An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

Nadine Graham*, 1, Anita R Gross1, Lisa C Carlesso2, P. Lina Santaguida3, Joy C MacDermid4, Dave Walton5, Enoch Ho1, ICON
1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
3 University Evidence-based Practice Centre, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
4 School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario and Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, Ontario, Canada
5 School of Physical Therapy, University of Western Ontario, London, Ontario, Canada

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© Graham et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the School of Rehabilitation Science, IAHS, 1400 Main Street West, 4th Floor, Hamilton, ON, L8S 1C7, Canada; Tel: 905-525-9140, Ext. 22524; Fax: 905-304-4431; E-mail:
§ ICON is a multi-disciplinary collaborative group that includes scientist-authors (listed below) and support staff (Margaret Lomotan) that conduct knowledge synthesis and translation aimed at reducing the burden of neck pain.The ICON authors that provided direction of the project and reviewed the findings/manuscript include (in alphabetical order): Gert Bronfort, Norm Buckley, Lisa Carlesso, Linda Carroll, Pierre Côté, Jeanette Ezzo, Paulo Ferreira, Tim Flynn, Charlie Goldsmith, Anita Gross, Ted Haines, Jan Hartvigsen, Wayne Hing, Gwendolen Jull, Faith Kaplan, Ron Kaplan, Helge Kasch, Justin Kenardy, Per Kjær, Janet Lowcock, Joy MacDermid, Jordan Miller, Margareta Nordin, Paul Peloso, Jan Pool, Duncan Reid, Sidney Rubinstein, P. Lina Santaguida, Anne Söderlund, Natalie Spearing, Michele Sterling, Grace Szeto, Robert Teasell, Arianne Verhagen, David M. Walton, Marc White.Expert Panel: Gert Bronfort DC, PhD, Northwestern Health Sciences University, USA; Duncan Reid PT, PhD, School Rehabilitation and Occupation Studies AUT University, NZ; Ron Kaplan Psychologist, PhD, Canada; Anne Söderlund PT, PhD, School of Health, Care and Social Welfare Malardalens University, Sweden; Grace P.Y. Szeto PT, PhD, Department of Rehabilitation Sciences Hong Kong Polytechnic University, Hong Kong; Marc White MD, Canadian Institute for the Relief of Pain and Disability, Canada.



Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited.


To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain.


A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus.


Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up.


The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research.

Keywords: Neck pain, review of reviews, modalities, knowledge synthesis.