At present there is no satisfactory treatment for non-specific or age related dizziness. However, there is preliminary evidence that physical treatment of the neck may improve balance in neck pain patients. Therefore, it is important to examine the possible therapeutic effect of chiropractic interventions (particularly SMT) directed at the neck in treatment of this condition and prevention of falls in this subpopulation of the elderly. The need for this research is particularly acute given the substantial health and economic costs of falls in the elderly and the aging of the population in the industrialised world. We know that postural stability and motor control relies on integration of proprioceptive vestibular and visual inputs by the CNS, inputs that are widely believed to deteriorate with age. Neck pain is widely believed to be capable of compromising mechanisms of postural balance by distorting the proprioceptive input from the neck to the CNS. It is possible that integration of incongruous inputs by CNS balance centres becomes more challenging as proprioceptive visual and vestibular sensory mechanisms age. Whilst neck manipulation, a commonly practiced treatment by chiropractors, has shown effectiveness for neck pain, it has not been adequately evaluated for non-specific dizziness. However, there is encouraging preliminary data that seems to support the use of neck manipulation in treating this condition. Given that both spinal pain and dizziness are risk factors for balance deficits and falls in the elderly, rigorously designed randomised controlled trials are needed in this area. These trials should focus on both efficacy and effectiveness of the various chiropractic neck manipulation and mobilisation techniques and strategies on: neck pain; non-specific dizziness; dizziness-related disability; and falls frequency in the community dwelling elderly population.
Spinal manipulative therapy (SMT) with home exercise resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.
The studies included in this guideline indicate that cervical manipulation, mobilization, manual therapy, exercise, and massage can be recommended for the chiropractic treatment of nonspecific, mechanical neck pain. The strongest recommendations are typically made for the primary intervention in combination with another intervention, usually exercise and/or patient education. Owing to conflicting findings in the literature, no recommendation could be made for laser, TENS, or thoracic manipulation in the treatment of chronic neck pain or for the use of thoracic manipulation in the treatment of acute neck pain. There is a lack of evidence to support the use of laser, trigger point therapy, or traction for nonspecific, mechanical neck pain in adults.
Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up
A high proportion of acute and most importantly subacute/chronic patients with MRI-confirmed symptomatic cervical disk herniations treated with high-velocity, low-amplitude cervical spine manipulation reported clinically relevant improvement at 1 and 3 months after the first treatment. There were no adverse events reported for patients in this study.
Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up
Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.
The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain.
The association of complementary and alternative medicine use and health care expenditures for back and neck problems
CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
This new study, published in the Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.
Predictors of Outcome in Neck Pain Patients Undergoing
Chiropractic Care: Comparison of Acute and Chronic Patients
For the most part, baseline variables were not predictive of outcome in neck pain patients and as a consequence prediction of outcome at 1 week was not possible using the potential predictors measured in this study. Instead, the most consistent predictor of improvement at both 1 and 3 months for both acute and chronic neck pain patients undergoing chiropractic treatment is significant self-reported improvement early on. Importantly, the co-existence of cervical radiculopathy or dizziness in addition to neck pain was not associated with a negative outcome for either acute or chronic patients.
Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial
For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.
This study provides a retrospective review of clinical outcomes for a sample of veterans with neck pain within a VHA chiropractic clinic. Despite the levels of service-connected disability and comorbidity among this sample of veteran patients seeking care for neck pain, mean clinical outcomes were considered to be both statistically significant and clinically meaningful. Although retrospective design-based limitations are identified, this study serves as a foundation for further research and provides the most extensive account to date of chiropractic clinical outcomes for veteran patients with neck pain.
The DBCDG can be applied in a busy private practice setting. It appears possible to investigate the usefulness of the DBCDG through practice-based comparative effectiveness research. Further research is needed to investigate the validity of the questions used in this study to identify problematic coping strategies and depression as well as to establish a threshold for a “positive” and “negative” finding for these measures. In addition, there is need to find better clinical means of identifying central pain hypersensitivity. Research is also needed to investigate correlations and patterns among the individual components of the approach, the reliability and validity of the diagnoses and the clinical utility and efficacy.
A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain
The results of our study are important because there has been minimal previous research regarding the prevention of NCNP. Our results suggest that the mere fact of taking charge of and managing a patient for this condition might decrease the recurrence of pain episodes and, therefore, change the course of the disease. Considering the societal burden of NCNP,  the issue is worth investigating, both in terms of treatment efficacy and cost-effectiveness. Further research related to our hypothesis might be conducted in the form of a RCT.
Our results also indicate that there is no additional benefit for patients with NCNP to receive monthly preventive SMT or monthly preventive SMT with a home exercise program compared to meeting a chiropractor once every 2 months to discuss neck problems. In view of the rare but possible adverse reactions to cervical SMT, this tends to reject CPC when SMT is the main intervention. However, the premise of CPC stating that regular treatments, designed to preserve optimum health, will also minimize the recurrence of clinical problems, might hold true when intervention is geared towards reassurance, patient education, help with self-management and active care strategies. Further research in this domain has to be conducted.
A final implication of these results is the equivalence between the SMT and combined intervention groups. The actual, best evidence regarding treatment for NCNP is a combined approach involving manual therapy and exercise . It is possible that the best strategy for prevention of NCNP might not be similar to the best strategy for treatment of this condition. Further research is warranted in this regard.
It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.
Eighty-two RAAF FJ aircrew responded to the survey. Ninety-five percent of the respondents experienced flight-related neck pain. The most commonly sought treatment modalities were on-base medical and physiotherapy services. Many respondents reported that currently provided on-base treatment and ancillary services such as chiropractic therapy are the most effective in alleviating symptoms.
The cervical flexion-relaxation ratio: reproducibility and comparison between chronic neck pain patients and controls
The cervical extensor muscles exhibit a consistent flexion-relaxation phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The FRR in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.
This is an accompanying commentary on the article by Gert Bronfort and colleagues about the effectiveness of manual therapy. The two commentaries were provided independently and combined into this single article by the journal editors
Rehabilitation program for traumatic chronic cervical pain associated with unsteadiness: a single case study
This case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma CNP patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness.
Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.
Moderate quality evidence showed cervical manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate-term follow-up. Low quality evidence suggested cervical manipulation may provide greater short-term pain relief than a control (pSMD -0.90 (95%CI: -1.78 to -0.02)). Low quality evidence also supported thoracic manipulation for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and immediate pain reduction in chronic neck pain (NNT 5; 29% treatment advantage). Optimal technique and dose need to be determined.
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.
Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
This study is the first attempt to identify variables that can predict immediate outcomes in terms of improvement and worsening of presenting symptoms, and global improvement, after cervical spine manipulation. The predictor variables were strongest for immediate improvement.
The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study
Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks.
Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits. Optimal dosage of effective techniques and prognostic indicators for responders to care should be explored in future research.
Neck or occipital pain and shoulder pain are very common symptoms among adolescents, and both prolonged sitting and a high level of physical activity seem to be related to them.
Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials
There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks posttreatment. The current evidence does not support a similar level of benefit from massage.
The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: results from the UCLA Neck Pain Study
We found some evidence that certain coping strategies and types of social support are associated with pain and disability outcomes in this population of largely subacute and chronic neck-pain patients.
Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial
Our results suggest that a single cervical HVLA manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain.
Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain
Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.
Symptomatic outcomes and perceived satisfaction levels of chiropractic patients with a primary diagnosis involving acute neck pain
Patients with acute neck pain involved in this study seemed to be satisfied with chiropractic treatment and reported reductions in associated pain levels and activity restrictions. However, because of the study’s design and limitations, care must be taken before drawing firm conclusions from the data presented.
This report is provided to illustrate a systematic approach diagnosis and treatment to assist this injured workers return to work. This case illustrates that even after 2 years successful return to work can be achieved.
Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain
The results of this study suggest that chiropractic care can be effective in influencing the complex process of proprioceptive sensibility and pain of cervical origin. Short, specific chiropractic treatment programs with proper patient information may alter the course of chronic cervical pain.
Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation
The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.
Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation
The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.
Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain
For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs. This effect was greater on a per-episode basis than on a per-patient basis.
The evidence summarised in this systematic review indicates that specific exercises may be effective for the treatment of acute and chronic MND, with or without headache. To be of benefit, a stretching and strengthening exercise program should concentrate on the musculature of the cervical, shoulder-thoracic area, or both. A multimodal care approach of exercise, combined with mobilisation or manipulation for subacute and chronic MND with or without headache, reduced pain, improved function, and global perceived effect in the short and long term. The relative benefit of other treatments (such as physical modalities) compared with exercise or between different exercise programs needs to be explored. The quality of future trials should improve through more effective ‘blinding’ procedures and better control of compliance and co-intervention. Phase II trials would help identify the most effective treatment characteristics and dosages.
It is discussed controversially whether cervicogenic pain in the head and/or neck is a pathogenic entity. The good results obtained with manual therapy in patients with head and neck pain contradict the refusal of the majority of the neurologists to accept the diagnosis “cervicogenic headache.” Complaints about headache are frequently encountered in the general ENT clinic. The versatile picture of the cervicogenic headache is caused by the complex neural connections in the region of the upper cervical spine. The differential diagnosis of the cervicogenic headache is described.
We found a statistically significant association between cervical pain and lordosis < 20 degrees and a “clinically normal” range for cervical lordosis of 31 degrees to 40 degrees. Maintenance of a lordosis in the range of 31 degrees to 40 degrees could be a clinical goal for chiropractic treatment.
Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes
In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.
Pain is a common problem among patients with NMDs. There are many similarities, but also some important differences, between NMD diagnostic groups on the nature and scope of pain and its impact. More research is needed to identify and test effective treatments for NMD-related pain.
The purpose of this paper was not to provide a comprehensive look at the diagnosis and management of patients with chronic cervical disorders, but rather to present an overview of an evidence-based model to the approach to these patients. Central to this model is the notion that the etiology of most chronic cervical disorders is usually multifactorial, and thus the approach to diagnosis and management must consider the many factors that can be present in each case. The model takes a systematic approach to diagnosis, based on what this author terms the Three Essential Questions of Diagnosis, which leads to the development of a working diagnosis, not of a single lesion, but of the entire clinical picture, including primary pain generators and perpetuating factors. A management strategy is then devised to address those specific factors that were detected on history and examination, in an environment in which the patient is empowered to self manage whenever possible.
Research into individual components of this model, as well as the model as a whole, is necessary to determine the applicability and effectiveness of the approach. This will allow for alteration or abandonment of any part of the model, as clinical and experimental evidence dictates.
Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study
A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.
Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis
Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care.
The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all P<0.05) and had significantly greater shortfalls from the pressure targets in the test stages (P<0.05). No significant differences were evident between the neck pain groups in either parameter indicating that this physical impairment in the neck flexor synergy is common to neck pain of both whiplash and insidious origin.
The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post-isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, no headaches and unrestricted cervical spine range of motion. At 4 months follow-up, the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain.
Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial
Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.
Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain
The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.
Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial
In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
The authors found a hypersensitivity to peripheral stimulation in whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles.
A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction
The results of this clinical trial indicate that both instrumental (MFMA) manipulation and manual (HVLA) manipulation have beneficial effects associated with reducing pain and disability and improving cervical range of motion in this patient population. A randomized, controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings.
The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis.
Although the treatment of neuropathic pain is difficult, sufficient evidence in the literature demonstrates that the treatment of nociceptive pain should be multimodal and involve spinal manipulation, muscle lengthening/stretching, trigger point therapy, rehabilitation exercises, electrical modalities, a variety of nutritional factors, and mental/emotional support.
Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation
Joint complex dysfunction should be included in the differential diagnosis of pain and visceral symptoms because joint complex dysfunction can often generate symptoms which are similar to those produced by true visceral disease.
Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.
The effects of spinal manipulation on cervical kinesthesia in patients with chronic neck pain: a pilot study
The results suggest a possible effect of manipulation on proprioception in subjects with chronic neck pain. The small sample size, lack of true randomization and lack of blinding of the examiner are factors that weaken these findings. Larger, more controlled studies are needed to determine what specific effects manipulation may have on the function of proprioception.
Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.
The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence tha indicates NSAID use is any more effective than cervical manipulation for neck pain.
This study revealed that palpation for pain was the most reproducable and accurate assessment of reported neck pain. They state: “Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self–reported questionnaires on dysfunctions of the neck.”
In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash
Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence
Peripheral tissue damage or nerve injury often leads to pathological pain processes, such as spontaneous pain, hyperalgesia and allodynia, that persist for years or decades after all possible tissue healing has occurred. Although peripheral neural mechanisms, such as nociceptor sensitization and neuroma formation, contribute to these pathological pain processes, recent evidence indicates that changes in central neural function may also play a significant role.
Development of neck pain after a motor vehicle accident is a complex phenomenon resulting from the combined effects of constitutional, mechanical, and psychosocial factors. Using 8 such variables it is possible to identify those at high risk of developing neck pain.
In young adults, the incidence of neck and shoulder pain is high, and the associated factors of neck and shoulder pain are already multifactorial in a young population.
A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong
Among those with neck pain during computer processing, 60.3% had a forward head posture. However, a low correlation between psychosocial factors and neck pain was demonstrated (r = 0.343). Academic staff in tertiary institutions could be considered as a high-risk group of job-related neck pain.
Chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine
The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient’s symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.
In the practice of dentistry, stress, tension, and postural practices can contribute to back and neck problems. Two hundred and four dentists and dental auxiliary (87 males and 117 females) in Riyadh city, Saudi Arabia were surveyed to determine the prevalence of postural problems. The candidates were interviewed and observed during practice. The data obtained showed that 111 (54.4%) of the subjects complained of neck pain and 150 (73.3%) complained of back pain.
For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone. The effect of low-technology exercise or spinal manipulative therapy alone, as compared with no treatment or placebo, and the optimal dose and relative cost effectiveness of these therapies, need to be evaluated in future studies.
Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings
Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. With regard to baseline findings the following significant differences were found (on this cohort): Symptomatic patients were older, had higher incidence of rotated or inclined head position at the time of impact, had higher prevalence of pretraumatic headache, showed higher intensity of initial neck pain and headache, complained of a greater number of symptoms, had a higher incidence of symptoms of radicular deficit and higher average scores on a multiple symptom analysis, and displayed more degenerative signs (osteoarthrosis) on X ray.
New England Journal of Medicine 1994 (Apr 14): 330 (15): 1083—1084
Whiplash injuries occur in more than 1 million people in the United States every year (1). Although the majority become asymptomatic in a matter of weeks to a few months, 20 to 40 percent have symptoms that are sometimes debilitating and persist for years. This so–called late whiplash syndrome has become one of the most controversial conditions in medicine. Some attribute the persistent symptoms to unresolved injury, whereas others attribute them to underlying psychological factors or the possibility of financial gain.
Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects
Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.