Multimodal Approach of the Patient with Non-specific Chronic Neck Pain: A Case Report

  • Carlos Bernal Utrera Physiotherapist, PT, MSc. Department of Clinical Research. Fisiosur I+D. Utrera, Seville. (SPAIN).


Background: Nonspecific chronic neck pain has a high incidence and prevalence in the population, supposes high socio-economic cost and having an impact on work absenteeism. The existence of myofascial trigger points, an inadequate joint position and muscle weakness, according to the scientific literature, are the main pain-generating factors in patients with non-specific chronic neck pain. We have observed, in subjects with this clinical picture, a great weakness of the cervical complex musculature, this being, according to some authors, one of the most relevant factors, together with the inadequate cervical proprioception, in the process of chronicity of the patients with neck pain. There are few studies that approach this type of subjects from a multimodal perspective, with the monotherapy studies being the most abundant.

Methods:A patient with non-specific chronic neck pain, who fulfilled all the inclusion and exclusion criteria, was included in our treatment protocol. The treatment lasted 8 weeks, with 10 sessions of treatment, in addition to therapeutic home exercise. We divided the physiotherapeutic treatment, which was designed in two therapeutic blocks, the first of them aimed at reducing pain and disability, through manual therapy, the second of them aims to avoid relapse and chronification, through exercise therapeutic. The follow-up was carried out in three evaluation sessions, after the first phase, for pain modulation, post-treatment and post-treatment in the medium term.

Results:Significant results were obtained, after the pain modulation, in the Analog Visual Scale, Maximum Analog Visual Scale, Pressure Pain Threshold and the Cervical Disability Index, although no changes were observed in the General Stability Index at this stage. . Beneficial short-term results were obtained in all the dependent variables of the study, keeping these changes in the medium term.

Conclusions:The multimodal treatment based on manual therapy and therapeutic exercise was effective in the patient studied, obtaining significant improvements in pain, functionality and proprioceptive postural stability in the short and medium term.

Key Words:Neck pain - Chronic Pain - Exercise Therapy - Musculoskeletal Manipulations - Postural Stability - Physiotherapy.