Summary of Recommendations for neck intervention:
NECK PAIN WITH MOBILITY DEFICITS Acute: - Clinicians should provide thoracic manipulation, a program of neck ROM exercises, and scapulothoracic and upper extremity strengthening to enhance program adherence. - Clinicians may provide cervical manipulation and/or mobilization. Sub acute: - Clinicians should provide neck and shoulder girdle endurance exercises. - Clinicians may provide thoracic manipulation and cervical manipulation and/or mobilization. Chronic: - Clinicians should provide a multimodal approach of the following: • Thoracic manipulation and cervical manipulation or mobilization • Mixed exercise for cervical/scapulothoracic regions: neuromuscular exercise (eg, coordination, proprioception, and postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements • Dry needling, laser, or intermittent mechanical/manual traction - Clinicians may provide neck, shoulder girdle, and trunk endurance exercise approaches and patient education and counseling strategies that promote an active lifestyle and address cognitive and affective factors.