Therapeutic modalities in the management of nonspecific neck pain

  • Rand S Swenson
    Correspondence. Dartmouth Medical School, HB 7100, Hanover, NH 03755, USA
    Departments of Anatomy and Medicine (Neurology), Dartmouth Medical School, Hanover, NH 03755, USA

    Section of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
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      Dr. Swenson gives a careful, comprehensive analysis of the validity, or the lack thereof, of the various therapeutic modalities, some or all of which we may have used in the treatment of our patients for cervical-related pain disorders. The article is extremely detailed, well documented–and humbling. Item by item, Dr. Swenson discusses the best available research attempts to validate the various therapies.–RLS
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        • Bovim G
        • Schrader H
        • Sand T
        Neck pain in the general population.
        Spine. 1994; 19: 1307-1309
        • Rush P.J
        • Shore A
        Physician perceptions of the value of physical modalities in the treatment of musculoskeletal disease.
        Br J Rheumatol. 1994; 33: 566-568
        • Beckerman H
        • Bouter L.M
        • van der Heijden G.J.M.G
        • et al.
        The efficacy of physiotherapy for musculoskeletal disorders.
        Br J Gen Pract. 1993; 43: 73-77
      1. Gross AR, Aker PD, Goldsmith CH, et al. Conservative management of mechanical neck disorders. A systematic overview and meta-analysis. Online Journal of Current Clinical Trials. Doc No 200–201, 1996.

        • Gross A.R
        • Aker P.D
        • Goldsmith C.H
        • et al.
        Physical medicine modalities for mechanical neck disorders.
        Cochrane Database Syst Rev. 2000; 2 (CD000961)
      2. Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain.
        Phys Ther. 2001; 81: 1701-1713
        • Gennis P
        • Miller L
        • Gallagher E.J
        • et al.
        The effect of soft cervical collars on persistent neck pain in patients with whiplash injury.
        Acad Emerg Med. 1996; 3: 568-573
        • Nordemar R
        • Thorner C
        Treatment of acute cervical pain–a comparative group study.
        Pain. 1981; 10: 93-101
        • Bonk A.D
        • Ferrari R
        • Giebel G.D
        • et al.
        Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany. World Congress on Whiplash-Associated Disorders in Vancouver, British Columbia, Canada in February of 1999.
        Journal of Musculoskeletal Pain. 2000; 8: 123-132
        • Borchgrevink G.E
        • Kaasa A
        • McDonagh D
        • et al.
        Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.
        Spine. 1998; 23: 25-31
        • McKinney L.A
        Early mobilization and outcome in acute sprains of the neck.
        BMJ. 1989; 299: 1006-1008
        • McKinney L.A
        • Dornan J.O
        • Ryan M
        The role of physiotherapy in the management of acute neck sprains following road-traffic accidents.
        Arch Emerg Med. 1989; 6: 27-33
        • Irnich D
        • Behrens N
        • Molzen H
        • et al.
        Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain.
        BMJ. 2001; 322: 1574-1578
        • Hanten W.P
        • Olson S.L
        • Butts N.L
        • et al.
        Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.
        Phys Ther. 2000; 80: 997-1003
        • Cummings T.M
        • White A.R
        Needling therapies in the management of myofascial trigger point pain: a systematic review.
        Arch Phys Med Rehabil. 2001; 82: 986-992
        • Brodin H
        Cervical pain and mobilization.
        Int J Rehab Research. 1984; 7: 190-191
        • Hoving J.L
        • Koes B.W
        • deVet H.C.W
        • et al.
        Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain.
        Ann Intern Med. 2002; 136: 713-722
        • Mealey K
        • Brennan H
        • Fenelon G.C
        Early mobilization of acute whiplash injuries.
        BMJ. 1986; 292: 656-657
        • van Schalkwyk R
        • Parkin-Smith G.F
        A clinical trial investigating the possible effect of the supine cervical rotatory manipulation and the supine lateral break manipulation in the treatment of mechanical neck pain: a pilot study.
        J Manipulative Physiol Ther. 2000; 23: 324-331
        • Wood T.G
        • Colloca C.J
        • Matthews R
        A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction.
        J Manipulative Physiol Ther. 2001; 24: 260-271
        • Bronfort G
        • Evans R
        • Nelson B
        • et al.
        A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.
        Spine. 2001; 26: 788-797
        • Cassidy J.D
        • Lopes A.A
        • Yong-Hing K
        The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial.
        J Manipulative Physiol Ther. 1992; 15: 570-575
        • Howe D.H
        • Newcombe R.G
        • Wade M.T
        Manipulation of the cervical spine–a pilot study.
        J R Coll Gen Pract. 1983; 33: 574-579
        • Jordan A
        • Bendix T
        • Nielsen H
        • et al.
        Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial.
        Spine. 1998; 23: 311-318
        • Koes B.W
        • Bouter L.M
        • van Mameren H
        • et al.
        Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.
        BMJ. 1992; 304: 601-605
        • Koes B.W
        • Bouter L.M
        • van Mameren H
        • et al.
        The effectiveness of manual therapy, physiotherapy and treatment by general practitioner for nonspecific back and neck complaints.
        Spine. 1992; 17: 28-35
        • Koes B.W
        • Bouter L.M
        • van Mameren H
        • et al.
        A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures.
        J Manipulative Physiol Ther. 1993; 16: 211-219
        • Skargren E.I
        • Oberg B.E
        • Carlsson P.G
        • et al.
        Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up.
        Spine. 1997; 22: 2167-2177
        • Skargren E.I
        • Carlsson P.G
        • Oberg B.E
        One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.
        Spine. 1998; 23: 1875-1883
        • Sloop P.R
        • Smith D.S
        • Goldenberg E
        • et al.
        Manipulation for chronic neck pain. A double-blind controlled study.
        Spine. 1982; 7: 532-535
        • Vernon H.T
        • Aker P
        • Burns S
        • et al.
        Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study.
        J Manipulative Physiol Ther. 1990; 13: 13-16
        • Bronfort G
        Efficacy of spinal manipulation and mobilisation for low back and neck pain.
        in: Efficacy of manual therapies of the spine. Thesis Publishers, Amsterdam1997: 117-135
        • Hurwitz E.L
        • Aker P.D
        • Adams A.H
        • et al.
        Manipulation and mobilization of the cervical spine. A systematic review of the literature.
        Spine. 1996; 21: 1746-1759
        • Shekelle P.G
        • Coulter I
        Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel.
        J Spinal Disord. 1997; 10: 223-228
        • Haldeman S
        • Carey P
        • Townsend M
        • et al.
        Arterial dissections following cervical manipulation: the chiropractic experience.
        CMAJ. 2001; 165: 905-906
        • Powell F.C
        • Hanigan W.C
        • Olivero W.C
        A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.
        Neurosurgery. 1993; 33: 73-78
        • Rothwell D.M
        • Bondy S.J
        • Williams J.I
        Chiropractic manipulation and stroke: a population-based case-control study.
        Stroke. 2001; 32: 1054-1060
        • van der Heijden G.J
        • Beurskens A.J
        • Koes B.W
        • et al.
        The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods.
        Phys Ther. 1995; 75: 93-104
        • Brewerton D.A
        Pain in the neck and arm: a multicentre trial of the effects of physiotherapy: arranged by the British Association of Physical Medicine.
        BMJ. 1966; 1: 253-258
        • Zylbergold R.S
        • Piper M.C
        Cervical spine disorders. A comparison of three types of traction.
        Spine. 1985; 10: 867-871
        • Goldie I
        • Landquist A
        Evaluation of the effects of different forms of physiotherapy in cervical pain.
        Scand J Rehabil Med. 1970; 2–3: 117-121
        • Lee J.C
        • Lin D.T
        • Hong C
        The effectiveness of simultaneous thermotherapy with ultrasound and electrotherapy with combined AC and DC current on the immediate pain relief of myofascial trigger points.
        Journal of Musculoskeletal Pain. 1997; 5: 81-90
        • Lewith G.T
        • Machin D
        A randomised trial to evaluate the effect of infra-red stimulation of local trigger points, versus placebo, on the pain caused by cervical osteoarthrosis.
        Acupunct Electrother Res. 1981; 6: 277-284
        • Foley-Nolan D
        • Barry C
        • Coughlan R.J
        • et al.
        Pulsed high frequency (27 mHz) electromagnetic therapy for persistent neck pain: a double blind, placebo-controlled study of 20 patients.
        Orthopaedics. 1990; 13: 445-451
        • Foley-Nolan D
        • Moore K
        • Codd M
        • et al.
        Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study.
        Scand J Rehabil Med. 1992; 24: 51-59
        • Vallbona C
        • Richards T
        Evolution of magnetic therapy from alternative to traditional medicine.
        Phys Med Rehabil Clin N Am. 1999; 10: 729-754
        • Alfano A.P
        • Taylor A.G
        • Foresman P.A
        • et al.
        Static magnetic fields for treatment of fibromyalgia: a randomized controlled trial.
        J Altern Complement Med. 2001; 7: 53-64
        • Klemetti M
        • Santavirta N
        • Sarvimaki A
        • et al.
        Tension neck and evaluation of a physical training course among office workers in a bank corporation.
        J Adv Nurs. 1997; 26: 962-967
        • Revel M
        • Minguet M
        • Gregoy P
        • et al.
        Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study.
        Arch Phys Med Rehabil. 1994; 75: 895-899
        • Takala E.P
        • Viikari-Juntura E
        • Tynkkynen E.M
        Does group gymnastics at the workplace help in neck pain? A controlled study.
        Scand J Rehab Med. 1994; 26: 17-20
        • Fitz-Ritson D
        Phasic exercises for cervical rehabilitation after “whiplash” trauma.
        J Manipulative Physiol Ther. 1995; 18: 21-24
        • Levoska S
        • Keinanen-Kiukaanniemi S
        Active or passive physiotherapy for occupational cervicobrachial disorders? A comparison of two treatment methods with a 1-year follow-up.
        Arch Phys Med Rehabil. 1993; 74: 425-430
        • Ozdemir F
        • Birtane M
        • Kokino S
        The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis.
        Clin Rheumatol. 2001; 20: 181-184
        • Thorsen H
        • Gam A.N
        • Jensen H
        • et al.
        Lav-energi laserbehandling-effekt ved lokaliseret fibromyalgi i nakke- og skulderregioner.
        Ugeskr Laeger. 1991; 153: 1801-1804
        • Thorsen H
        • Gam A.N
        • Svensson B.H
        • et al.
        Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study.
        Scand J Rheumatol. 1992; 21: 139-141
        • Waylonis G.W
        • Wilke S
        • O'Toole D
        • et al.
        Chronic myofascial pain: management by low-output helium-neon laser therapy.
        Arch Phys Med Rehabil. 1988; 69: 1017-1020
        • Beckerman H
        • de Bie R.A
        • Bouter L.M
        • et al.
        The efficacy of laser therapy for musculoskeletal and skin disorders.
        Phys Ther. 1992; 72: 483-491
        • Linton S.J
        • Ryberg M
        A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial.
        Pain. 2001; 90: 83-90
        • Kamwendo K
        • Linton S.J
        A controlled study of the effect of neck school in medical secretaries.
        Scand J Rehabil Med. 1991; 23: 143-152
        • Gross A.R
        • Aker P.D
        • Goldsmith C.H
        • et al.
        Patient education for mechanical neck disorders.
        Cochrane Database Syst Rev. 2000; 2 (CD000962)
        • Taimela S
        • Takala E.P
        • Asklof T
        • et al.
        Active treatment of chronic neck pain: a prospective randomized intervention.
        Spine. 2000; 25: 1021-1027
        • Karjalainen K
        • Malmivaara A
        • van Tulder M
        • et al.
        Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group.
        Spine. 2001; 26: 174-181