Key aspects from exam for neck pain (4)
- mechanism of injury
- SMT/mobs
- Exercise
- Surgery
Overall care pathway of NAD1-2
- Rule out serious pathology (if pathology identified, specific cause must be identified)
- conduct appropriate clinical eval (Inspection, ROM, Palp, neuromuscular)-> classify as NAD 1/2
- Assess prognostic factors for delayed recovery (prior hx, old, high lvl of pain, post collision psychological factors)
- Educate/reassure the pt
- Determine if ongoing clinical care is necessary
- Reassess px every visit
Care plan options for acute neck pain
- Education and reassurance (course, prognosis, mgmt strats, etc)
ONE OF:
- Unsup ROM ex (5-10 6x day)
- Short cause of multimodal care (manip/mob, unsupervised rom) (6 session over 8 w)
- mm relaxants (short course)
do not offer for acute neck pain
- structured ed alone
- Strain-counter strain
- cervical collar
- Electroaccu
- EMS, heat, moist
Key recommendations from NICE for acute neck
- Provide partnership w px, involve in care/planning
- Reassure px of benign and self limiting nature of pain
- Educate pt about beliefs of being actively engaged in participating in care plan
- Emphasize active rather then passive care
- Deliver time- limited care
- Do not provide ineffective/experiment tx
median time to accident to recovery in whiplash pts
98day (3m)
23% were not recoved at 1 yer
persistent NAD 1-2 tx options
Education
ONE OF:
- Supervised combined exercise (ROM, Strengening, FLex) (2x 12 weeks)
- Qigoing (2x12 weeks)
- Iyegner yoga (9 sessions over 9w)
- Short course multimodal care (if not done yet) (6x 8 weeks)
- Short course clinical massage)
6 LLLR
- NSAIDs (short course)
- Psych interventions
Recent onset NAD 3 things you can offer
- Education
- Supervised graded neck strengthening exercises supplemented by home ex and acetaminiphen/NSAID (2 sessions per week 6 weeks)
Persistent NAD3 recomendations
px who still suffers from neuro deficits 3 m after collision should be referred to physician for further eval
management of recent onset headaches associated w neck pain
Should be managed under the care pathway for management of recent onset NAD1-2
Management of persistent headaches associated w neck pain
Conduct eval to rule out major structural pathologies ID;d during Hx and physical
Once patho ruled out, px tx according to appropriate care pathway for mgmt of HA associate w NP (NAD1,2,3 guideline)
Care pathway for episodic tension type HA (4-6 m) (initial and interventions)
Initial:
-Rule out serious patho, Education, Assessment for symptom improvement/worsening etc,
Interventions:
-Low load endurance craniocervical and cervicoscapular ex
(consider max 8 sessions over 6 weeks w resistance (supervised) and 2x day at home)
interventions for management of chronic tension type headaches
-general exercise (warm up, neck and shoulder stretching, aerobic ex)
-low load endurance craniocervical + cervicoscapular exercise (supervised)
-Multimodal care
-massage
key recomendations for management of chronic tension type headaches
Structured Ed
-Gneeral exercise
-Low load endurance craniocervical and cervicoscapular ex
-multimodal care
Care pathway for recent onset TMD
Id red flags
-monitor and reassure pt
-lack of effective interventions to manage recent onset TMD (no intervention)
-reassess and take indicated course of action
Interventions for persistent TMDs
-self care management (education on condition)
-Intraoral myofascial therapy (10sessions over 5 w)
-Cognitive behavioural therapy (4 sessions over 8weeks)
donot recommend for persistent TMD
Occlusal device for pain reduction and imp of ROM
