Effectiveness of Neural Mobilisation Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report

Objective The objective was to assess the effectiveness of neural mobilisation (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). Methods We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion and mechanosensitivity as the main outcome measures. Results The systematic review included 22 studies (n = 978). More favourable outcomes were observed for NM on pain intensity compared with control interventions (standardised mean differences (SMDs) −0.92; 95% CI − 1.66-−0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI − 0.02-2.15). Regarding neck pain intensity, no significant differences were found in favour of NM compared with OTs (SMD 0.37; 95% CI − 0.35-1.1). However, between-treatment differences were found in favour of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI − 0.06-0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD −0.08; 95% CI − 0.36-−0.20, and SMD −1.44; 95% CI − 2.28-−0.6, respectively). Finally, NM was associated with more favourable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). Conclusions NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Effects of Sling Exercise for Neck Pain: A Systematic Review and Meta-Analysis

Objective The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. Methods We searched The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases from inception to July 2020. We also screened the reference lists of relevant articles to identify additional trials. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the GRADE approach, respectively. The random-effects model was used to perform meta-analyses. Results Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = −1.23; 95% CI = −1.88 to −0.58) immediately postintervention compared to the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion, and sustained effects on disability at intermediate-term follow-up. Conclusion Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. Impact This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

Myofascial Pain Dysfunction Syndrome

Myofascial Pain Dysfunction Syndrome or myofascial pain disorder is one among the triad of disturbances that is encompassed within the umbrella term, TMJ disorders. Due to a lack of consensus on definitive symptoms and mode of diagnosis, it continues to remain an elusive entity for clinicians working with head and neck disorders and dentists alike. Additionally, There is a general lack of simplification in literature to enhance understanding and this is further complicated by the use of multiple descriptive terminologies to refer to the disorder. It is the objective of this chapter to provide a comprehensive overview of the subject for the reader, to clarify the various nuances of diagnosis, treatment planning and management modalities in addition to throwing light on the evolving terminologies, causative mechanisms and recent trends in MPDS management. The author has also highlighted the importance of a multi modality management approach, psychological rehabilitation with long term patient follow up. The authors personal experience with the use of specialised splints has been elucidated with relevant clinical case scenarios.

How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence???

Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.

Effects of manual continuous home cervical traction in cervical spondylosis

Background: Cervical spondylosis is the results of disc degeneration with associated osteophytosis. Cervical traction is widely used to treat neck disorders. Rehabilitation treatment like cervical traction along with other measures at home may play an important role to reduce symptoms of the patients with cervical spondylosis. Objective: A randomised clinical trial was conducted among 125 patients having cervical spondylosis to find out the effects of manual continuous home cervical traction. Methods: The patients were selected on the basis specific selection criteria. They were subdivided into two groups. In Group-A (manual continuous home cervical traction group), 61 patients were treated with exercise, cervical collar, neck support, manual continuous home cervical traction, NSAID, warm moist compression and instruction in posture. In Group-B (conventional treatment receiving group), 64 patients were treated with exercise, cervical collar, neck support, warm moist compression, NSAID and instruction in posture. Results: Among the subjects there were 68 (54.4 %) male and 57 (45.6 %) female. The mean age of the subjects was 45.94 ± 11.65 years. There was marked improvement of symptoms of the patients of Group-A in response to treatment for 6 weeks (p < 0.007). It indicates that manual home cervical traction was found effective to reduce the sign and symptoms of cervical spondylosis. There was improvement after treatment in Group-B also (p < 0.01). It indicates that conventional treatment was also found effective. In comparison, there was no significant difference between two groups (p < 0.36, 95% CI= ‐0.56 to 1.51) found after first week. But there was significant improvement in Group-A than Group-B after six weeks of treatment (p < 0.003, 95% CI= -2.40 to -0.51). Conclusion: It may be concluded that manual continuous home cervical traction is beneficial for the patients with cervical spondylosis. Bangladesh Med Res Counc Bull 2020; 46(2): 128-133

How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence???

Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.