A majority of the population will experience neck pain at some point in life.
Treatments commonly used for neck pain are spinal manipulation therapy, medication and a home exercise program.
Bronfort et al (2012) tried to answer the question regarding which option may be the best treatment for neck pain.
The manipulation group received mobilization and manipulation of the cervical or thoracic spine after an evaluation in order to determine if there were any areas of the spine that did not move well. These patients were assessed by chiropractors with at least 5 years of experience. The chiropractors could use any technique and see the patient for over a 12 week period. The patients in the spinal manipulation group could also receive light massage, assisted stretching, and hot/cold packs. The visits lasted 15-20 minutes.
The medication group received NSAIDs, acetaminophen, narcotics, and muscle relaxants. The visits lasted 15-20 minutes and the patient was seen based on a physicians recommendations.
The home exercise group received 2 sessions lasting an hour per session split over the course of 1-2 weeks. These patients were issued “Treat Your Own Neck” by Robin McKenzie. These patient’s sessions also discussed basic anatomy and advice regarding posture, lifting, pushing and pulling.
How’s this sound thus far? We all have our biases. Aside from medication management, as a PT, I am trained on both Spinal Manipulation Therapy and Mechanical Diagnosis and Therapy, which is the basis for the book used in the study.
Having treated patients for 20 years has allowed for perspective. My bias is that the exercises will have a greater effect than the manipulations, but I also believe that manipulations have value for patients. The thought is that if we spend our time with patients only doing hands on activities such as massage and manipulations, that we will never “ teach a patient to fish”. The patient will always be depending on the “hand out” or better described as the “hands on” from the therapist. In reality, spinal manipulation therapy and exercises are meant to be used as an adjunct to get the patient back to life and no longer need to grab their wallet to pay for healthcare services.
In the end, both spinal manipulation resulted in similar outcomes for patients except for one category in which spinal manipulation will typically be favored as explained above…patient satisfaction.
In my humble opinion, people like when things are done to them or for them instead of having to do the work themselves…especially when they are paying for it! This holds true for going out to dinner, oil changes, home repairs etc. There will always be a service sector making money by minimizing the work needed by the customer.
One result that favored the exercise group was neck range of motion.
The exercise group and manipulation group scored similar on their perception of function, but the exercise group moved more.
Let’s put this in perspective:
The manipulation group used 15 vists on average
The home exercise program used 2 visits on average
The medication group used 5 visits on average
Time is money. Would you rather pay for 15 visits to get similar functional results, but less range of motion if it saves you the effort of doing exercise yourself or would you rather save the time and money but put the effort in yourself?
The good news is that you have options and both lead to similar results.
If you have a high deductible, you may prefer to pay out of pocket for 2 visits instead of 15.
If you have met your out of pocket max, you may just see it as free healthcare and want to go for the hands on experience.
All of this is important and your physical therapist or chiropractor should be having this discussion with you at some point t in your care.
If you are in need of physical therapy in the South Chicago Suburbs, I’m here to help. I’m trained in both spinal manipulation therapy and the “McKenzie Method” and finally am a Board Certified Physical Therapist in Orthopedics through the American Physical Therapy Association.
If you are interested in the book that resulted in 2 visits, click the link below