Neck pain position statement
After the successful production of the Back Pain Position Statement, the Australian Physiotherapy Association has further produced a Neck Pain Position Statement. The position statement is a set of recommendations regarding the management of neck pain based on the most recent scientific evidence that evaluates the efficacy of physiotherapeutic management of neck pain. Only Level I (systematic reviews) and Level II (randomised controlled trials) was considered and the conclusions were:
Manipulative Physiotherapy--
There is considerable evidence to support the benefits of manipulative physiotherapy is reducing acute (early stage) and chronic (long-standing) neck pain. Studies in the main have evaluated spinal manipulative therapy in short-term follow-ups. Manipulative therapy comprises passive joint mobilization and manipulation. Insufficient studies have undertaken long-term follow-up to allow firm conclusions to be drawn about the long-term efficacy of manipulative therapy for neck pain.
Traction--
Firm conclusions about efficacy of traction cannot be drawn from Level I evidence at this stage. Of five randomised controlled trials, two had positive and three negative outcomes.
Exercise--
There is recent Level II evidence to support the use of specific exercise rehabilitation, but no evidence is available on Pilates therapy, Feldenkrais, Alexander techniques.
Electrophysical Agents--
The evidence available regarding the efficacy of electrophysical agents (treatment with electrical machines) is limited. Some limited experience is available in support of pulsed electromagnetic therapy, TENS and biofeedback. At present there is no evidence that supports the use of ultrasound, infra-red therapy, or laser therapy. The efficacy for acupuncture has minor support from Level I evidence and moderate support from Level II evidence.
Collars--
Level II evidence suggests that cervical collars are not useful. There is no support for bed rest.
Multimodal Therapy--
Level II evidence suggests that multimodal therapy, combining manipulative therapy, exercise and cognitive-behavioural therapy is effective in the management of neck pain.
Summary--
There is strong evidence to support the use of manipulative physiotherapy for the short-term management of neck pain. Evidence also supports the use of pulsed electromagnetic therapy, biofeedback, acupuncture, TENS and exercise rehabilitation. At present, on the basis of Level I and II evidence, cervical (neck) collars, ultrasound, laser and traction cannot be recommended for the treatment of neck pain. In regards to long-term effects of manipulative therapy or other forms of physiotherapy, there is insufficient literature to make firm conclusions. This is an area open for further research.
Luck LI
Musculoskeletal Physiotherapist
Manipulative Physiotherapy--
There is considerable evidence to support the benefits of manipulative physiotherapy is reducing acute (early stage) and chronic (long-standing) neck pain. Studies in the main have evaluated spinal manipulative therapy in short-term follow-ups. Manipulative therapy comprises passive joint mobilization and manipulation. Insufficient studies have undertaken long-term follow-up to allow firm conclusions to be drawn about the long-term efficacy of manipulative therapy for neck pain.
Traction--
Firm conclusions about efficacy of traction cannot be drawn from Level I evidence at this stage. Of five randomised controlled trials, two had positive and three negative outcomes.
Exercise--
There is recent Level II evidence to support the use of specific exercise rehabilitation, but no evidence is available on Pilates therapy, Feldenkrais, Alexander techniques.
Electrophysical Agents--
The evidence available regarding the efficacy of electrophysical agents (treatment with electrical machines) is limited. Some limited experience is available in support of pulsed electromagnetic therapy, TENS and biofeedback. At present there is no evidence that supports the use of ultrasound, infra-red therapy, or laser therapy. The efficacy for acupuncture has minor support from Level I evidence and moderate support from Level II evidence.
Collars--
Level II evidence suggests that cervical collars are not useful. There is no support for bed rest.
Multimodal Therapy--
Level II evidence suggests that multimodal therapy, combining manipulative therapy, exercise and cognitive-behavioural therapy is effective in the management of neck pain.
Summary--
There is strong evidence to support the use of manipulative physiotherapy for the short-term management of neck pain. Evidence also supports the use of pulsed electromagnetic therapy, biofeedback, acupuncture, TENS and exercise rehabilitation. At present, on the basis of Level I and II evidence, cervical (neck) collars, ultrasound, laser and traction cannot be recommended for the treatment of neck pain. In regards to long-term effects of manipulative therapy or other forms of physiotherapy, there is insufficient literature to make firm conclusions. This is an area open for further research.
Luck LI
Musculoskeletal Physiotherapist