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Neck

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What about spinal manipulation for neck pain, the second most common reason patients consult doctors of chiropractic? A 2006 study stated that neck pain is a common ailment, with approximately 10-15% of the population suffering from it at any given time. The researchers in this study reviewed 1980 citations and found 13 high quality trials utilizing manipulation or manual therapy. Their review found that the benefit from manipulation was greater. The long-term data regarding spinal manipulation for chronic neck pain was not as conclusive. However, the results demonstrated a great benefit with treatment up to 104 weeks. The spinal mobilization trials also showed very good benefit at a 6 to 7 week outcome point, with 70% of patients having full recovery or important improvement at that point. The researchers attempted to determine whether the benefit could be the natural history and placebo effect and compared these trials with a separate group of controlled no-treatment patients. The researchers concluded that the benefit noted in this review exceeded the placebo effect and natural history of the no treatment group. [1]

Another study focused on 35 patients who were diagnosed with cervical radiculitis caused by either lateral stenosis or cervical disk herniation. The patients were treated with spinal manipulative therapy and were monitored for an average of 8 months. Improvement in disability was prospectively measured with a disability questionnaire and pain rating scale. The patients’ cervical joints were palpated and SMT was applied to the level of dysfunction using both high-velocity and lower-velocity techniques. In some cases, anti-inflammatory modalities such as ice and anti-inflammatory drugs were used, although most of the patients were already taking these medications before the study began. Patients were typically treated 2 to 3 times per week with reduction of frequency thereafter. Almost 90% of the patients described their improvement as excellent or good. The patients had marked improvement in both pain intensity (62%) and disability (75%) at the end of the treatment. This improvement continued and increased at long-term follow-up. There were no major complications reported and there were no reports of short-term increases in pain. The researchers concluded the non-surgical approach to be safe and effective for the 35 patients in the study. The investigators reported favorable outcomes in this patient sample and concluded that SMT appears to be a safe option for patients with CR. [2]

Researchers reviewed literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. The researchers found that for whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. Researchers also found that therapies involving manual therapy and exercise were effective for patients with neck pain. [3]

Exercise is an integral component of well-rounded treatment protocol utilized by doctors of chiropractic for the recovery of musculoskeletal injury. This section will review the literature related to neck and low back pain. According to a 2010 systematic review by Miller et al, there is much quality evidence for manual therapy and exercise in the treatment of whiplash associated disorder (WAD). The paper states: “Favored over traditional care in reducing pain at short-term follow-up for acute WAD”. [4]


References

  1. Hagino, C (2007 Mar-Apr). "Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials". J Manipulative Physiol Ther 30 (3): 215-27. http://www.ncbi.nlm.nih.gov/pubmed/17416276. Retrieved 6/23/2012. 
  2. Clary, R (2006 May). "A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study". J Manipulative Physiol Ther 29 (4): 279-87. http://www.ncbi.nlm.nih.gov/pubmed/16690382. Retrieved 6/23/2012. 
  3. Hurwitz, EL et al (2008 Feb). "Treatment of Neck Pain: Noninvasive interventions". Spine 15 (33): S123-52. http://www.ncbi.nlm.nih.gov/pubmed/?term=Hurwitz+2008+Treatment+of+Neck+Pain%3A+Noninvasive+interventions. Retrieved 3/09/2013. 
  4. Miller, J et al (Aug 2010). "Manual therapy and exercise for neck pain: a systematic review". Man Ther 15 (4): 334-354. http://www.ncbi.nlm.nih.gov/pubmed/20593537. Retrieved 12-1-2013.