GUIDELINES: LONG-TERM (CHRONIC) NECK PAIN
Primärt behandlingsområde, Infrarött ljus, 808–830 nm, 904 nm
LONG-TERM (CHRONIC) NECK PAIN (cervical osteoarthritis, whiplash) At some point throughout life it is common to suffer from neck pain, either work-related or as a result of osteoarthritis or whiplash injury. For most of us these symptoms are temporary, but for some people they tend to cause a lot of trouble and persist for a long time. The prevalence of neck pain is increasing among the population up to 55-60 years of age. At older age the symptoms are less common. The vast majority of cases with chronic neck pain due to degenerative spinal disease are treated practicing non-surgical methods. Regarding whiplash, the symptoms after an injury usually occur within a few days and about 50 per cent of these cases have recovered after a few days. The majority of these patients experience complete recovery or only mild physical inconvenience after a month. If experiencing severe pain, a period of rest and sick leave from work combined with physical therapy and short-term use of analgesics may be an appropriate start of treatment. If however the symptoms are still affecting the patient’s everyday life after a year, the risk of long-term pain is very relevant, particularly if the injury causing the pain has not been located and therefore cannot be treated. The symptoms after a whiplash injury usually occur within a few days. For some patients with a whiplash diagnosis the quality of life gets seriously affected. 79 80
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Laser Therapy – a practical guide
GUIDELINES START OF TREATMENT
As soon as possible after onset of symptoms. TYPE OF LASER
Infrared and red light, for example: 904 nm, sp, 60mW 780-860 nm, p/k, 300 mW/450 mW 650-660 nm, k, 35 mW Or a laser shower with a combination of above. DOSE
904 nm: minimum 2-4 J (about 30-65 sec) per point. 780-860 nm: minimum 4-16J (300 mW about 15-55 sec, 450 mW about 10-35 sec) per point. 650-660 nm: minimum 1-3J (30-90 sec) per point. Also note that a high output power requires a higher dose to ensure a sufficient treatment time per point. METHOD AND AREA OF TREATMENT
Treat with infrared light (for example sp 904 nm) in skin contact with a light pressure over the most painful areas. Usually this means certain cervical facet joints, over muscle, origin and attachment for the sub occipital muscles, m trapezius, m levator scapulae, m sternocleidomastoid and scalene muscles. If level of pain is not reduced after re-test, a dose of
example 808 nm with skin contact and pressure over facet joints as well as painful areas in the muscular system is recommended. In case of nerve disorders, use 650 nm over the spots where the nerve is superficial, such as at the level of the facet joint, the gap between m scalenus anterius and medius, the elbow and in the hand. Which area to treat in the elbow or hand is depending on the symptom area (for example, see cervical herniated disc). If the client can tolerate pressure, a light pleasure over the nerve may be applied. Infrared light is recommended for nerve treatment on areas where the nerve is located deeper than 1-2 cm from the skin surface.
EVALUATION
Pain evaluation according to vas or vrs -scale during functional movement tests and palpation. If pain assessment is difficult to accomplish, which is sometimes the case with chronic pain symptoms, use evaluation by measuring for example the activities of daily living (adl). Furthermore, questions regarding consumption of painkillers, quality of sleep and a pain diary may be useful as evaluation. Results that influence these abilities usually take a longer time to register and therefore a longer series of treatments may be required before a positive result can be noted. COMBINED TREATMENT
> Customized training - focusing on pain reINTERVAL OF TREATMENT
2-3 treatments during the first week and 1-2 treatments the week after is recommended, based on intensity of symptoms. The higher the intensity, the more frequent the intervals. As the symptoms begin to decrease in terms of intensity it is recommended to phase out the intervals accordingly. TREATMENT RESULTS
Results should be clearly measurable from 5-7 treatments. Improvements are however frequently noted also after about three treatments sessions.
lief and improved posture. > Posture correction. >Ergonomic coaching > tens, massage and stretching. IMPORTANT
Make sure to inform about possible reactions to the treatment before starting session. Also consider lower doses and determine, in cooperation with the client, the size of the dose considering the risk of occasional increase of pain. REFERENCES
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Laser Therapy – a practical guide
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