Bryans R, DC, Decina P, DC, Descarreaux M, DC, PhD, et al.


WFC 2013 AWARD WINNING PAPER. Evidence-based Guidelines for the Chiropractic Treatment of Adults with Neck Pain. JMPT 2013;xx:1-22. Epub ahead of print

Comments: This is a new evidence-based guideline based on a systematic review of the scientific literature for chiropractic treatment of adults with nonspecific/mechanical neck pain. Eleven recommendations including some with strong, moderate, weak evidence are made. The strongest evidence includes HVLA manipulation in combination with exercise. Look to see if what you are currently doing in practice conforms to recommendations in this new guideline.

Background:Study to develop evidence-based Tx recommendations for nonspecific (mechanical) neck pain in adults.

Methods:Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice using databases: MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, & the Cochrane Library. Number, quality, & consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) & formulate Tx recommendations.

Results: 41 RCTs met the inclusion criteria, scoring a low risk of bias & were used to develop 11 Tx recommendations (condensed here into 7 because some are combined):
      1. Strong recommendations were made for the Tx of CNP w SM, manual therapy, & exercise in combination w other modalities.
      2. Strong recommendations were also made for the Tx of CNP w stretching, strengthening, & endurance exercises alone.
      3. Moderate recommendations were made for the Tx w acute NP with SM & MO in combination w other modalities.
      4. Moderate recommendations were made for the Tx of CNP w MO as well as massage in combination with other therapies.
      5. A weak recommendation was made for Tx of acute NP w exercise alone & Tx of chronic NP w manipulation alone.
      6. Thoracic manipulation & trigger point therapy could not be recommended for Tx of acute NP due to insufficient evidence.
      7. TENS, thoracic SM, laser, & traction could not be recommended for Tx of chronic NP due to insufficient evidence.


Conclusion: Interventions commonly used in chiropractic care improve outcomes for the treatment of acute & chronic NP. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.