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Mechanical neck pain treatment: where does the evidence stand?

Mechanical neck pain refers to pain in the neck that is primarily attributed to the musculoskeletal structures, such as muscles, ligaments, and joints. Treatment for mechanical neck pain often involves a combination of approaches, including exercise, manual therapy, and pain management strategies. Here is an overview of the evidence base for various treatments commonly used for mechanical neck pain:

  1. Exercise Therapy:

  • Evidence: Strong

  • Details: Exercise therapy, including neck-specific exercises, stretching, and strengthening exercises, has robust support in the literature for the management of mechanical neck pain. Exercise programs are often tailored to the individual's needs and may include range of motion exercises, strengthening exercises for the neck and shoulder muscles, and postural exercises.

  1. Manual Therapy:

  • Evidence: Moderate

  • Details: Manual therapy techniques, such as spinal manipulation, mobilisation, and massage, have demonstrated effectiveness in reducing pain and improving function in individuals with mechanical neck pain. The evidence suggests that manual therapy can provide short-term and, in some cases, long-term benefits.

  1. Cervical Manipulation:

  • Evidence: Moderate

  • Details: Cervical manipulation, a specific form of spinal manipulation performed by trained healthcare professionals, has shown effectiveness in reducing pain and improving function in individuals with mechanical neck pain. However, it is essential to ensure that this technique is performed by qualified practitioners to minimise risks.

  1. Heat and Cold Therapy:

  • Evidence: Limited

  • Details: The evidence supporting the use of heat and cold therapy for mechanical neck pain is somewhat limited. While some individuals may find relief from applying heat or cold to the affected area, the overall evidence is not as strong compared to exercise and manual therapy.

  1. NSAIDs and Analgesics:

  • Evidence: Limited to Moderate

  • Details: Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics (pain relievers) are commonly used for managing neck pain. While they can provide symptomatic relief, the evidence supporting their long-term efficacy for mechanical neck pain is limited. Care should be taken regarding potential side effects and risks associated with prolonged use.

  1. Posture Education and Ergonomics:

  • Evidence: Limited to Moderate

  • Details: Educating individuals about proper posture and ergonomics, both at work and in daily activities, is considered a part of comprehensive neck pain management. While the evidence is not overwhelming, there is support for the role of posture education and ergonomic interventions in preventing and managing mechanical neck pain.

It's important to note that treatment recommendations may vary based on individual factors such as the underlying cause of neck pain, the presence of coexisting conditions, and individual preferences. If you are experiencing neck pain, it's advisable to consult with a healthcare professional to determine the most appropriate and evidence-based treatment plan for your specific situation.


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