Neck Pain Rehabilitation

Abstract

Neck pain is defined as a pain that comes from an area between the nuchal line and another imaginary line passing through the lower end of the spinous process of first thoracic vertebra and sagittal plans tangent to the side edges of the neck (IASP). Cervical pain can be fully considered a multifactorial disease. Neck pain resolves itself within a few days or weeks, however half of the patients develop a chronic disease and in 5% of cases it can cause severe disability. The treatment consists in an integration of drug therapy and an individual rehabilitation program, tailor-made for each patient. According to 2011 SIMFER guidelines paracetamol/NSAID/Steroids/muscle relaxants are recommended for the reduction of the painful symptoms in the short term rehabilitation treatment will be aimed at the reduction or resolution of pain, the global and segmental joint recovery, and especially the restoration of skills decreased from cervical disease. The rehabilitation program, will include different manual techniques, such as global postural re-education by Mezieres. Several studies support the role of therapeutic exercise that involves strengthening and stretching of the stabilizing muscles of the cervical spine and shoulder girdle, improved mobility and proprioception. The aforementioned exercises seems to have a synergistic effect in combination with manual therapy, as it’s recommended in the guidelines. In case of post-surgery chronic neck pain, the painful component is partly attributable to the presence of the surgical scar, to the possible manifestation of adhesions and mainly to the onset of contractures. In this case it’s recommended the stretching exercise of the scalene muscles, trapezius, scapulae, pectoralis minor and major, together associated with manual therapy and physical exercise. A proprioceptive exercise program can be considered a valuable treatment in patients with neck pain, as Espi-Lopez et al. demonstrated in their study. TENS and ultrasound instead, lacking systematic reviews, are recommended in combination with exercise therapy and other methods of physical therapy in chronic neck pain. In case of post-surgery chronic neck pain, the painful component is partly attributable to the presence of the surgical scar, to the possible manifestation of adhesions and mainly to the onset of contractures. In this case it’s recommended the stretching exercise of the scalene muscles, trapezius, scapulae, pectoralis minor and major, together associated with manual therapy and physical exercise. A proprioceptive exercise program can be considered a valuable treatment. TENS and ultrasound, are recommended in combination with exercise therapy.