Functional rehabilitation of the neck

Abstract

Introduction: Spinal pain is a leading cause of disability worldwide and there is convergent epidemiological data describing neck pain as a recurrent and episodic condition. Recent work suggests that addressing sensorimotor impairments (e.g. proprioception, oculomotor control or postural stability) and impairments in muscle performance (e.g. neck strength training) may improve outcomes in neck pain but there appear to be two main problems facing such active rehabilitation strategies: Firstly, contemporary surveys of clinical practice demonstrate poor translation of research findings to the clinical setting – with passive modalities dominating the clinical picture - and secondly, there appears to be a disinclination to progress rehabilitation of the neck beyond the ‘treat what you find’ impairment stage, in both the clinical and research setting.

Purpose: The aim of this paper is to delineate functional rehabilitation of the neck and it will focus upon; (i) existing impairment-based sensorimotor approaches to neck pain, (ii) a critique of impairment-based approaches, (iii) consideration of the utility of a functionally orientated and task-based rehabilitation and (iv) an attempt to define functional rehabilitation of the neck.

Implications: Evidence suggests that outcomes from neck pain treatment may be improved by means of impairment-based interventions. The proposal in this paper is that by addressing function of the neck throughout rehabilitation - as would readily occur in rehabilitation of a peripheral condition such as an ankle sprain for example – outcomes and perhaps patient compliance would be improved. High quality randomised controlled trials are needed to evaluate the role of functional rehabilitation in the management of this challenging condition.

KEYWORDS:

• cervical spine
• physical therapy
• rehabilitation
• neck pain
• function

Acknowledgments

I would like to thank Professor Anne Moore, Professor Karen Beeton and Professor Jeremy Lewis for their helpful comments on an early version of this paper and Tim Allardyce for kindly allowing use of the images from his exercise prescription software www.rehabmypatient.com.

Disclosure statement

I affirm that I have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. There are no conflicts of interest.

Additional information

Notes on contributors

Chris Worsfold

Chris is a Physiotherapist specialising in neck pain & Visiting Lecturer in Physiotherapy at the University of Hertfordshire where he mainly contributes to the MSc in Advanced Neuromusculoskeletal Physiotherapy programme. He divides his time between the clinic, teaching, blogging & research. His research is focussed upon developing a functional approach to rehabilitation of the neck. He lectures internationally, has represented the Chartered Society of Physiotherapy in Parliament & appeared on BBC Radio, TV & in the National press discussing neck pain.