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Chiropractic Research Review

Active Management of Chronic Neck Pain

Because the causes of many cervical disorders are not well understood, clinical management of chronic neck disorders has varied from traditional pain management and manipulative therapy to group gymnastics, neck-specific strengthening exercises, and recommendations on instituting ergonomic changes at work.

Strengthening exercises have also been suggested for treatment of neck pain, although few previous studies have examined the specific utility of active therapy in managing nonspecific chronic neck pain.

This study compared the efficacy of three different treatment protocols for patients with nonspecific, chronic neck pain. Seventy-six men and women with chronic neck pain were randomly assigned to one of three treatment groups: proprioceptive training (active group); activated home exercises (home group); and recommendations of exercise (control group). Sixty-two of the 76 participated in the one-year followup.

Active treatment was provided by two specially trained physical therapists over 24 sessions. Active care consisted of:

* cervical muscle endurance and coordination training;
* relaxation training to reduce muscle tension;
* behavioral support to diminish anxiety and fear of pain;
* eye exercises to prevent dizziness; and
* postural control exercises using a wobble board.

Home treatment involved a neck lecture and two sessions of practical training for home exercises, including instructions for maintaining a progress diary. Control treatment comprised a lecture regarding neck care and general recommendations to exercise. Outcome measures (assessed at baseline, three months and 12 months) included subjective pain and disability, cervical range of motion (ROM), and pressure pain threshold in the shoulder region.

Results: Patients in the active group reported greater satisfaction, reduction in pain severity, and improvements in working ability at three and 12-month follow-ups compared to the home group and the control group. Home exercises were not as effective as active exercises, but both were more efficacious than simple recommendations for exercise (control group). Only minor differences were noted at 12 months in cervical mobility, persistence of pain, or pressure pain threshold in the trapezius or levator scapulas musculature. The authors conclude that despite these potential limitations, multimodal treatment emphasizing exercises can benefit patients with chronic, nonspecific neck problems.

Taimela S, Takala E, Asklof T, et al. Active treatment of chronic neck pain: a prospective randomized intervention. Spine 2000:25(8), pp1021-27.

Chiropractic Research Review

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