The treatment of neck pain is multifactorial. The articular, muscular, and motor control (neural) systems may all or in part be implicated. This triad can be influenced by non-neuromusculoskeletal factors such as the clients’ current emotional and psychosocial well-being. As many physiotherapists treat neck pain, it is important to be aware of the most recent and up to date research investigating the efficacy of various physiotherapeutic techniques and interventions in the management of neck pain. According to the Manipulative Physiotherapists Association of Australia (MPAA) the following conclusions can be made.
Manipulative Physiotherapy
Appropriate treatment depends on an accurate diagnosis. Manual diagnosis by a trained manipulative physiotherapist can be as accurate as the “Gold standard” radiologically-controlled diagnostic blocks in the diagnosis of cervical “Z” joint syndromes (Jull et al 1988).
Evidence suggests that manual therapy is effective in both the treatment of acute and chronic neck pain. Manipulative therapy is a highly effective treatment approach that involves the application of specific therapies to reduce pain, restore normal movement and prevent future problems. Manipulative therapy consists of passive joint mobilizations (gentle movement of individual joints and surrounding structures), manipulation (controlled quick thrusting techniques to the joint which produces at times an audible clicking or popping sound) and therapeutic exercise.
(Note: Alessandro Rosatelli is a registered manual and manipulative physiotherapist and clinic co-owner of Body in Balance Physiotherapy in Bradford, Ontario).
Traction
Traction has been shown to separate vertebrae, hence it may be hypothesized that it could give relief from radicular symptoms by decreasing forces on sensitive neural structures. The efficacy of using traction for the treatment of neck pain has not been established. Of five randomized control trials, two had positive and three had negative results.
Exercise
There is recent level II evidence which supports the use of specific exercises in the management of neck pain. So far there is no evidence in support of Pilates, Feldenkrais, or Alexander technique.
Collars
Level II evidence suggests that cervical collars are not helpful in the treatment of neck pain. Furthermore, available evidence does not support the use of bed rest.
Electrotherapy
Evidence is limited. There are a few studies that support the use of TENS, biofeedback, and pulsed electromagnetic therapy. Despite its wide use, there is no support for ultrasound. Laser therapy and infra-red therapy also does not seem to have much support. There is some support for the use of acupuncture (primarily level I & II evidence).
Multimodal Therapy
Is multimodal therapy effective in the management of neck pain? Some recent level II evidence seems to suggest that it is. Hence, combining manual therapy, exercise and cognitive-behavioural therapy may be more beneficial than individual therapies on their own.
Summary
There is good evidence to support the use of manual and manipulative therapy in the short term management of neck pain. There is also some evidence to support the use of modalities such as TENS, acupuncture, biofeedback and exercise. In contrast, level I and II evidence seems to suggest that the use of bed rest, collars and traction does not seem to have any effect on neck pain and hence is not recommended. The long term effects of manual therapy cannot be determined at this time due to lack of literature on this topic. Research in this area is forthcoming.
image source