Physical Therapists Kapaa HI
Health Spa, Physical Therapist
Massage Practitioner, Physical Therapist
Osteopath (DO), Physical Therapist
Impairment-Based Physical Therapy Program for Neck Pain
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 mini...
Scientific Evidence for Physical Therapy to Treat Neck Pain
Physical therapists, like everyone else in the health care field, are working hard to find ways to treat patients safely and effectively. Instead of treatment as usual, therapists are striving to find scientific evidence to support (or refute) current treatment approaches.
One of the ways this is done is to compare treatment of a common problem (e.g., acute neck pain as in this study) using one type of therapy versus another. In this study, the use of electro/thermal therapy is compared with thoracic manipulation (joint thrust).
A previous study by the same authors showed evidence that thoracic spine manipulation combined with other treatment is more effective than electro/thermal therapy alone. The results were reported in terms of short-term improvement. Specifically, improvements in neck range-of-motion, pain, and function were observed at the time of immediate follow-up. No long-term studies have been done in this area.
So, taking the same model used in the previous study, the physical therapists repeated the experiment. This time, they compared two groups of acute neck pain patients using the same treatment and reporting on the same results for a longer period (up to four weeks). Repeating results from a previous study helps validate the treatment as an effective way to manage neck pain.
Everyone in both treatment groups had neck pain lasting less than one month. That meets the criteria for acute pain. Everyone was screened carefully for a serious medical cause of their neck pain such as a tumor, infection, or fracture. Certain patient groups were excluded (e.g., fibromyalgia patients, anyone who had a recent spinal manipulation, or anyone with osteoporosis). Only patients between the ages of 18 and 45 were allowed to participate.
Forty-five patients were selected and randomly assigned to one of two groups. The first group received five electro/thermal therapy sessions over a three-week period. This treatment consisted of 15 minutes of superficial heat to the neck area using an infrared lamp. This was followed by electrical nerve stimulation applied with electrodes on either side of the spine at the C7 (seventh cervical vertebra) level.
The second group had the same electro/thermal therapy treatment and three (once a week for three weeks) thoracic spine thrust manipulations. The thrust manipulation was done with the patient in a seated position, arms folded across the chest. The therapist stood behind the patient and applied an upward distraction manipulation by grasping under the patient's elbows and lifting. One physical therapist administered all of the treatments to all of the patients.
The results concurred with the first study done as well as other independent studies (i.e., not this group of researchers) in this same area of research. Patients improved more with the manipulation procedure (combined with the heat and electrotherapy) than with just heat and electrotherapy alone (nonthrust group). There wa...