Management of Neck Pain Disorders: a research-informed approach

Helen Harte, CSP Professional Advisor, reviews this issue's featured book.

When I was completing my musculoskeletal rotations, the very idea of seeing a person with neck pain would send shivers down my spine, resulting in a cold sweat. I remember that feeling like it was yesterday and it was with that same trepidation that I approached this book.

In the foreword, Jeremy Lewis sums it up for me.

As physiotherapists we are ‘entrusted with the unassailable privilege’ to use our knowledge and skills to improve patient care, and we have a responsibility to learn and refine our knowledge throughout our careers.

And so it was with a deep breath that I cracked the spine of this book.

As the title suggests, the researched-informed approach of this book is clear and the referencing style  is easy to follow. What I particularly like about the written style  is the balanced view represented by the authors in gently challenging existing practice. New and innovative therapies are given consideration, where supported with evidence. The tone is accessible and easy to follow. Similarly, the authors overtly tackle some of the contemporary issues in managing neck pain disorders in an easy-to-digest style of writing.

The inclusion of a chapter on case presentations towards the end is a really helpful means of concluding the book, in supporting the application of new knowledge through clinical reasoning and decision making.

Making it visual

The book itself is laid out into four discrete sections:

  • introduction
  • clinical sciences
  • clinical assessment and
  • clinical management.

They are then subdivided into chapters, each averaging a very accessible and digestible 10 pages, with the exception of the chapter on physical examination. This chapter, just shy of 40 pages long, particularly grabbed my attention, presumably because of my own clinical anxieties. It was pleasing to see numerous photographs of the techniques described on models of ‘normal proportions’.

The authors do not shy away from grappling with issues, such as the inter-rater reliability of grading segmental motion. But they refrain from throwing out the baby with the bath water, in terms of the place of manual therapy.

On the whole, I found this chapter really useful in supporting clinical reasoning. My only critique would be that the black and white photography did feel a little dated, a throwback to the texts of my student years.

My favourite chapter of this book was Management of sensorimotor control disturbances. The authors tackle the clinical dilemma of cervicogenic dizziness and address specific rehabilitation strategies to address the dysfunction, including the use of manual therapy.

They introduce the idea of overlapping vestibular rehabilitation strategies with more traditional musculoskeletal approaches. Perhaps an example of confirmation bias in action, this supports my own world view of systems working in harmony and conjunction with one another.

I am, therefore, inclined to look favourably on any clinical research that brings us out of our respective musculoskeletal or neurology silos into a more person-centred arena.

Using the right language

There is an excellent, if too brief, chapter on communication, which focuses on the use of language and patient education. In its brevity, it can only scratch the surface of an increasingly topical issue for people living with pain.

I would support the significant expansion of this chapter in the second edition and perhaps link it more strongly to chapter seven, The psychological and social considerations in neck pain disorders. Within this chapter there is a huge emphasis on the workplace, and return to work recommendations. Given there was a UK author within the group, it seems unfortunate not to have referenced the value of the Allied Health Professional Fit for Work Report.

I was provided with a hardback copy of this first edition, which is 270 pages long. Currently this book is retailing on the Elsevier website at £40, and an e-book is also available at a reduced cost. I wasn’t provided access to the e-book, but I would hope and anticipate it has been thoroughly edited for digital content. What is never clear in the text itself, is which author is writing at any one point. Perhaps that doesn’t matter, but as a curious reader I would have liked some greater clarity.

On the whole, I would recommend this book to anyone with more than a passing interest in cervical pain and dysfunction. As with all texts that package themselves as ‘research informed’, I fear it is already out-of-date, even so soon after  publication. I will watch with interest for the second edition.

Jull, G; Falla, D; Treleaven, J; O’Leary, S. 2018. 

ISBN: 978-0-7020-7477-6

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