Rationale: The use of ultrasound as an adjuvant to conservative treatment for neck pain is common, but the evidence of its benefit remains unclear. Objective: To determine the effectiveness of ultrasound as an adjuvant to exercise or/and manual therapy for the improvement of patient-centered outcomes in adults with non-specific neck pain. Methods: Electronic databases including MEDLINE, EMBASE, AMED, CINAHL, CENTRAL, PEDro and PubMed were searched from date of inception to March 2019 for controlled trials involving ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy in adults with non-specific neck pain. Review Manager 5.3 was used to calculate mean group differences. Main results: Six studies (361 participants) examining ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy for sub-acute and chronic non-specific neck pain were included. The quality of evidence was of very low GRADE. Phonophoresis with capsaicin plus exercise improved pain immediately post-treatment (MD -3.30, 95% CI: -4.05 to -2.55) but not with diclofenac sodium plus exercise as compared to exercise alone. Continuous ultrasound plus exercise improved pain and Pressure Pain Threshold (PPT) at immediate post-treatment (pain: MD -3.42, 95% CI: -4.08 to -2.7; PPT: MD 0.91, 95% CI: 0.68 to 1.14 ) and at intermediate - term (pain: MD -2.70 95% CI: -3.62 to -1.78; PPT: MD 0.27 95% CI: 0.03 to 0.51) as compared to exercise alone. Continuous ultrasound or High Power Pain Threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD -0.75, 95% CI: -2.08 to 0.58), increase in PPT (MD -1.15, 95% CI: -2.55 to 0.25) or improved function/disability (MD -1.05, 95% CI: -4.27 to 2.17) at immediate or short-term as compared to manual therapy and exercise. Conclusion: Based on very low quality evidence, there is insufficient data to support ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain. / Thesis / Master of Science Rehabilitation Science (MSc) / Ultrasound therapy is widely used with exercise or manual therapy for the treatment of neck pain. Yet, its benefits are not clear. This review looked at the benefits of ultrasound added to exercise, manual therapy or both for the treatment of neck pain. The review contains six studies with 361 participants who suffered from neck pain. The results showed very low quality evidence. Applying capsaicin cream with ultrasound or continuous ultrasound in conjunction with exercise had some benefit for improving pain. The same treatment did not improve function as compared to exercise alone. There was no benefit in improving pain or function by adding continuous or high power ultrasound to manual therapy and exercise compared to manual therapy and exercise alone. Due to very low quality evidence, we are uncertain of whether there is a benefit to adding ultrasound to exercise or/and manual therapy for treatment of neck pain.

Background: Neck pain has a prevalence at 15-30 % in diffrent populations with diffrent causes like whiplash or tension in the muscle. It has proven a positive association between reduced pain and inhibiting the endorphin systems with physical activity. No recent review has been made since 2015, so there was a need to compile recent studies in the field.  Objective: Searches for litterature were made in the databses PubMed, PEDro and CINAHL to find randomized controlled studied that investigated strengthening training of the neck and the thoracal part of the back in persons with neckpain. All of the included articles were appraised by the PEDro-scale and the level of reliability was graded using GRADEstud.  Results: Six studies were included in this review with 382 participants. In one of six studies a significant between group diffrence was seen, the results should be discussed according to the studie's diffrent intervention/control groups. Three studies showed high quality and three showed moderate quality according to PEDro-scale. The grading in evidence showed that strengthening training of the neck and the thoracic back as treament for neckapin has a high level of evidence (++) to not reduce pain according to GRADEstud. The variation in population and time resulted in point deduction for lack of precision.  Conclusion: The results shows that strengthening training of the neck and the thoracic back does not reduce neckpain. Only one of six studied could show a significant between group diffrence. According to GRADEstud a high level of evidence is shown that the treatment dose not give effekt. The results of this study should be drawn with caution due to a low number of studies and the lack of precision in the interventions.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-17T20:45:16Z No. of bitstreams: 1 Andréia Cristina de Oliveira Silva.pdf: 1199678 bytes, checksum: 371b5a5aa25f1178d00c0d687e7bd352 (MD5) / Made available in DSpace on 2018-07-17T20:45:16Z (GMT). No. of bitstreams: 1 Andréia Cristina de Oliveira Silva.pdf: 1199678 bytes, checksum: 371b5a5aa25f1178d00c0d687e7bd352 (MD5) Previous issue date: 2016-12-12 / Non-specific neck pain (NS-NP) is characterized by multifactorial causes, such as a change in the mobility or functioning of viscera that are found in the abdominal cavity, due to a possible neural relationship between these two regions. Thus, the objective of this study was to evaluate the pain, cervical mobility and electromyographic activity of the upper trapezius (UT) muscle in patients with NS-NP pre and post immediately visceral manipulation (VM) and after 7 days. This study was a placebo-controlled, randomized, blind study of subjects with IC. Thirty individuals with NS-NP were divided into two groups: Manipulation Group: 15 subjects treated with visceral manipulation and Placebo Group: 15 subjects receiving placebo treatment. The possible effects of the therapy were verified by the analysis of the pain performed through the Numeric Pain Rating Scale (NPRS) and by the measurement of the area of pain, the electromyographic activity of the UT muscle and the cervical mobility. In the analysis of mobility and pain verified by the area of pain, NPRS and algometry, no significant difference (p> 0.05) was found between the studied groups. The results obtained in the ANOVA of the group interaction (F = 0.09, p = 0.05, p2 <0.001) and treatment vs group (F = 0.69, p = 0.49, p2 = 0.006), showed no influence of VM on the amplitude of the electromyographic signal of the UT muscle. The present study demonstrated that a single intervention of visceral manipulation, of the stomach and liver, does not alter the pain, cervical mobility and electromyographic signal of trapezius muscle descending fibers, both in immediate posttraining and after 7 days. / A cervicalgia inespecífica (CI) pode ser decorrente de causas multifatoriais, como por exemplo, uma alteração na mobilidade ou funcionamento de vísceras que se encontram na cavidade abdominal, devido à uma possível relação neural entre essas duas regiões. O objetivo desse estudo foi avaliar a dor, mobilidade cervical e a atividade eletromiográfica (EMG) do músculo trapézio fibras descendentes (TFD) em pacientes com CI pré e pós mobilização visceral (MV) imediata e após 7 dias. Esse foi um estudo, placebo controlado, randomizado cego, composto por 30 indivíduos com CI distribuídos em dois grupos: GM: 15 indivíduos tratados com mobilização visceral e GP: 15 indivíduos que receberam tratamento placebo. Os possíveis efeitos da MV foram verificados pela análise da dor realizada por meio da Escala Numérica Verbal de Dor (ENVD) e pela mensuração da área de dor, pela atividade eletromiográfica do músculo TFD e pela mobilidade cervical. Na análise da mobilidade e da dor verificada pela área da dor, ENVD e algometria, não foi encontrada nenhuma diferença significativa (p>0,05) entre os grupos estudados. Os resultados obtidos na ANOVA das interações grupo (F=0,09, p=0,05; p2 <0,001) e tratamento vs grupo (F=0,69, p=0,49; p2 =0,006), não demostraram influência da MV na amplitude do sinal EMG do músculo TFD. O presente estudo demonstrou que uma única intervenção de manipulação visceral, do estômago e fígado, não altera a dor, mobilidade cervical e sinal eletromiográfico do músculo trapézio fibras descendentes, tanto no pós tratamento imediato, como após 7 dias.

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M