L10 treatment guidelines neck disorders Flashcards
SIRA acute WAD guidelines
recommended Rx reassure and stay active return to usual activities exercise ROM exercises low load isometric postural endurance and strengthening exercises pharmacology - simple analgesics NSAIDs opioids analgesics
not routinely recommended manual therapy - may be effective - provided there is evidence of continuing measurable improvement thoracic manipulation acupuncture trigger point needling surgical intervention
not recommended traction pilates massage cervical pillows heat ice laser SWD magnetic necklaces
recommendations reduction of usual activities immobilisation collars pharm - anti-depressants muscle relaxants injections - steroid injections PEMT
APTA neck pain guidelines
Neck Pain with Coordination Impairments (e.g. WAD)
Acute
Education ‘Act as usual’ + minimal use of collar + natural hx
Multimodal approach
MT + Ex (all forms incl aerobic) if moderate to slow recovery expected
Low risk Ex prog + TENS
Monitor recovery status more intensive rehab + early PNE
Chronic
Multimodal approach
Patient Ed + MT + Ex + TENS
Neck Pain with Mobility Deficits Acute Multimodal approach Thx Manip + neck Mobilising & scap/UL strengthening exercise \+/- CxSp Manip and/or Mob Sub-acute Exercise – Neck & Scap endurance \+/- Thx Manip and CxSp Manip and/or Mob
Chronic
Multimodal approach
MT + Ex + Dry needling, laser, or intermittent mechanical/manual traction
new clinical guidelines
Dutch Clinical Practice Guideline for PT for Nonspecific Neck Pain, including CRad
Bier et al 2018
Danish National Clinical Guidelines for recent onset neck pain & CRad Kjaer et al 2017
Canada - OPTIMa Clinical Guidelines for recent onset Neck pain, including CR
Cote et al 2016
APTA Revised Neck Pain Guidelines, including CRad
Blanpied et al 2017
Dutch PT CPG - primary care
Neck Pain – Grade I & II
Advice – Natural history & ‘act as usual’
Multimodal Care - Cervical mobilization or manipulation combined with exercise therapy
Recommendation based on high quality of evidence
Do Not Offer Collar Dry needling Low-level laser, Electrotherapy Ultrasound Traction Recommendation based on low quality of evidence
danish national clinical guidelines
Recent Onset Neck Pain
Education – Favourable prognosis, Warning signs & individualised PA advice
Multimodal approach
Combined supervised exercise & MT before Pharma
Acupuncture*
If Pharma Topical NSAID*, NSAIDS > Tramadol
Do Not Offer Routinely
Massage*
Rx dose should be proportionate to pain & disability
*Weak recommendation
Recent Onset Cervical Radiculopathy
Education – Favourable prognosis, Pain mechanism, Warning signs & individualised PA advice
Multimodal approach Directional exercise to ↓ arm pain Low intensity MT* Non-provocative DNF training* Pharma (NSAIDS > Tramadol) Manual / mechanical traction*
*Weak recommendation FOR
Do Not Offer Routinely
Massage / Acupuncture
exercise for mechanical neck disorders
Objectives:
To assess the effectiveness of exercise to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain.
Methods:
Evidence current up to 21 May 2014
Participants: Adults with neck pain categorized as mechanical neck disorders, cervicogenic headache or neck disorders with radicular findings
Intervention: Exercise therapy specified in the Therapeutic Exercise Intervention Model to sub-classify exercise (Sahrmann 2002) prescribed or performed in the treatment of neck pain
Outcomes:
Primary: pain, function/disability, patient satisfaction and global perceived effect
Secondary: No specified
Evidence
Scapulothoracic and upper extremity strengthening had better improvements than controls for pain and function
Small to large effect combining cervical, shoulder/scapulothoracic strengthening and stretching
Stretching added to manual therapy - no extra benefit
Endurance training combined to stretching or strengthening exercises shows uncertain efficacy for pain and function
Neuromuscular exercises only when combined to physical and cognitive affective exercises improves pain, function and quality of life
Cervicogenic headache (CH)
Endurance training plus motor control neck exercises more effective than no treatment but no extra benefit than manual therapy for chronic NP
exercise for chronic neck pain RCT results
RCT interventions
motor control - muscle impairments persist despite pain relief
strength and endurance
- motor control impairments persist with strength training
mobility - exercises will not improve strength or endurance
motor control and endurance and mobility Ex programmes all reduce chronic neck pain
motor control and PA both reduce chronic CRad pain
motor control exercise will not improve strength
role of exercise
Short-term pain relief Gross et al 2015
Multiple mechanisms
includes reduced neural inflammation
Longer term impact on activity levels / disability
Impact on recurrence?
Axial neck pain (incl WAD)
Axioscapular muscle imbalance & scapular dyskinesis patterns exist
CRad
Scapular pattern unknown
Neuromechanosensitivity driven initially
stockholm public health cohort
Healthy lifestyle behaviour (HLB) in terms of physical activity, alcohol intake, smoking, and diet PROTECTIVE against chronic troublesome neck pain (in women)
neural tissue mobilisation
Indication – nerve-related arm pain without significant neurological dysfunction.
RCT in patients with nerve-related arm pain > 4/52 with inclusion criteria -
Arm pain below Deltoid tuberosity
Arm pain reproduced by UNLT1 with structural differentiation but
Less than 2 neurological signs on exam.
Rx aims to be non-provocative. Neuro exam & ULNT to be closely monitored throughout
Lateral Glide (30, 60 & 90degs shoulder abduction) – Gr III- or III x 30 secs x 2
Shoulder Girdle Oscillation with combined with Active Craniocervical Flexion with arm in 30degs abduction – 60 secs x 2
HEP – Sliding nerve exercises (30, 60 & 90degs abduction) with ipsilateral Cervical Sideflexion or Rotation. 10-15reps TID
HEP – Tensioning nerve exercises (30, 60 &90degs abduction with contralateral Cervical Sideflexion or Rotation or in neutral. 10-15reps TID
