Manual Physical Therapy, Exercise May Improve Neck Pain, Disability CME

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD

October 24, 2008 — A program of manual physical therapy and exercise was statistically significantly better in improving mechanical neck pain and disability than a program combining advice, mobility exercise, and ultrasound, according to the results of a randomized controlled trial reported in the October 15 issue of Spine.

"Although many interventions are accepted as standard of care for mechanical neck pain, substantial evidence regarding the effectiveness of nonoperative interventions such as traction, active and passive exercise, ultrasound, transcutaneous electrical nerve stimulation, patient education, and nonsteroidal anti-inflammatory medication is lacking," write Michael J. Walker, PT, DSc, OCS, CSCS, FAAOMPT, from the US Army-Baylor University in Fort Sam Houston, Texas, and colleagues. "Mounting evidence does support the combined use of manual therapy and exercise for patients with cervicogenic headache and mechanical neck pain."

The goal of this study was to compare the efficacy of manual physical therapy and exercise and a minimal intervention approach for mechanical neck pain with or without unilateral upper extremity symptoms.

At 3 physical therapy clinics, 94 patients referred for mechanical neck pain, with or without unilateral upper extremity symptoms, were randomly assigned to treatment with manual physical therapy and exercise or with a minimal intervention approach consisting of advice, motion exercise, and subtherapeutic ultrasound. The main endpoints were the neck disability index, cervical and upper extremity pain visual analog scales (VAS), and patient-perceived global rating of change at 3, 6, and 52 weeks, whereas secondary endpoints were treatment success rates and posttreatment healthcare utilization.

Compared with the minimal intervention group, the manual physical therapy and exercise group had significantly larger improvements in short- and long-term neck disability index scores (mean 1-year difference –5.1; 95% confidence interval [CI], –8.1 to –2.1; P = .001) and in 6-week cervical VAS scores (mean difference, –14.2; 95% CI, –22.7 to –5.6; P = .001). At all periods, the manual physical therapy and exercise group also had significant within-group improvements in short- and long-term upper extremity VAS scores (mean 1-year difference, –16.3; 95% CI, –23.1 to –9.5; P = .000). At 1-year, 62% (29/47) of patients in the manual physical therapy and exercise group reported that they perceived their treatment to be successful vs 32% (15/47) of the minimal intervention group (P = .004).

"An impairment-based MTE [manual physical therapy and exercise] program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound," the study authors write.

Limitations of this study include possible lack of generalizability beyond military beneficiaries, use of broad mechanical neck pain inclusion criteria, limited ability to identify a specific subgroup of patients likely to respond to manual physical therapy and exercise, absence of a no-intervention control group, treatment limited to 6 sessions, and lack of blinding of patients.

"The benefits of this intervention are the reduction of cervical and UE [upper extremity] pain, neck disability, and healthcare utilization rates, and in the increase of perceived recovery and treatment success," the study authors conclude. "These treatment effects are maintained during both short- and long-term follow-ups."

No funds were received to support this study, and no benefits were or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The opinions of the authors are not to be construed as official or as reflecting the views of the Department of Defense, the Department of the Army, Department of the Air Force, or the United States Public Health Service.

Spine. 2008;33:2371-2378.

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