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Glendale Adventist Medical Center
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Glendale, CA 91206
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Impairment-Based Physical Therapy Program for Neck Pain

Posted on: 11/20/2008
Neck pain got you down? You're not alone. On any given day, 20 per cent of adults in the United States report similar symptoms. And two-thirds of all adults will experience neck pain at some point their lives. Some get better without treatment. Others seek the services of physical therapists.

Physical therapists are working hard to narrow down what treatment works best with which group of patients. In the past 10 years, the results of research studies in physical therapy have changed the way low back pain patients are treated. The results of this study may do the same for patients with neck pain.

Research has shown us two important things about neck or back pain patients. First, it is possible to identify subgroups of patients. These are patients who respond better to one treatment over another. They may have a particular characteristic about them that puts them in that subgroup.

For low back pain patients, the presence of leg pain along with back pain has created a subgroup of patients who seem to respond to manual therapy of the lumbar spine. Manual therapy refers to nonthrust joint mobilization and/or thrust joint manipulation of the spine. In this study, the same idea is applied to patients with mechanical neck pain with and without arm pain.

Mechanical neck pain tells us the problem is within the joints and/or soft tissue structures. It is not caused by tumor, infection, or fracture. Patients with whiplash injuries, stenosis, or previous neck surgery were not included in this study. One group received manual physical therapy and exercise (MTE). The second group had minimal intervention (MIN) therapy.

MTE included joint mobilization or manipulation, muscle energy techniques, and stretching. Home exercise programs were prescribed based on impairments identified during the exam. Impairment areas identified included dysfunction of the cervical spine, thoracic spine, and ribs.

MIN patients received advice, range-of-motion exercises for the neck, and subtherapeutic ultrasound. Subtherapeutic means this form of heat was applied at a low intensity (low enough so it did not actually heat the tissue).

Everyone in both groups was treated for six sessions over a period of three weeks. There were no significant differences in the baseline characteristics of patients in both groups. Baseline factors included age, gender, type of symptoms, use of medications, neck motion, and arm pain.

The one difference that might have made a difference was the duration of symptoms. More patients in the manual therapy and exercise group (74 per cent) had symptoms lasting longer than 12 weeks when compared with patients in the minimal intervention therapy group (48 per cent).

The results were compared using pain, patient satisfaction, and function. There were two significant findings. First, patients in the manual physical therapy and exercise (MTE) group had much better improvement in all areas compared with patients in the minimal intervention (MIN) group. Second, the MIN group was much more likely to seek additional health care services after the treatment period was over. Increased utilization of health care services increases the overall costs.

The authors used a high global rating of change (GRC) to clearly define success. And the success rates lasted as long as two years after treatment. The authors concluded that using manual therapy for neck and/or arm pain caused by specific impairments of the cervical spine (neck), thoracic spine, and rib cage works better than standard minimal care.

The use of specific impairment-based exercises for each patient in the MTE group adds to the challenge of sorting out what worked. Was it just the manual therapy that was effective? Just the exercises? Or both combined together in a multimodal approach? The researchers were able to use specific statistical analyses to measure the effect of each treatment component.

They did this by assessing each patient after manual therapy techniques and before instructing the patient in the exercise(s). They felt this was an effective way to sort out what part of the treatment had a direct effect on the patient.

Although the study did not identify a subgroup of patients most likely to benefit from either MTE or MIN, the results did confirm the value of manual therapy and exercise for patients with neck pain (with or without arm pain). Reducing pain, disability, and overall health care costs is possible in the short- and long-term for patients with mechanical neck pain using manual physical therapy and exercise. The MTE approach is both safe and effective.

Michael J. Walker, PT, DSc, OCS, CSCS, FAAOMPT, et al. The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain. In Spine. October 15, 2008. Vol. 33. No. 22. Pp. 2371-2378.

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