Mechanical Neck Disorders Research Articles

Orthoses for mechanical neck disorders

Orthoses for mechanical neck disorders

The effectiveness of manual therapy for neck pain: a systematic review of the literature

A systematic review of randomised, controlled trials was undertaken to determine the effectiveness of manual therapy for mechanical neck disorders in reducing pain and disability in adult populations. Neck pain is a common ailment that can result in pain, disability and considerable cost. Manual therapy is a treatment modality commonly sought by patients to manage neck pain.A literature search of MEDLINE, CENTRAL, CINHAL, SPORTdiscus, PEDro and MANTIS was conducted. Articles were included if manual therapy was performed on one group within the trial, on participants with mechanical neck pain, including neck disorders with associated headache. Studies were excluded if the cause of neck pain was serious pathology, systemic disease, or trauma, or if neck pain was associated with radicular findings, or the headache was the primary disorder.Five trials involving 995 participants were included; four of the trials were of high methodological quality according to the validated Jadad criteria. Due to the heterogeneity of the data from the included trials, the studies could not be pooled for meta-analysis and a qualitative analysis was performed instead. Strong evidence demonstrated that manual therapy was not significantly superior to other interventions (exercise, physical therapy, medication, short wave diathermy) for relief of neck pain. Patients who received manual therapy reported being significantly more satisfied with their care than patients who received any other single therapy. A trend across three of the studies showed that manual therapy combined with exercise returned moderately larger improvements, although not statistically significant, improvements in pain, disability and patient-perceived recovery than manual therapy alone. Results in favour of combined therapies suggest multinodal care, including manual therapy and exercise, may be a potentially useful intervention in the treatment of mechanical neck disorders.

Manual Forces Applied During Cervical Mobilization

Objective Manual therapists routinely use passive accessory mobilization techniques to treat patients with mechanical neck disorders, but little is known about the manual forces applied. The aim of this study was to quantify the manual forces applied to the cervical spine during joint mobilization. Methods Ten physiotherapists performed posterior-to-anterior mobilizations to C2 and C7 (both centrally and unilaterally, 1 right and 1 left, grades I-IV) on a single asymptomatic male subject. Manual forces were measured in 3 planes using an instrumented treatment table. Results The instrumented table showed excellent reliability (intraclass correlation coefficient [2,1], 0.99; 95% confidence interval, 0.97-1.00) and accuracy (mean absolute error; vertical force, 1.1 N; SD, 1.5). There were considerable differences between therapists for mean peak force, force amplitude, and oscillation frequency for each technique and grade. Mean peak forces (grade I, 21.8 N; SD, 15.0; grade II, 34.9 N; SD, 20.9; grade III, 58.2 N; SD, 27.5; grade IV, 61.0 N; SD, 29.9) were considerably lower than previously reported lumbar mobilization forces. Intratherapist repeatability for all mobilization parameters was high. Force amplitude and oscillation frequency measures indicated that therapists generally adhered to the published definitions of the grades of mobilization when applying force, but when asked, provided quite different definitions of the grades. Conclusions This study provides preliminary evidence that cervical mobilization forces vary considerably between therapists, but intratherapist repeatability is high.

MECHANICAL TRACTION FOR MECHANICAL NECK DISORDERS: A SYSTEMATIC REVIEW

To assess whether mechanical traction, either alone or in combination with other treatments, improves pain, function/disability, patient satisfaction and global perceived effect in adults with mechanical neck disorders. We conducted a systematic review up to September 2004 of randomized controlled trials and used pre-defined levels of evidence for qualitative analysis. Two independent reviewers conducted study selection, data abstraction and methodological quality assessment. Using a random effects model, relative risk and standardized mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated. Of the 10 selected trials, one study was of high quality. Our review revealed low-quality trials for mechanical neck disorders, showing evidence of benefit favouring intermittent traction for pain reduction. Continuous traction showed no significant difference for defined outcomes. Inconclusive evidence for continuous and intermittent traction exists due to trial methodological quality. Two clinical conclusions may be drawn, one favouring the use of intermittent traction and the other not supporting the use of continuous traction. Attention to research design flaws and description of traction characteristics is needed.

(857): Update on conservative management of mechanical neck disorders: A series of 11 systematic reviews

Mechanical neck pain (MND) is common. We determined if conservative treatments - manual therapies, physical medicine methods, medication, patient education - relieved pain or improved function/disability, patient satisfaction, global perceived effect in adults with MND by updating 11 systematic reviews of randomized trials. Databases were searched without language restrictions from root to Sept 2004. Two independent authors selected studies, abstracted data, and assessed methodological quality using Jadad 5-point scale.

Electrotherapy for Neck Disorders (Review)

Purpose: Neck disorders are common, disabling and costly. The effectiveness of electrotherapy as a physiotherapy option has remained unclear. Objective of this systematic review is to assess whether electrotherapy, either alone or in combination with other treatments, relieves pain, or improves function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).

A Cochrane Review of Electrotherapy for Mechanical Neck Disorders

Systematic review. To assess whether electrotherapy relieves pain or improves function/disability in adults with mechanical neck disorders (MND). The effectiveness of electrotherapy as a physiotherapy option has remained unclear. Databases were searched from root to March 2003. Independent reviewers conducted selection, data abstraction, and quality assessment. Relative risk and standard mean differences were calculated. Fourteen comparisons were included. For the pain outcome, we found limited evidence of benefit, ie, pulsed electromagnetic field (PEMF) therapy resulted in only immediate post-treatment pain relief for chronic MND and acute whiplash (WAD). Other findings included unclear or conflicting evidence (Galvanic current for acute or chronic occipital headache; iontophoresis for acute, subacute WAD; TENS for acute WAD, chronic MND; PEMF for medium- or long-term effects in acute WAD, chronic MND); and limited evidence of no benefit (diadynamic current for reduction of trigger point tenderness in chronic MND, cervicogenic headache; permanent magnets for chronic MND; electrical muscle stimulation (EMS) for chronic MND). In pain as well as other outcomes, the evidence for treatment of acute or chronic MND by different forms of electrotherapy is either lacking, limited, or conflicting.

Estimate of the number of treatment visits involving cervical spine manipulation carried out by members of the British and Scottish Chiropractic Associations over a one-year period

Background context: Neck pain is a leading cause of morbidity and health care utilisation worldwide, and spinal manipulative therapy (SMT) has become an increasingly popular therapeutic approach for the treatment of mechanical neck disorders and headache. Within the UK, the chiropractic profession is one of the main providers for SMT, however, the frequency with which neck manipulations are carried out is unknown. Purpose: To establish the number of annual patient visits at which at least one cervical manipulation treatment had been performed by practising members of the British (BCA) and Scottish (SCA) chiropractic associations. Methods: A self-administered questionnaire was sent to 399 registered chiropractors chosen from the membership databases of the BCA and SCA. The chiropractors were asked to enter the total number of patient visits in which at least one cervical manipulation had been administered during a predetermined study week. Results: A total of 291 questionnaires were returned (response rate 72.9%). Based on 281 usable data files, one BCA or SCA chiropractor performs on average a minimum of 40 cervical spine manipulations each week. Assuming that the average BCA/SCA chiropractor works for 49 weeks per year, this equates to 1975 treatment visits per year at which at least one cervical spine manipulation is administered. At the time the sample was taken for this study, a combined total of 1139 chiropractors were registered on the BCA and SCA databases. By extrapolation, the combined membership of the BCA and SCA, would therefore perform a minimum of 2,250,664 cervical spine manipulations or adjustments in 1 year. Conclusions: This study, for the first time, established that, for 2003, the average BCA and SCA chiropractor administered a weekly minimum of 40 cervical spine manipulations and that, on an annual basis, a conservative estimate of 2.25 million cervical spine manipulations are carried out.

Acupuncture for Neck Disorders

Systematic review. To determine the effects of acupuncture for individuals with neck pain. Neck pain is one of the 3 most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. METHODS.: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, Cumulative Index to Nursing and Allied Health Literature from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. Any published trials using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included. We found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodologic quality had a mean of 2.3 of 5 on the Jadad scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately posttreatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately posttreatment, and at short-term follow-up (pooled standardized mean difference, -0.37; 95% confidence interval, -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up. There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short-term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain posttreatment, and this is maintained at short-term follow-up.

A Cochrane review of manipulation and mobilization for mechanical neck disorders.

Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders. Neck disorders are common, disabling, and costly. Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model. Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache. Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

Other: Medicines and injections for neck pain: A systematic review

Our goal was to systematically review randomized trials used to improve pain, function/disability, patient satisfaction and range of motion in patients with mechanical neck disorders We searched MEDLINE, EMBASE, MANTIS, CINHAL from root to March 2003 and Cochrane CENTRAL in the fourth installment, December 2002. We scrutinized reference lists. We included studies with subjects aged 18 years and older with mechanical neck disorders, with or without associated headache or radicular findings. We considered medicinal and injection therapies. Two independent reviewers made decisions for each step of the review: article inclusion, data abstraction and trial methodological quality. Study quality was assessed using Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies with meta-analysis. We found 32 trials that examined NSAIDs, muscle relaxants, epidural steroids, intravenous steroids as well as muscle and joint injections. Quality overall showed a mean of 3.2/5. We found conflicting evidence for benefits with oral muscle relaxants, with positive results for eperison hydrochloride, cyclobenzaprine and tetrazepam, but negative results for diazepam and phenobarbital in subacute/chronic neck disorders. In whiplash, IV methylprednisolone within 8 hours reduced sick leave at 6 months. Epidural methylprednisolone and lidocaine reduced neck pain at 1 year compared to IM methylprednisone and lidocaine. IM lidocaine was superior to neck stretches, but similar to ultrasound for chronic myofascial pain. There was consistent evidence from 5 high quality trials showing Botox A IM was similar to saline for pain, disability or global perceived effect in chronic neck disorders. Meta-analysis showed a standard mean difference (SMD) for pain of -0.39 (95%CI -1.25 to 0.47). Other medications and injections lead to mixed results. IM lidocaine or prilocaine, IV ethylprednisolone, and epidural methylprednisolone work. Muscle relaxants had mixed results. Botox A intramuscular injections were similar to saline for chronic myofascial pain.

Manipulation and mobilisation for mechanical neck disorders.

Neck disorders are common, disabling, and costly. The effectiveness of manipulation and mobilisation remains unclear. To assess whether manipulation and mobilisation, either alone or in combination with other treatments, relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND). Computerised bibliographic databases including CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, were searched without language restrictions from their respective starting dates to March 2002. The studies had to be randomised (RCT) or quasi-randomised and investigate the use of manipulation or mobilisation as a treatment for mechanical neck disorders. Two independent reviewers conducted citation identification, study selection, data abstraction, and methodological quality assessment. Using a random effects model, relative risk and standardised mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated. Of the 33 selected trials, 42% were high quality trials. Single sessions of manipulation or multiple sessions (3 to 11 weeks) of manipulation or mobilisation, or manipulation and mobilisation showed a nonsignificant benefit in pain relief when assessed against placebo, control groups or other treatments for acute/subacute/chronic MNDs with or without headache. There was strong evidence of benefit favouring multimodal care over a waiting list control for pain reduction [pooled SMD -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [SMD -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic MND with or without headache. The common elements in this care strategy were mobilisation and/or manipulation plus exercise. There was moderate evidence of no difference in effect when multimodal care was compared to various other treatments. Multimodal care has short-term and long-term maintained benefits for subacute/chronic MND with or without headache. The common elements in this care strategy were mobilisation and/or manipulation plus exercise. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. The added benefit of exercise needs to be further explored. Factorial design would help determine the active treatment agent(s) within a treatment mix. Phase II trials would help identify the most effective treatment characteristics and dosages. Greater attention to methodological quality is needed.

Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders

Purpose: An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cerviogenic headache. Pain, function, patient satisfaction and adverse events were appraised. Methods: The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used. Results: Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief. While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect. Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone. Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest. Based on weak evidence, estimates for serious complication for manipulation ranged from one in 20,000 to five in 10,000,000. Recommendations: Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise. The risk rate is uncertain.

Manual therapy for mechanical neck disorders: a systematic review

SUMMARY. Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. Two independent reviewers extracted data while three assessed trial quality. Standard mean difference and relative risks were translated to number needed to treat (NNT) and the percent treatment advantage. The 20 selected trials' quality was 2.4 (SD: 1.04) on the 5-point scale described by Jadad. Trials were clinically heterogenous. Manipulation alone, mobilizations alone, manipulation/mobilization and treatments including massage consistently showed similar effects to placebo, wait period or control. Multimodal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain and patient satisfaction. The NNT for a clinically important reduction in pain varied from 2 to 11 and treatment advantage from 6% to 41% at the cost of benign transient side-effects. While results remain inconclusive, some clinical themes have emerged. For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.

Efectividad del tratamiento fisioterápico en pacientes con cervicalgia mecánica

Physical therapy is used to treat patients with mechanical neck disorders. This article shows scientific evidence about physiotherapy techniques effectiveness in these cases. Six reviews and four recent randomized clinical trials (RCTs) have been examined. The main conclusions are the following: exercise, cervical traction, spray and stretch techniques, transcutaneous electrical nerve stimulation (TENS), infrared light therapy and patient education have not been sufficiently studied, and their effectiveness has not been shown yet. Pulsed electromagnetic therapy is effective to reduce pain intensity at short term. Laser therapy ineffectiveness in these cases is suspected. Development of future RCTs about physical therapy applied on patients with mechanical neck disorders is urgently needed. The next researches will have to be well designed.

Physical Medicine Modalities for Mechanical Neck Disorders

Physical Medicine Modalities for Mechanical Neck Disorders

Physical medicine modalities for mechanical neck disorders.

Multiple physical medicine modalities are commonly included as part of therapeutic interventions for mechanical neck disorders (neck pain). The objective of this review was to assess the effects of physical medicine modalities for pain in adults with mechanical neck disorders. We searched Medline, Embase, Chirolars, Index to Chiropractic Literature, Cinahl, Science Citation Index, Conference Proceedings Index, National Technical Information Services and reference lists of the retrieved articles from 1985 to December 1993 and we contacted content experts. Randomised trials and controlled trials of physical medicine modalities in adults with mechanical neck disorder. Three reviewers independently assessed trial quality and two reviewers independently extracted data. Investigators were contacted to obtain information or data that could not be found in the published reports. Thirteen trials were included. The overall quality of the included trials was generally good. Two trials using electromagnetic therapy produced a significant reduction in pain (p <0.01) with three to four weeks of daily (eight hours per day) therapy sessions; and three using laser therapy did not differ significantly from a placebo (p=0.20) for six to 10 sessions of treatment. Not enough scientific testing exists to clearly determine the effectiveness of other therapies. This includes treatments such as exercise, traction, acupuncture, heat / cold applications, electrotherapies, cervical orthoses and chronic pain / cognitive behavioural rehabilitation strategies. There is little information available from trials to support the use of physical medicine modalities for mechanical neck pain. There is some support for the use of electromagnetic therapy and against the use of laser therapy with respect to pain reduction.

Patient education for mechanical neck disorders.

To track down the best estimate of efficacy of the various conservative management strategies for mechanical neck disorders, a four-part systematic review was prepared. Part four investigates the efficacy of patient education strategies as the therapeutic intervention. This review of patient education is one of four reviews of conservative management of mechanical neck disorders. The other reviews address manual, physical and drug therapies. The objective of this review was to assess the effects of patient education for pain in adults with mechanical neck disorders. We searched Medline, Embase, Chirolars, Index to Chiropractic Literature, Cinahl, Science Citation Index, Conference Proceedings Index, National Technical Information Services from 1985 to December 1993, reference lists of the retrieved articles and we contacted experts in the field. Randomised trials or controlled clinical trials of patient educational strategies for adults with mechanical neck disorders. Three reviewers independently assessed trial quality and two reviewers independently extracted data. Investigators were contacted to obtain data that could not be found in the published reports. Three trials were included. Their methodological quality varied from weak to strong. One trial did not find a significant reduction in pain using group instructional strategies (neck school) and exercise with or without psychological counselling compared to no treatment (standardised mean difference 0.07, 95% confidence interval -0.51 to 0.66, and -0.37, 95% confidence interval -0.95 to 0.22, respectively). Another trial did not find a significant reduction in pain using individualised patient education (advice), anti-inflammatories and analgesics compared with placebo (standardised mean difference 0.24, 95% confidence interval -0.58 to 1.07). The third trial found that advice which included demonstrated mobilization exercises, verbal and written instruction on posture correction, the use of a collar, heat sources, muscle relaxation and analgesics gave significant pain relief compared with general advice about mobilisation after a period of rest and use of analgesics at 4 weeks of treatment (standardised mean difference -0.62, 95% confidence interval -1.05 to -0.19) but at 6 weeks of treatment there was no longer any difference (s.m.d. -0.37, 95% confidence interval -0.8 to 0.05). The first two trials lacked statistical power and the third was methodologically weak. Patient education utilising individualised or group instructional strategies has not been shown to be beneficial in reducing pain for mechanical neck disorders.