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Research-Based Treatment for Neck Pain (3 CE Hours)

This course is approved by the Texas Department of State Health Services DSHS for Continuing Education for Massage Therapists CE0009 and by the NCBTMB for Nationally Certified Massage Therapists for 3 CE Hours.

Learning Outcome:
The student will be proficient in explaining the etiology, prevalence and risk factors associated with neck pain and headaches and be able to explain valuable research-based information on the efficacy of massage therapy in the treatment of neck pain and headaches.

Learning Objectives:
At the conclusion of this program, the....            

  1. Student will be able to describe the research-based etiology, prevalence, risk factors and pathoanatomy associated with neck pain and headaches.
  2. Student will be able to describe the research-based clinical presentation of patients with neck pain and headaches.
  3. Student will be able to list the research-based impairment classifications of neck pain.
  4. Student will be able to list appropriate questions to assess a patient’s activity limitations and level of function related to neck pain supported by the research.
  5. Student will be able to list the research-based appropriate special tests for neck pain performed during patient assessment.
  6. Student will be able to list research-based diagnostic classifications that are inconsistent with neck pain.
  7. Student will be able to list appropriate functional outcome measures supported by the research for patients with neck pain.
  8. Student will be able to describe the research-based efficacy of manual therapy in the treatment of patients with neck pain.
  9. Student will be able to describe the research-based efficacy of therapeutic massage in the treatment of patients with neck pain.
  10. Student will be able to describe the research-based efficacy of therapeutic exercise and stretching in the treatment of patients with neck pain.
  11. Student will be able to describe the research-based importance of patient education in the treatment of patients with neck pain.
  12. Student will be able to list and explain the research studies that promote the use of massage in the treatment of neck pain.

 

Research-Based Prevalence of Neck Pain
Statistical research has estimated that 20–70% of the population will experience neck pain at some time in their lives and that at any one time approximately 10-20% of the population has neck pain. (1)  Neck pain is often a chronic problem and a recent study reported that 37% of people with neck pain will complain of persistent symptoms for at least a year. (2)  Neck pain affects the older adult population to a greater extent and 50% of the over-50 population suffers from neck pain each year.  In the United States, neck pain is second to low back pain in worker compensation claims and the annual cost of neck pain is estimated at $7 billion. (3)  Neck pain patients are often treated non-surgically by primary care physicians and physical therapists and neck pain patients comprise approximately 25% of the case load of a typically orthopedic physical therapist. (4) 

Research-Based Etiology and Pathoanatomy of Neck Pain
The causes attributed to neck pain are many and varied, including trauma with associated strain and sprain, degenerative disc disease, disc herniation, facet joint osteoarthritis, osteophytosis (bone spurs), infection, tumors, torticollis and myofascial pain syndrome.  Once serious causes (like fractures, tumors, infection, neuropathy and myelopathy) are ruled out, the most common classification is mechanical neck disorder.  Although many structural abnormalities may be visible on imaging (X-ray, MRI) including osteophytosis, degenerating discs, herniated discs, nerve root and spinal cord impingement) and these may be possible causes of neck pain, a specific pathoanatomical cause is not identifiable in the majority of cases. (5) 

Research-Based Risk Factors Associated with Neck Pain
In a recent study, researchers followed 443 patients with neck pain for 1 year. (6)  Risk factors associated with poor pain-related and disability-related outcomes were:  Worse pain and disability at baseline, a history of neck pain, longer duration of symptoms, loss of strength in hands, more worrying, low vitality, worse self-perceived health, poor quality of life.  In another recent study, researchers found that certain baseline characteristics were associated with persistent neck pain. (7) They found that age between 45 and 59, off work due to neck pain, co-morbidity with low back pain, and bicycling as a regular activity were significant risk factors.  In a prospective cohort study of 183 patients with neck pain, researchers found that older age (≥ 40 years), co-morbidity of low back pain, headaches, previous trauma, and long duration of neck pain were risk factors associated with poor prognosis. (8)  Based on these studies, the main risk factors associated with poor outcomes are:
Older age (40-59)                                              Worse pain at baseline
History of neck pain                                           Longer duration of neck pain symptoms
Co-morbidity with low back pain                        Headaches
Previous trauma                                                 Loss of strength in hands
More worrying                                                    Low vitality
Bicycling as an activity                                        Poor quality of life

Research-Based Categorization of Patients with Neck Pain
As stated earlier, the majority of patients that present with neck pain are categorized as having “mechanical neck pain.”  A minority of patients with neck pain may have a more serious underlying cause including possible fracture, tumor, infection, neuropathy or myelopathy.  In these cases, it is important that the clinician is aware of the signs and symptoms of these more serious neck conditions and screen for them during the initial evaluation.  If the patient’s symptoms are not resolving with physical therapy interventions, it may also be appropriate to consider other underlying causes.
A diagnosis of cervicalgia (ICD9-723.1) is consistent when a patient presents with the following clinical findings: Younger age (< 50), acute neck pain (< 12 weeks), symptoms isolated to the neck, and limited cervical range of motion. (10)

A diagnosis of cervicocranial syndrome (ICD9-723.2) is consistent when a patient presents with the following clinical findings: Headache aggravated or produced by provocation of cervical joints or myofascia, limited cervical range of motion, limited cervical segmental mobility, below normal performance on cranial cervical flexion test. (10)

A diagnosis of strain and sprain of cervical spine (ICD9 847.0) is consistent when a patient presents with the following clinical findings: chronic neck pain (>12 weeks), below normal performance on cranial cervical flexion test, below normal performance on the deep neck flexor endurance test and muscle strength and flexibility deficits in neck and upper quarter muscles. (11)

A diagnosis of cervical radiculopathy (ICD9-723.4) is consistent when a patient presents with the following clinical findings: radicular or referred upper extremity symptoms which are increased by Spurling’s test and upper limb tension tests and decreased by the neck distraction test, and limited cervical rotation toward the involved side. (12)

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