Neck pain affects a significant number of individuals. Recent studies have found more than 10% of Americans suffer from neck pain at any given time. The reason is that the neck region contains many delicate, pain sensitive structures commonly exposed to abuse and abnormal stresses. Incomplete rehabilitation of past injuries, poor posture, prolonged sitting, and lack of periodic spinal alignments are some of the more common factors in the development of neck problems. Fortunately, most individuals suffering from neck problems will find chiropractic care extremely beneficial. Most chiropractic procedures address the cause of the majority of neck problems, not simply the symptoms. Best of all, chiropractic care is safe, natural, and noninvasive.
In this University of Colorado study, researchers compared chiropractic spinal manipulation with Acetaminophen for the treatment of chronic neck pain. On average, patients had been suffering from neck pain on and off for approximately 10 years. Patients were split into 2 groups, receiving either:
Both groups were also instructed to exercise and use a heating pad. At the end of the 6 weeks, patients who received the chiropractic spinal manipulation reported a significant improvement in neck pain and function, showing increased range of motion and strength. Patients receiving medication and nurse care showed no significant changes or improvements. Researchers are currently performing a long-term follow-up.
Baker B. Family Practice News 1996; June 1:14.
Cervical mobilization in comparison to other therapies has not been reported, but several researchers have found positive effects of mobilization. The purpose of this study is to address two problems:
Subjects were patients with restricted movement in the pain-producing segment. The patients were examined and randomized into three groups:
(The special information given to groups 2 and 3 included anatomy and pathophysiology of the cervical spine as well as biomechanical problems and practical problems such as lifting, carrying and relaxation).
Each patient estimated their pain and reported the actual level each week. Total cervical mobility in the coronal, sagittal and transverse planes was recorded before and after therapy each week and even one week after the therapy finished by a physiotherapist. In addition, social conditions were recorded by a social worker, and Eysenck personality inventory tests were used by assistants.
Results showed that the initial pain level was about the same in all three groups. Before the treatment, tender spots with increased consistency in the muscle were frequent in 80-90% of the patients in all three groups. Manual examination revealed the same distribution of hypo mobile segments, C7-T2, in the three groups. The effect on pain was evaluated by the pain level and the decrease of pain. Group 3 showed a significant difference in pain level after treatment from the other groups. Group 3 also showed a significant difference in decrease of pain one week after the treatment and at the conclusion of the treatment. Mobility increased significantly at the final treatment for group three compared to the other groups.
This study concludes that cervical pain patients can be improved by simple manual technique as a first step towards complete treatment.
H. Brodin, Manuelle Medizin 1982; 20:90-94. From the Institution of Physical Medicine, Karolinska, Sjukhuset, Sweden.
In a randomized trial, the effectiveness of manual therapy (manipulative techniques), physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for patients (n=256) with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6 and 12 weeks follow-up. Both physiotherapy and manual therapy (manipulation) decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.
Spine 1992; 17:28-35. From the University of Limburg, Maastricht, the Netherlands.
Nine subjects with chronic mechanical neck pain syndromes were evaluated for pressure pain threshold (PPT) over standardized tender points in the paraspinal area surrounding a manipulable spinal lesion. The subjects were then allocated randomly to an intervention consisting of either an oscillatory mobilization of the cervical spine (n=4), which was designated as the control procedure, or a rotational manipulation of the cervical spine (n=5). An assessor-blinded re-evaluation of the pressure pain threshold levels was conducted after 5 minutes. In the group receiving a manipulation the mean increases in pressure pain threshold ranged from 40-56% with an average of 45%. In the control group no change in any of the pressure pain thresholds was found. These results were analyzed using ANOVA and were found to be statistically significant (p < 0.0001). This study confirms that manipulation can increase local paraspinal pain threshold levels. The use of the pressure pain threshold meter allows for the determination of such a beneficial effect in the deeper tissues.
Very few clinical trials have been produced to provide evidence that manipulative treatment by chiropractors is beneficial to patients with neck pain. The senior author of this study, Howard T. Vernon, conducted clinical analog studies in which the results of a single manipulation were compared to control procedures. In the first study, a single thoracic manipulation produced a significantly higher rise in cutaneous pain tolerance levels than the shashared/stockpages/cp/conditions/neckpain/m/manipulation group. In the second study, a single manipulation of the cervical spine produced a modest increase in plasma beta-endorphin levels while control and sham procedures dropped. These studies support the idea that pain relief occurs subsequent to manipulation, and to the theory that this pain relief is a result of reflex mechanisms activated by the thrust. The reflex mechanisms can be described as afferent bombardment from the articular and myofascial receptors which produces pre synaptic inhibition of segmental pain pathways and possibly activation of the endogenous opiate system. The purpose of this study is to extend this earlier work to prove that a single manipulation would produce a significantly higher rise in pressure pain threshold levels in the paraspinal area surrounding a spinal fixation as compared to a control procedure. In this study, a more accurate device is used, the pressure threshold meter. The advantages are that this device can objectively measure pressure pain threshold over tender points in muscles as well as measure functional changes in the deeper tissues around a joint. Subjects were chiropractic patients diagnosed with chronic mechanical neck pain for an average duration of less than 3 months. The research treating physician assessed for joint dysfunction of the cervical spine, and marked the "fixated" or hypo mobile segment. The treater left the room and the assessor entered to conduct a PPT assessment of four tender points above and below, and on each side of the fixated level. The points were consistently measured as:
Two measurements were taken at each point and the assessor left the room. The treater entered and applied the appropriate treatment of either a rotational mobilization with gentle oscillations into the elastic barrier, or a rotational manipulation (high velocity, low amplitude thrust). All subjects were asked if they felt pain and if they believed that they had received a "real" treatment. Finally, the blinded assessor re measured the tender points twice after 5 minutes.
Results revealed a statistically significant rise in pressure pain threshold ranging from 40-55% in all four points around the fixation level in the manipulation group compared to virtually no change in the mobilization group. All subjects that were manipulated reported no pain and regarded the manipulation as a "real" treatment. Of the four mobilized subjects, three reported no pain and none regarded the mobilization as "real". These findings are behavioral as related to the subjects perception of pain, but the underlying mechanism of spinal reflexes causing pain threshold changes is still supported especially since no subject felt pain from the manipulation.
In conclusion, the pressure pain threshold meter has proven to be useful in objectifying the effect of manipulation versus mobilization in the cervical spine of subjects suffering from chronic mechanical neck pain, and these findings support the theoretical mechanisms proposed to explain the effects of spinal manipulation on spinal pain.
Journal of Manipulative and Physiological Therapeutics 1990; 13:13-16. From the Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.