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Neck Pain Abstracts
Soft-Tissue Neck Trauma
R. C. Schafer Rehabilitation Monograph Series ~ Chapter 15
By Richard C. Schafer, D.C., FICC
The mechanical relationship between the head and neck has been crudely compared to a brick attached to a flexible rod. As the structural mass of the head is so much greater than that of the neck, it is no wonder that injuries of the neck are so prevalent. Even the person with a short neck and well-developed neck muscles and ligaments is not free of potential injury.
The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, and spinal cord, and as a site for lymph and endocrine glands. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.
Cervical Spine Trauma
R. C. Schafer Rehabilitation Monograph Series ~ Chapter 22
By Richard C. Schafer, D.C., FICC
The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.
Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults, and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.
Joint Trauma
R. C. Schafer Rehabilitation Monograph Series ~ Chapter 8
By Richard C. Schafer, D.C., FICC
The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur. The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.
A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain
J Manipulative Physiol Ther 1995 (Oct); 18 (8): 530–536
As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions. In conclusion,
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 that indicates NSAID use is any more effective than cervical manipulation for neck pain.
Predictors For Immediate and Global Responses to Chiropractic Manipulation of the Cervical Spine
J Manipulative Physiol Ther 2008 (Mar); 31 (3): 172–183
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.
From the findings, it was possible to identify some predictors of immediate improvement in presenting symptoms after cervical spine manipulation. Patients presenting with symptoms of “reduced neck, shoulder, arm movement, stiffness,” “neck pain,” “upper, mid back pain,” “headache,” “shoulder, arm pain,” and/or “none or one presenting symptom only” are likely to report immediate improvement in these symptoms after treatment. Patients presenting with any 4 of these symptoms were shown to have the highest probability of immediate improvement. This finding may enhance clinical decision making for selecting cervical manipulation in the treatment of patients with one or more of these complaints. Although it was possible to identify a number of predictor variables for immediate worsening in presenting symptoms and global improvement after cervical spine manipulation, these failed to provide a robust predictive model for clinical application.
The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain: A Prospective, Multicenter, Cohort Study
J Manipulative Physiol Ther 2007 (Jul); 30 (6): 408–418
In contrast to clinical trials of prescription medication, researchers in the area of conservative care for musculoskeletal complaints have focused their attention on treatment effectiveness and, to a much lesser degree, on adverse events. This study, consisting of patients treated in a wide variety of chiropractic practices and settings, describes both positive and negative, and short- and long-term clinical outcomes for a relatively large study population with neck pain.
Although many of the subjects (in this study) had chronic, recurrent neck pain and had undergone prior care for this complaint, many patients experienced benefit from the treatment (based upon diminished pain and disability, the percentage of patients recovered and percentage satisfied with care). Furthermore, many responded relatively quickly to treatment (48% were recovered at the fourth visit).
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
J Manipulative Physiol Ther 2006 (Sep); 29 (7): 511–517
A group of 70 patients with neck pain (25 males and 45 females, ages 20-55 years) participated in this study. The lateral gliding test was used to establish an intervertebral joint dysfunction at the C3 through C4 or C4 through C5 levels. The subjects were randomly divided into either an experimental group, which received an HVLA thrust, or a control group, which received manual mobilization. Results suggest that a single cervical HVLA manipulation is 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.
The Impact of Psychosocial Factors on Neck Pain and Disability Outcomes Among Primary Care Patients: Results from the UCLA Neck Pain Study
Disabil Rehabil 2006 (Nov 15); 28 (21): 1319–1329
Of 960 eligible patients, 336 were enrolled and 80% were followed up through 6 months. Coping strategies involving self-assurance resulted in better disability outcomes, whereas getting angry or frustrated resulted in worse pain and disability outcomes. Participants with high levels of social support from individuals were more likely to experience clinically meaningful reductions in pain and disability. No consistent relations of internal health locus of control, and physical and psychological job demands with improvements in pain and disability were detected.
Symptomatic Outcomes and Perceived Satisfaction Levels of Chiropractic Patients with a Primary Diagnosis Involving Acute Neck Pain
J Manipulative Physiol Ther 2006 (May); 29 (4): 288–296
A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years (SD, 15.7). The mean number of visits was 24.5 (SD, 21.2). Pain levels improved significantly from a mean of 7.6 (median, 8.0) before treatment to 1.9 (median, 2.0) after treatment (P < .0001).
The overall patient satisfaction rate was 94%.
Improvement After Chiropractic Care in Cervicocephalic Kinesthetic Sensibility and Subjective Pain Intensity in Patients with Nontraumatic Chronic Neck Pain
J Manipulative Physiol Ther 2006 (Feb); 29 (2): 100–106
There was no difference between the treatment patients and the control subjects at the beginning with regard to age, sex, subjective pain intensity, range of motion, and HRA. At the 5-week follow-up, the treatment patients showed significant reductions in pain and improvement of all HRA aspects measured whereas the control subjects did not show any reduction in pain and improvement in only one HRA aspect. 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.
Determining the Relationship Between Cervical Lordosis and Neck Complaints
J Manipulative Physiol Ther 2005 (Mar); 28 (3): 187-193
In a study of 277 lateral cervical x-rays, patients with lordosis of 20° or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0° or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0° or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges.
There are more articles like this in the Spinal Allignment and Function Page.
Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis
Spine Journal (of the North American Spine Society) 2004 (May); 4 (3): 335–356
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 neck pain. 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.
Cost Effectiveness of Physiotherapy, Manual Therapy, and General Practitioner Care for Neck Pain: Economic Evaluation Alongside a Randomised Controlled Trial
British Medical Journal 2003 (Apr 26); 326 (7395): 911 ~ FULL TEXT
A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to this study. After seven and 26 weeks, they found significant improvements in recovery rates in the manual therapy group compared to the other 2 groups. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group. You may also enjoy the following WebMD review about this article.
Manual Therapy Eases Neck Pain, Cheaply
WebMD Medical News ~ Thursday, April 24, 2003
A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to a new study. After seven and 26 weeks, the study found significant improvements in recovery rates in the manual therapy group compared to the others. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group. This article quotes the the FULL TEXT British Medical Journal 2003 (Apr 26) article listed above.
Validity of Five Common Manual Neck Pain–provoking Tests
Scand J Rehabil Med 1995 (Sep); 27 (3): 131–136 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."
The Chiropractic Outcome Study: Pain, Functional Ability and Satisfaction With Care
J Manipulative Physiol Ther 1997 (May); 20 (4): 235–240
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
J Manipulative Physiol Ther 1997 (Feb); 20 (2): 80–85
Subjects receiving manipulation demonstrated a mean reduction in visual analogue scores of 44%, along with a 41% improvement in mean scores for the head repositioning skill. In comparison, a 9% mean reduction in visual analogue scores and a 12% improvement in head repositioning scores was observed for the stretching group. The difference in the outcomes of the head repositioning skill scores was significant (p < or = .05).
There are more articles like this in the
Chiropractic And Chronic Neck Pain Research Page.
Chiropractic Management of Intractable Chronic Whiplash Syndrome
Clinical Chiropractic 2004 (Mar): 7 (1): 16—23
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.
Hearing Loss, Otalgia and Neck Pain: A Case Report on Long-Term Chiropractic Care That Helped to Improve Quality of Life
Chiropractic Journal of Australia 2002 (Dec); 32 (4): 119-130 ~ FULL TEXT
Observation over an extended period assists in understanding the progression of chronic disorders. This patient experienced substantially reduced symptoms with chiropractic care during the 7-year observation period. Of note is the repeated exacerbation of neck pain that often precedes exacerbation in ear symptoms, along with the relief of both following adjustment and an association between improved hearing and improved cervical alignment.
Impairment in the Cervical Flexors: A Comparison of Whiplash and Insidious Onset Neck Pain Patients
Manual Therapy 2004 (May); 9 (2): 89–94
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.
Cervicogenic Head and Neck Pain in the ENT Clinic
HNO 2005 (May 11)
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.
Dose Response for Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 547—553
Patients were randomly allocated to 1, 3, or 4 visits per week for 3 weeks. All patients received high-velocity low-amplitude spinal manipulation. Doctor of Chiropractics could apply up to 2 physical modalities at each visit from among heat and soft tissue therapy. They could also recommend modification of daily activities and rehabilitative exercises. 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.
Who Are Candidates for Neck Pain?
Back and Neck Problems Among Dentists and Dental Auxiliaries
J Contemp Dent Pract 2001 (Aug 15); 2 (3): 17-30
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 (73.5%) complained of back pain.
Predictive Factors for Neck and Shoulder Pain: A Longitudinal Study in Young Adults
Spine 2004 (Aug 1); 29 (15): 1662-1669
A random sample of 826 high school students was investigated when they were 15 to 18 years old and again at 22 to 25 years of age. In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. In an adjusted model, psychosomatic symptoms remained an associated factor for prevalent neck and shoulder pain 7 years later for both females and males. In females, neck and shoulder pain in adolescence was associated with prevalent neck and shoulder pain in adulthood, and sports loading dynamically in the upper extremities was an associated factor for a low prevalence of neck and shoulder pain 7 years later. In separate analyses of incident neck and shoulder pain, psychosomatic stress symptoms predicted neck and shoulder pain in adulthood.
Chiropractic Care of a Patient with Vertebral Subluxations and Unsuccessful Surgery of the Cervical Spine
J Manipulative Physiol Ther 2001; 24 (7) Sept: 477-482
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.
Onset of Neck Pain After a Motor Vehicle Accident: A Case-control Study
J Rheumatol 2005 (Aug); 32 (8): 1576—1583
In total, 26% of drivers reported post-accident neck pain. Women, younger individuals, and those with a history of neck pain were more likely to report neck pain following their accident. In addition, a number of accident related and psychosocial factors were independently associated with reporting post-accident neck pain: collision from behind; vehicle stationary at impact; collision severity; not being at fault; and monotonous work. Based on these 8 factors, the likelihood of having neck pain increased from 7% with < 2 risk factors to 62% with > 5.
Whiplash Injury and Chronic Neck Pain
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.
A Study on the Prevalence of and Risk Factors for Neck Pain Among University Academic Staff in Hong Kong
J Occup Rehabil 2002 (Jun); 12 (2): 77–91
Among those with neck pain during computer processing, 60.5% 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.
Long-term Outcome After Whiplash Injury: A 2-year Follow-up Considering Features of Injury Mechanism and Somatic, Radiologic, and Psychosocial Findings
Medicine (Baltimore) 1995 (Sep); 74 (5): 281–297
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.
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