Neck Pain

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Books to read later

• Bonicas CHAPTER 68 Neck and Arm Pain¹

Epidemiology

• 22-70% of the population will have neck pain at some point
• 10-20% of the population reports neck problems
  • 54% experienced neck pain within last 6 months

Acute phase

Rehabilitation

• Encourage ADLs 2-4 days after injury (dependent on serverity)
  • Absence from abuse, not absolute rest, usually advocated within the first 24-72 hrs
  • Absolute rest indications: pain with all neck motions and high irritability
• Discourage prone lying and encourage SL/supine w/pillow for neutral neck
• Cervical stabilization at earliest opportunity:
  • General strength/endurance exercises for neck flexors
  • Specific exercises for coordination/control of neck and upper extremity mm
• HVLATs?
  • Pts with neck pain in acute and subacute phase
  • RCT Dunning et al → HVLATs in cervical and upper thoracic for mechanical neck pain better than non thrust mobilization
  • RCT Masaracchio et al→ t spine thrust manips and c spine non thrust manipulations + exercise = better outcomes on numeric pain rating scale, NDI, global rating of change. AROM/AAROM Focus is motor control not strength Rotation recommended, 10 times each direction Bird et al: to improve endurance 4-6 sets per ex, rest 30-60 sec Incorporate breathing: end of range w tissue resistance, take moderate breath in then release it, (should be able to inc range a little without causing pain) NWB → sitting → standing

Chronic Neck Pain

Symptoms

• Pain
• “Proprioceptive deficit is also associated with chronic neck condtions”²
  • “Moreover, neck pain has a direct influence on an individual’s ability to gain accurate proprioceptive information relative to position sense (PS) and alignment”²

Rehabilitation

• Oculocervicokinetic reeducation (exercises to address eye, head coordination to improve cervicocephalic anesthesia- ability to relocate accurately the head on the trunk after active mvmt in the horizontal plane) will be used^{saturnoValidityReliabilityGuidelines2003?}
• Trigger points should be treated with transcutaneous e-stim^{saturnoValidityReliabilityGuidelines2003?}
• Dysfunction of analytic joint passive mobility should be treated with:
  • Joint mobs/manips
  • Contract/relax techniques
• Radiating pain to the upper limb should be treated with traction

General Interventions

EBP recommendations for cervical intervention@saturnoValidityReliabilityGuidelines2003

Saturno (2003) Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain

Saturno et al., assessed different neck pain guidelines from primary health care in Spain for the validity and reliability of the recommended interventions.

Advice on reducing repetitive movements and/or postures

Physical therapy

• Active stretching^{saturnoValidityReliabilityGuidelines2003?}
• Dynamic muscular strengthening exercises^{saturnoValidityReliabilityGuidelines2003?}
• HEP^{saturnoValidityReliabilityGuidelines2003?}

ROM

AROM/AAROM

• Focus is motor control not strength
• Rotation recommended, 10 times each direction
• Bird et al: to improve endurance 4-6 sets per ex, rest 30-60 sec
• Incorporate breathing: end of range w tissue resistance, take moderate breath in then release it, (should be able to inc range a little without causing pain)
• NWB → sitting → standing

Activity

• Encourage ADLs 2-4 days after injury (dependent on serverity)^{saturnoValidityReliabilityGuidelines2003?}
• Absence from abuse, not absolute rest, usually advocated within the first 24-72 hrs^{saturnoValidityReliabilityGuidelines2003?}
• Absolute rest indications: pain with all neck motions and high irritability^{saturnoValidityReliabilityGuidelines2003?}

NM Re-ed

• Oculocervicokinetic reeducation (exercises to address eye, head coordination to improve cervicocephalic anesthesia- ability to relocate accurately the head on the trunk after active mvmt in the horizontal plane) will be used^{saturnoValidityReliabilityGuidelines2003?}

Manual Therapy

• HVLATs:
  • Indicated for Acute & Subacute neck pain

Modalities

• E-stim: Trigger points in chronic neck pain

References

1.

Ballantyne J, Fishman S, Rathmell JP, eds. Bonica’s Management of Pain. 5th ed. Wolters Kluwer; 2019.

2.

Burke S, Lynch K, Moghul Z, Young C, Saviola K, Schenk R. The reliability of the cervical relocation test on people with and without a history of neck pain. The Journal of Manual & Manipulative Therapy. 2016;24(4):210-214. doi:10.1179/2042618615Y.0000000016