Study on Electromyographic Characteristics of Neck Muscles in College Students with Chronic Neck Pain

Objective:To provide new insights for the evaluation and diagnosis of chronic neck pain(CNP).Methods:22 patients with CNP and 22 healthy individuals were recruited from South China Normal University,who were all college students.The subjects'neck extensor muscle strength in the head neutral position,the natural anteversion position,and the maximum forward flexion position were measured by an isometric muscle strength tester respectively.The neck extensor strength of CNP patients and healthy subjects were compared.Results:In the neutral position,the maximum isometric muscle strength of neck extensor muscles was 12.31 kg for CNP patients and 15.16 kg for healthy individuals,resulting in a ratio of 81%strength in patients compared to healthy subjects.This difference was highly significant(P<0.000).In the natural anteversion position,the respective values were 12.6 kg for CNP patients and 15.05 kg for healthy individuals,with a ratio of 83%,and a significant difference between groups(P<0.001).In the maximum forward flexion position of the head,the values were 13.36 kg for CNP patients and 16.15 kg for healthy individuals,with a ratio of 82%,and a highly significant difference(P<0.000).Conclusion:The neck extensor muscle strength levels in college students with CNP were significantly lower compared to healthy college students across all measured positions.

Case-control study on regular Ba Duan Jin practice for patients with chronic neck pain

Purpose:To observe the long-term effects of regular Ba Duan Jin exercises for patients with chronic neck pain.Methods:Participants with chronic neck pain were instructed to perform
30 min/d of Ba Duan Jin exercises(n?36)or assigned to a control group(n?36)for six months.Data from a visual analogue scale,Northwick Park Neck Pain Questionnaire,and the 36-item Shortform Health Survey(SF-36)were collected before,and three and six months after intervention began.Results:Participants undergoing Ba Duan Jin exercises achieved significantly greater improvement than the controls in visual analogue scale,Northwick Park Neck Pain Questionnaire and SF-36 health transition scores(all p<0.05).However,no significant differences were observed in SF-36 physical or mental component summaries.Conclusion:Regular Ba Duan Jin practice reduces suffering and pain,and increases health satisfaction in individuals with chronic neck pain.

Research progress of non-specific neck pain in traditional Chinese medicine and western medicine

Non-specific neck pain is a common disease in clinic,and its pathogenesis is not clear.With the progress of the times and the change of living and working habits,the incidence of non-specific neck pain is increasing year by year,which has a great impact on people’s physical and mental health,work and life.Traditional Chinese medicine mainly treats non-specific neck pain by acupuncture and massage,while western medicine generally uses exercise and manipulation therapy,but the quality of clinical evidence of all kinds of therapy is not high,which needs to be verified.This paper summarizes the research progress of traditional Chinese medicine and western medicine in the treatment of non-specific neck pain from the aspects of pathogenesis,etiology and pathogenesis of traditional Chinese medicine,and treatment of traditional Chinese medicine and western medicine,so as to provide reference for doctors in clinical treatment of this disease.

Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke:Two case reports

BACKGROUND Cervical myelopathy is a potential stroke imitator,for which intravenous thrombolysis would be catastrophic.CASE SUMMARY We herein present two cases of cervical myelopathy.The first patient presented with acute onset of right hemiparesis and urinary incontinence,and the second patient presented with sudden-onset right leg monoplegia.The initial diagnoses for both of them were ischemic stroke.However,both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset.Their cervical spinal cord lesions were finally confirmed by cervical computed tomography.A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy.CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients,especially those within the thrombolytic time window.

Resolving Specific Psychological Stressors Can Instantly Reduce or Relieve Chronic Neck Pain and Upper Back Pain: Case Reports

Introduction: The goal of this study was to use a novel approach to pain relief which includes a participant using their mind to reduce or relieve their neck pain in a matter of minutes and taking continuous thermal medical imaging scans during the process to capture any concurrent temperature changes at the location of the self-reported pain. Previous studies using multidisciplinary approaches have shown that it is possible for a person to achieve a moderate reduction in pain over a period of time (typically two or more months). However, in this innovative study, the goal was to demonstrate rapid pain relief (in a matter of minutes) using only the mind. Case report: For this study, six subjects were selected, all of whom were experiencing long-term chronic neck pain. The subjects consisted of five adult females and one adult male. Several of the subjects also had pain that radiated into their upper back region. Each subject participated in one talk therapy session during which the subject’s neck was actively scanned by a thermal imaging (TI) camera that was programmed to take a new thermal image every thirty (30) seconds. The goal of the talk therapy session was to create a strong emotional shift by encouraging the subject to let go of negative emotions and replace buried painful feelings with feelings of positive expectation and optimism. Then, as the subject created this emotional shift, the goal was to observe if this change affected the subject’s self-reported physical pain, as well as noting any visible effects in thermal images. Results: All six subjects reported that they were able to relieve some or all of their pain by the end of the talk therapy session. As they did, there was simultaneously a significant decrease in temperature recorded on the TI images in the corresponding location in their neck and upper back region. This suggested that the pain relief the subjects reported was not merely “mind over matter”, since there were marked physiological changes taking place. Discussion and Conclusion: It’s worth noting that three of the subjects had moments during their talk therapy session where they thought about a specific painful memory that increased their negative emotions. At that moment, their self-reported pain also increased, and simultaneously, the infrared camera detected an increase in temperature in the corresponding location where the subjects reported increased pain. Subsequently, when the subjects were able to change the painful memory and once again move towards feelings of optimism, they reported pain relief, and simultaneously, the TI camera reported a decrease in temperature. Neither this potential outcome nor any other potential outcome was discussed with the subjects before or during the session. This research shows that talk therapy may be used as a new therapeutic option for people not only with neck pain, but possibly other types of pain, and that under certain circumstances, the results can be rapid.

Ultrasound-Guided Dorsal Scapular Nerve Blockade in the Diagnosis and Management of Neck Pain

Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.

Results of Chronic Neck Pain Rehabilitation at Cotonou

Background: Neck pain is a real public health problem. Its treatment uses different techniques, such as functional rehabilitation, whose results are not widely popularized, from developing countries in Black Africa. Objective: To assess the result of rehabilitation of chronic common neck pain (CCNP) at the CNHU-HKM in Cotonou. Methods: Cross-sectional, retrospective, descriptive and analytical study. It was carried out from May to September 2020, based on the files of former patients followed in functional rehabilitation department at CNHU-HKM in Cotonou, from 2015 to 2019, for CCNP. The result of rehabilitation was assessed based on the progress, between the start and the end of the rehabilitation sessions, of pain intensity, mobility of the cervical spine, muscle strength and functional capacity of the patient. Anova and chi-square tests were used for the analysis of factors associated with the result of rehabilitation. Results: The sample consisted to 73 patients. They were predominantly female (58.90%), with a mean age of 53.60 ± 14.08 years. The neck pain, at least of moderate intensity (97.26%), was present since 12.54 ± 8.54 months, on average. Patients have done 10 to 20 functional rehabilitation sessions, the result of which was satisfactory in 67.12%. This result was mainly associated with patient’s age, sports practice and the seniority of pain progression. Discussion-Conclusion: Rehabilitation results in the management of CCNP are interesting. They prove the need to sensitize patients and prescribers on the importance of early treatment of CCNP.

Effectiveness of a 12-Week Program of Active and Passive Stretching in Improving Low Back and Neck Pain in Japanese Sedentary Men

Purpose: Muscle stretching is frequently prescribed in physical therapy to manage lower back and neck pain. However, there is no clear evidence regarding the differences in effectiveness of active and passive stretching. Therefore, we aimed to evaluate the relative effectiveness of a 12-week program of active and passive stretching on selected physical and mental stress variables of sedentary men with lower back and neck pain. Methods: A cohort of 28 sedentary men, 30 - 49 years old, were divided into two intervention groups: the passive stretching group (PSG, n = 15) and the active stretching group (ASG, n = 13). A trainer assisted with static passive stretching, while participants in the ASG were provided with an instructional video. The following outcomes were measured at the start and end of the first and twelfth week of the stretching program: physical measures (visual analogue scale score of lower back and neck pain;finger-to-floor distance, gravimetric assessment of pelvic tilt, muscle hardness of the biceps femoris, and straight-leg raising) and mental stress measures (α-amylase and cortisol levels in saliva samples). Results: Although both active and passive stretching produced acute changes in lower back and neck pain, only passive stretching yielded long-term improvement in pain, finger-to-floor distance, pelvic tilt, hardness of biceps femoris muscle and cortisol levels (p Conclusion: Passive stretching is superior to active stretching in reducing pain, increasing muscle extensibility and correcting posture among a group of sedentary men with lower back and neck pain.

Spinal accessory neuropathy in patients with chronic neck pain

AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.

Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following Neck Muscle Treatment

We report three patients with cervical neuromuscular syndrome (CNMS) who followed similar courses. Autonomic imbalance may occur following neck muscle pain, and a wide variety of somatic symptoms including headache and vertigo appear and a generalized poor condition may continue for long periods. If many such somatic symptoms persist for months to years, symptoms of depression are exacerbated. The patients end up in psychiatric clinics, where they are diagnosed with depression, but they do not respond to antidepressants. Thus, they continue to suffer for many years. These patients eventually were completely cured with the resolution of neck pain by neck muscle treatment, using two types of special low-frequency therapy equipment, far-infrared radiation and acupuncture. When treatment for the neck muscles is initiated, symptoms of depression are quickly relieved, and diverse somatic symptoms disappear one after another as neck muscle tension is gradually alleviated (the number of abnormal neck muscle checkpoints decreases). Such a course suggests that neck muscle tension and chronic pain are closely related to depression. Neck muscle-related depression due to CNMS clearly differs from psychiatric conditions such as major and bipolar depression. In patients with neck muscle-related depression, symptoms of depression are not accompanied by ungrounded anxiety, a sense of emptiness, apathy, or self-rejection. Neck muscle abnormalities leading to CNMS are caused by head injury, whiplash injury, and a prolonged forward-bent-posture due to using a personal computer, playing computer games, texting, and engaging in machine-paced work such as assembly-line operation.

Fever and neck pain after pacemaker lead extraction: A case report

BACKGROUND Venous thrombosis(VT) is one of the minor complications of pacemaker lead extraction. It is often found due to the swelling of the limbs after the extraction. It is easy to be neglected or even misdiagnosed in the absence of typical clinical symptoms. The incidence, risk factors, and long-term impact of this complication are still unclear. Herein, we report a case of deep VT caused by transvenous lead extraction, which is easily misdiagnosed.CASE SUMMARY A 66-year-old woman underwent a pacemaker lead extraction at our hospital because of a pacemaker pocket infection. After the extraction, she began to experience intermittent fever accompanied by sweating. The highest body temperature recorded was 37.9℃. Additionally, she reported migratory pain that made her uncomfortable. The pain was mistakenly thought to be caused by operation trauma. At first, the pain radiated from the left chest to the mandible.Then, the pain in the left chest was alleviated, but pain in the left neck and throat appeared. Finally, the pain was confined to the mandible and a submandibular mass was palpated with no other abnormalities upon physical examination.Computed tomography venography and angiography finally indicated that the fever and pain were the symptoms of thrombophlebitis caused by lead extraction.The patient was then treated with rivaroxaban for more than three months and has shown no symptoms since she left the hospital.CONCLUSION The possibility of thrombosis should be considered when pain and recurrent fever occur after pacemaker lead extraction.

Validation of the functional rating index for the assessment of athletes with neck pain

AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.

Neck neuromuscular treatment for depressive disorders with cervical muscular tension or chronic neck pain—A pilot study

BACKGROUND: An intimate relationship between depressive disorders and chronic pain is well known but often neglected. We studied patients with depressive disorders accompanying cervical muscular tension or neck pain. They also complaints of various physical, psychosomatic, and psychiatric signs such as anxiety and non-specific complaints related to autonomic imbalance. These complaints or symptoms are commonly resistant to pharmacological treatment, and thus we tried to treat these conditions by reducing their cervical muscular tension or pain. METHODS: We evaluated 30 complaints of 138 patients suffering from depressive disorders with cervical muscular abnormality (52 men and 86 women). The presence of the 30 complaints was evaluated as ‘positive’ or ‘negative’ before and during treatment. The necks of all patients were treated using low-frequency stimulation, micro-wave therapies, electric needle application, and acupuncture. RESULTS: Reducing cervical muscular tension remitted or cured the 30 complaints including depressive mood. The reduction of cervical muscle pain or tension initially ameliorated the depressive symptoms and anxiety, and subsequently improved their autonomic imbalances. Discriminant analysis of the first and second examinations correctly classified 95.3% of original grouped cases. CONCLUSION: Reducing cervical muscular tension is an effective treatment for patients suffering from depressive disorders with cervical neuromuscular pain or rigidity.

Pharyngeal gonorrhea presenting with isolated neck pain

We present a case of a 22-year-old man with isolated neck pain due to pharyngeal gonorrhea.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review

Chronic neck pain(CNP)is a worldwide health problem with several risk factors.One of the most widely used treatments for managing this condition is therapeutic exercise,which could generate a response called exerciseinduced hypoalgesia(EIH).There is no consensus on the best exercise modality to induce hypoalgesia.Therefore,this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP.We included articles on EIH and CNP in patients older than 18 years,with pain for more than three months,where the EIH response was measured.Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded.The studies reviewed reported variable results.Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity;however,in people with chronic pain,the response is variable.Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity,others found no clinical response,and some even reported EIH with decreased pain and increased sensitivity.EIH is an identifiable,stimulable,and helpful therapeutic response in people with pain.More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon.In addition,it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

Logistic regression analysis on therapeutic effect of acupuncture on neck pain caused by cervical spondylosis and factors influencing therapeutic effect

Objective To explore the main factors influencing the therapeutic effect of acupuncture on neck pain caused by cervical spondylosis, so as to provide references for further increasing the therapeutic effect of acupuncture. Methods One hundred and six cases were randomly divided into an observation group and a control group, 53 cases in each group. The observation group was treated with routine acupuncture at Dazhui （大椎GV 14）, Jingbailao （颈百劳 EX-HN 15） and Jianzhongshu （肩中俞 SI 15）; and the control group was treated with sham acupuncture at 1 cm lateral to Jingbailao （颈百劳 EX-HN 15） and Jianzhongshu （肩中俞 SI 15）. The needles were retained for 20 min in the two groups and infrared radiation was used for adjuvant treatment in this period. Northwick Park Neck Pain Questionnaire （NPQ） was used to assess the patients＇ quality of life before and after the treatment and compare the therapeutic effect between two groups. The potential influential factors were analyzed by Logistic regression. Results The effective rate was 75.5% in the observation group and 52.8% in the control group with a significant difference between the two groups （P〈0.05）. The Logistic regression analysis indicated that the therapeutic effect in the observation group was superior to that of the control group （OR=2.670）, and both the attack frequency and duration of the neck pain would influence the therapeutic effect （OR=1.055 and OR=2.446）. Conclusion Acupuncture has a preferable therapeutic effect on neck pain caused by cervical spondylosis, and patient＇s clinical history about attack frequency and duration of neck pain are factors influencing clinical therapeutic effect.

Tendon-regulating and bone-setting manipulation plus endurance resistance exercises for female with chronic neck pain

Objective:To observe the clinical efficacy of tendon-regulating and bon e-setting manipulation combined with en dura nee resistance exercises in treating female with chronic neck pain,and explore the mechanism.Methods:A total of 57 female patients with chronic neck pain who met the inclusion criteria were randomly divided into a manipulation group(29 cases)and a medium-frequency electrotherapy group(28 cases).Patients in both groups received the same endura nee exercise therapy,while those in the man ipulation group received additi onalten don-regulating and bone-setting manipulation,and those in the medium-frequency electrotherapy group received additional medium-frequency electrotherapy.Both groups were treated for 5 weeks.Before and after treatment,the neck function of patients was evaluated by visual analog scale(VAS),Analgesy-Meter,Northwick Park questionnaire(NPQ),root mean square(RMS)and median frequency(MF)of surface electromyography of sternocleidomastoid muscle and posterior cervical extensor muscle,and the patients were followed up at a month after treatment.Results:All patients completed the treatment and were followed up.Compared with the same group before treatmerrt,the VAS scores of both groups decreased,the tenderness values increased,the RMS and MF values increased,and the NPQ scores decreased after treatment(all P<0.05).The improvement of manipulation group was more notable than that of medium-frequency electrotherapy group(all P<0.05).At one-month follow-up,the VAS and NPQ scores of the manipulation group were lower than those before and after treatment,and the VAS and NPQ scores of the mediumfreq ue ncy electrotherapy group were only lower than those before treatment;the two scores of the manipulation group were lower than those of the medium-frequency electrotherapy group(both P<0.05).Conclusion:Tendon-regulating and bone-setti ng man ipulati on combi ned with endurance resista nee exe rcises can relieve neck pain and cervical dysfunction in female patients with chronic neck pain.The efficacy of this method is more durable and better than that of medium-frequency electrotherapy combined with enduranee exercises.

Post-Marketing Surveillance of Qishe Pill(芪麝丸)Use for Management of Neck Pain in a Chinese Patient Cohort to Determine Its Safety,Tolerability and Effectiveness

Objective:To evaluate the safety and effectiveness of Qishe Pill(芪麝丸)on neck pain in realworld clinical practice.Methods:A multi-center,prospective,observational surveillance in 8 hospitals across Shanghai was conducted.During patients receiving 4-week Qishe Pill medication,Visual Analogue Scale(VAS)and Neck Disability Index(NDI)assessments have been used to assess their pain and function,while safety monitoring have been observed after 2 and 4 weeks.Results:Results from 2,023 patients(mean age 54.5 years)suggest that the drug exposure per unit of body mass was estimated at 3.41±0.62 g/kg.About 8.5%(172/2,023)of all participants experienced adverse events(AEs),while 3.8%(78/2,023)of all participants experienced adverse reaction.The most common AEs were gastrointestinal events and respiratory events.The VAS score(pain)and NDI score(function)significantly decreased after 4-week treatment.An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3–4 g/kg,at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS.Conclusion:These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function.(Registration No.NCT01875562).

Is Manipulative Therapy Clinically Necessary for Relief of Neck Pain？A Systematic Review and Meta-Analysis

Objective：To summarize and critically assess the efficacy of Eastern and Western manipulative therapies for the treatment of neck pain in adults. Methods：A search of Pub Med/MEDLINE, the Cochrane Central Register of Controlled Trials, Clinical Trials.gov, EMBASE, etc. from their inception date to January 2014 with Chinese, Japanese, and Korean databases. Two reviewers independently selected randomized controlled trials（RCTs） with negative control or blank control, extracted data and assessed methodological quality. Meta-analysis and levels of evidence were performed by Revman5.1 and Grades of Recommendations Assessment, Development and Evaluation（GRADE） approach. Results：Nineteen clinical trials with adequate randomization were included in this review, 11 of them had a low risk of bias. The primary outcome for shortterm pain had no significant differences, however, the secondary outcome, only the Numerical Pain Rating Scale（NPRS） score of intermediate-term [n=916, pooled mean differences（MD） =–0.29, P=0.02], the Neck Disability Index（NDI） score of short-term（n=1,145, pooled MD=–2.10, P〈0.01）, and intermediate-term（n=987, pooled MD=–1.45, P=0.01） were significantly reduced with moderate quality evidence. However, it supported the minimally clinically important difference（MCID） of the Visual Analogue Scale and NPRS pain score to be 13 mm, while NDI was 3.5 points. The meta-analysis only suggested a trend in favor of manipulative therapy rather than clinical significance. Conclusions：The results do not support the existing evidences for the clinical value of Eastern or Western manipulative therapy for neck pain of short-term follow-up according to MCIDs. The limitations of our review related to blinding, allocation concealment and small sample size.

Kinematic Effect of Chinese Herbal Fomentation on Patients with Chronic Neck Pain

Objective：To clarify the effectiveness of Chinese herbal fomentation in treating chronic neck pain by means of changes in cervical kinematics.Methods：Seventy-six patients with chronic neck pain were included in the study and were randomized into two groups based on the random number generator of the SPSS software：fomentation combined with Chinese herbal（Group 1） and fomentation without any medicine（Group 2）.In both groups,the fomentation lasted for 60 min and heated to 35 ℃,once a day for 28 consecutive days.Standard lateral radiographs of the cervical spine were obtained including the neutral,full flexion,and full extension positions.Before and after intervention,the following parameters were used to evaluate the changes in kinematics：range of motion（ROM）,sagittal alignment and instantaneous center of rotation（ICR）.Results：After treatment,the ROM was significantly higher than that of before treatment in Group 1（51.5,95%CI：49.8-55.9;P〈0.05）.There was no significant difference between before and after treatment in Group 2（P〉0.05）.Although C2-C7 cervical alignment was increased in both groups after treatment,no significant difference was detected between before and after treatment（P〉0.05）.For Group 1,the significant X coordinate variation was only observed at C5/C6 level（38.1;95%CI：34.0,42.1;P〈0.05）.There was a significant upward trend in the Y coordinate of the ICR at C5/C6（-30.5;95%CI：-34.3,-26.8;P〈0.05） and C6/C7 after treatment（-6.1;95%CI：-6.7,-5.4;P〈0.05）.For Group2,the ICR location of each level was not statistically different between the pre- and post-treatment（P〉0.05）.Conclusions：Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR.Chinese herbal fomentation might be an effective treatment for chronic neck pain.