title: Evidence-based guidelines for the chiropractic treatment of adults with neck pain.
abstract: OBJECTIVE
  The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults.
  
  
  METHODS
  Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations.
  
  
  RESULTS
  Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain.
  
  
  CONCLUSIONS
  Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.
authors.affiliation: Guidelines Development Committee (GDC) Chairman; Chiropractor, Clarenville, Newfoundland, Canada.
authors.forename: Roland
authors.initials: R
authors.lastname: Bryans
authors.affiliation: Assistant Professor, Canadian Memorial Chiropractic College, Clinical Education, Toronto, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Decina
authors.affiliation: Professor, Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Descarreaux
authors.affiliation: Chiropractor, Montréal, Quebec, Canada.
authors.forename: Mireille
authors.initials: M
authors.lastname: Duranleau
authors.affiliation: Chiropractor, Winnipeg, Manitoba, Canada.
authors.forename: Henri
authors.initials: H
authors.lastname: Marcoux
authors.affiliation: Chiropractor, North Vancouver, British Columbia, Canada.
authors.forename: Brock
authors.initials: B
authors.lastname: Potter
authors.affiliation: Editor, Clinical Practice Guidelines Initiative, Toronto, Ontario, Canada. Electronic address: rruegg@cogeco.ca.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Ruegg
authors.affiliation: Associate Professor, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Shaw
authors.affiliation: Public Member, Toronto, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Watkin
authors.affiliation: Chiropractor, Markham, Ontario, Canada.
authors.forename: Eleanor
authors.initials: E
authors.lastname: White
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D026882:Manipulation, Chiropractic; D019547:Neck Pain / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
keywords: Chiropractic; Evidence-Based Practice; Practice Guideline; Review; Therapeutics; Therapy