Cervicalgia (neck pain). Treatment modalities
In 2019, the Journal of Physiotherapy published an article titled “Physiotherapy management of neck pain,” dedicated to the therapeutic management of cervicalgia. The author of the article, Arianne P. Verhagen, presents a contemporary approach to diagnosing and treating this common symptom complex.
Neck pain is one of the four most frequent conditions encountered in orthopedic practice and is a heavy burden for society these days. Adequate modern diagnostics allow for choosing the optimal method of treating this condition. The preferred treatment methods for such patients include the following:
- Education
- Physical exercises
- Manual therapy
- Massage
Other treatment methods include:
- Medication therapy
- Surgical treatment
Most guidelines for diagnosing and treating cervicalgia recommend a combination of manual therapy, physical exercises, and patient education based on an evidence-based approach.
Education
Education is an integral part of overall therapy and serves as a means of communication between the patient and the physiotherapist. The educational elements consist of:
- Providing information about the causes of pain and the disease prognosis.
- Convincing patients that the pain is not a severe condition.
- Informing that imaging is generally not recommended.
- Recommending an active lifestyle.
- Teaching exercises and stress coping skills.
Exercises
The range of recommendations for cervicalgia includes a wide variety of exercises, from gym or home-based routines to aquatic activities. The following sets of exercise are recommended:
- Endurance exercises
- Strength exercises
- Stretching exercises
- Strengthening exercises
- Stabilization exercises
- Motor control exercises
- Breathing exercises
Manual therapy
Manual therapy consists of various techniques, including mobilization and manipulation.
Mobilization is defined as the use of low-velocity, low-amplitude passive movements within the range of motion of the patient under supervision.
Manipulation is defined as a localized, high-velocity, low-amplitude thrust directed at specific cervical or thoracic spinal segments at the limit of the patient’s range of motion. A Cochrane review showed that cervical mobilization and manipulation were equally beneficial for patients with nonspecific neck pain (J.J. Wong et al, 2016).
Massage
Massage therapy is one of the oldest methods for treating musculoskeletal pain. It involves the mobilization and manipulation of soft tissues through touch, pressure, and rubbing. There is a wide range of techniques falling under the term “massage therapy.” Massage techniques vary in the way touch is applied and the amount of pressure used.
Medication therapy
Medication therapy typically includes prescribing over-the-counter drugs, such as:
- Paracetamol (acetaminophen)
- NSAID’s (non-steroidal anti-inflammatory drugs), for example, topical or oral diclofenac gel
Surgical treatment
In cases when the above-mentioned conservative methods have not provided lasting relief, patients may be recommended corticosteroid injections or surgical intervention. Recent research has not found significant differences in the effectiveness of surgical treatment compared to conservative approaches (M. van Middelkoop et al, 2013).
Despite the considerable amount of research, neck pain remains a condition with insufficient understanding. The Global Burden of Disease study (S. Safiri et al, 2020) emphasizes that the patient’s awareness of neck pain, risk factors, the importance of early detection, and timely treatment determine the effectiveness of recommended methods and improve population’s social health indicators.