three groups: p=0.159, 0.58 and 0.179, respectively. At week 4 of the study, however, a significant difference in pain intensity and anxiety scores across the three groups was recorded - p=0.018, p=0.011, respectively, but no significant difference was noted in depression scores (p=0.93). At week 8 of the study, it was determined that there were significant differences in pain intensity and depression scores p=0.001 and p=0.041, but no significant dissimilarities in the anxiety scores. Post hoc revealed that only pain was significant and lay with NSEG. The study concluded that the stabilisation, dynamic and stabilisation, plus dynamic exercises were effective in relieving pain and reducing depression and anxiety in patients with NsNP. However, stabilisation showed a more marked effect than the combination exercises of stabilisation plus dynamic exercises, and dynamic exercises in reducing pain intensity in patients with NsNP. It is recommended that stabilisation exercises be chosen over stabilisation plus dynamic exercises, or dynamic exercise, while treating patients with NsNP. However, both are effective.

Comparison of Sustained Natural Apophyseal Glides and Maitland Manual Therapy in Non-Specific Neck Pain on Numeric Pain Rating Scale and Neck Disability Index

Incidence of neck pain is increasing day by day due to changed, sedentary, non-ergonomic environment and life style. This becomes the reason of an increased load of human resource and cost. To shed this load of resources and cost, it’s essential to sort out means which give real relief to this increasinglysignificant problem. To compare outcomes of sustained natural apophyseal glides (SNAGs) versus Maitland manual therapy in improving non-specific neck pain. It was a quasi-experimental study design. The study was conducted in Chaudhary Muhammad Akram, Teaching &amp; Research Hospital, Lahore and SuriyaAzeem Teaching Hospital, Lahore within six months from June 2015 to December 2015. A total of 75 subjects with non-specific neck pain using non-probability convenience sampling technique who fulfilled the specific inclusion and exclusion criteria were randomly allocated to three groups; group 1 received SNAGs,group 2 Maitland mobilization and group 3 conventional treatment. Baseline, post-intervention and follow up readings were taken through numeric pain rating scale (NPRS) for pain intensity, neck disability index (NDI) for functional status,goniometer for range of motion and manual muscle testing for muscle strengthof neck. The subject in each group were given twelve sessions, with three sessions a week. Data were analyzed through statistical package of social sciences (SPSS) 21. The results of each group showed pre-treatment pain intensity for group 1 was 7.04+1.338 that changed to 3.52+0.714 and for group 2 it was changed from 7.52+0.872 to 5.16+0.850 and 7.16+0.943 to 5.12+0.781 for group 3. The NDI score for group 1, 2 and 3 were 31.56+5.560, 25.040+7.086 and 25.560+5.477 that were changed to 13.120+2.759, 16.360+2.899 and 12.600+2.020 respectively. The one way ANOVA test compared mean of three groups and p-value for painintensity after treatment was p=0.000 and for functional status p=0.000. The study showed that SNAGs mobilization was more effective in the management of non-specific neck pain and also conventional treatment improved functional status of neck than Maitland mobilization.

Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial

BackgroundNeck pain in adults is common and a leading cause of physical disability. Recently, a guideline was developed for the management of non-specific neck pain (NSNP) with an aim to improve the quality of the delivery of chiropractic care. One key guideline recommendation is to undertake multimodal care for patients with NSNP. The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP.Methods/designThe design is a cluster-randomized controlled pilot and feasibility trial. Chiropractors in private practice in Canada will be approached to participate in the study. Thirty consenting chiropractors will be randomized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group. Each chiropractor will recruit five neck pain patients (a total of 150 patients) into the study. Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars, two online case scenarios, a self-management video on Brief Action Planning, and a printed copy of the practice guideline. Primary feasibility outcomes for both chiropractors and patients include rates of (1) recruitment, (2) retention, and (3) adherence to the intervention. A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors’ compliance with guideline recommendations (e.g. exercise and self-care prescriptions) at study onset and at 3 months. Secondary outcomes include scores of behavioural constructs (level of knowledge and self-efficacy) for recommended multimodal care. Clinical outcomes include pain intensity and neck pain-specific disability. Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest (recruitment, retention, adherence, pain intensity, Neck Disability Index).DiscussionResults of this study will inform the design of a larger cluster-randomized controlled trial aimed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https://clinicaltrials.gov/, NCT02483091Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0076-9) contains supplementary material, which is available to authorized users.

A Comparative Study between Combinations of Ultrasound Therapy with Active Chin Tuck Exercise and Ultrasound Therapy with Sub Occipital Muscle Release in the Management of Non-Specific Neck Pain due to Sub Occipital Muscle Tightness among Computer Professionals

Neck pain is more common in people who spend most of their day working at a desk, in front of the computer with a ‘bent-forward’ posture or ‘forward head carriage’ posture. Non-Specific Neck Pain is most often caused by continuous forward head carrying posture leading to sub-occipital muscle tightness, decreased cervical mobility and obliterated cervical spine curvature. Forward head posture is commonly adopted by visual display terminal [VDT] workers involving a combination of lower cervical flexion and upper cervical extension. The rotatory motion of C1 and C2 is coupled to a vertical translation of the same two vertebrae. The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The first three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected, then the muscles in the area will becometight, causing neck pain. A constant forward head posture reduces the average length of the rectus capitis posterior minor, the superior oblique, rectus capitis posterior major and inferior oblique muscles. It contributes to the development of chronic neck pain. Forward head posture is the anterior positioning of the cervical spine. In this position, head is slightly leaning forward which causes strain in cervical joints and muscles. There will be flexion in lower cervical region and extension in upper cervical region. Question: To determine the efficacy of physiotherapeutic techniques in the treatment of Non-Specific Neck Pain due to Sub-occipital muscle tightness among computer professionals. To systematically compare the efficacy of Active Chin Tucking Exercises and sub occipital muscle release in the treatment of Non-Specific Neck Pain due to Sub-occipital muscle tightness among computer professionals. Design: Comparative Study design Methodology: It is a pre and post-test Experimental study, 20 computer professionals aged between 22 and 30 years who fulfilled inclusion criteria were randomly selected and assigned in to two groups of 10 subjects each. Group A was assigned for Ultrasound Therapy with Active Chin Tucking Exercises and Group B for Ultrasound Therapy with Sub Occipital Muscle release Technique. The study was conducted for a period of 7 days. Pain and neck function were measured before and after intervention by Visual Analog Scale and Copenhagen Neck Function Disability Scale respectively. The data collected from 20 subjects were evaluated statistically. Descriptive analytical study was done by using Paired’ test and Unpaired’ test. Conclusion: It is concluded that there is reduction of pain & there is improvement in Neck function among computer professionals treated with Ultrasound Therapy and Active Chin Tuck Exercise for their neck pain & also in group treated with Ultrasound Therapy and Sub Occipital Muscle Release Technique for their neck pain. It is concluded that combination of Ultrasound Therapy with Active Chin Tuck Exercise training group showed statistically significant improvement & found superior in improving neck function, whereas Ultrasound Therapy with Sub Occipital Muscle Release Technique training group showed statistically significant reduction in pain.

Fast tracking the design of theory-based KT interventions through a consensus process.

BackgroundDespite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.MethodsIndividual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.ResultsNine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients’ treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.ConclusionsA multifaceted KT educational intervention targeting chiropractors’ management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0213-5) contains supplementary material, which is available to authorized users.

Systematic review of manual therapies for nonspecific neck pain

ObjectiveTo evaluate the effectiveness of manual therapies in the treatment of nonspecific neck pain. Materials and methodsMedline and the Cochrane Library were searched for randomized controlled trials of manual therapy or mobilization, used alone or with exercises to treat pain and functional impairment related to nonspecific neck pain. Cochrane Back Review Group criteria were used to assess the quality of the trials and the level of evidence (unclear, limited, moderate, or high) for short-, medium-, and long-term effects. ResultsOf 27 identified trials, 18 were of high quality. In acute neck pain, effective treatments were thoracic manipulation combined with electrothermal therapy in the short term and cervical manipulation in the long term. In chronic neck pain and neck pain of variable duration, both pain and function improved consistently at all follow-up time points. None of the manual therapies used alone or in combination was superior over the others. In the long term, exercises alone or combined with manual therapies were superior over manual therapies used alone. ConclusionManual therapies contribute usefully to the management of nonspecific neck pain. The level of evidence is moderate for short-term effects of upper thoracic manipulation in acute neck pain, limited for long-term effects of neck manipulation, and limited for all techniques and follow-up durations in chronic neck pain.

GPs' experiences of managing non-specific neck pain--a qualitative study

Non-specific neck pain is a common complaint in general practice. Little is known about GPs' experiences of managing non-specific neck pain. This qualitative study aims to elucidate GPs' opinions on the cause, diagnosis and management of non-specific neck pain and their experiences with patients suffering from this complaint. A purposive sample of 19 German GPs was interviewed. Analysis was guided by predefined research questions and the general principles of grounded theory. We condensed the data into three key themes. The first key theme was the aetiology of neck pain and the patients' difficulty in accepting psychological explanations. GPs reported that their patients asked for definite and expensive forms of therapy. Though GPs preferred cost-efficient forms of therapy, fulfilment of patient expectations was the second key theme. Some felt that satisfying patient wishes may facilitate a trusting relationship so that psychological explanations or advice to adopt an active physical lifestyle would be accepted by patients more open-mindedly. The third key theme was the GPs' view on orthopaedic surgeons. Sometimes specialist diagnoses helped to reinforce the GPs findings. But many GPs had doubts as to whether an orthopaedic surgeon could tackle psychosomatic aspects of this complaint. In the case of non-specific neck pain, GPs often feel confronted with patients that demand dubious therapies and fail to consider psychological influences. The prescription of non-evidence-based therapies or referrals does not necessarily reflect a lack of knowledge but the GPs' strategic decision to improve the doctor-patient relationship.