Neck Solutions Blog

February 2, 2012

Epidemiology: Spinal manipulation utilization

Filed under: Chiropractic,General Health — Administrator @ 8:04 am

Epidemiology: Spinal manipulation utilization

From: J Electromyogr Kinesiol. 2012 Jan 28. [Epub ahead of print]

The objectives of this article are to (1) describe spinal manipulation use by time, place, and person, and (2) identify predictors of the use of spinal manipulation. We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world.

In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies. Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.

January 14, 2012

Neck pain: manipulation of your neck and upper back leads to quicker recovery

Filed under: Chiropractic,Neck Pain — Administrator @ 5:23 am

Neck pain: manipulation of your neck and upper back leads to quicker recovery

From: J Orthop Sports Phys Ther. 2012;42(1):21.

Neck pain is very common and fortunately resolves quickly in most individuals. However, in certain cases neck pain can last longer and result in chronic pain, limited neck motion, and disability. In fact, chronic neck pain is the second leading cause of workers’ compensation claims in the United States. Treatments that can quickly reduce pain, increase motion, and improve the ability of the muscles to protect the neck may help decrease long-term disability associated with neck pain. A variety of manual therapy treatments are currently used to manage neck pain. These treatments include mobilization, which slowly and repeatedly moves the neck joints and muscles, and manipulation, which delivers a single, small, quick movement to the joints and muscles.

Researchers treated 107 patients. About half of these patients received a manipulation of the neck, on the part closest to the head, and of the upper back. The other patients received manual therapy that mobilized the spine without using manipulation. After 48 hours, the patients who received the manipulation treatment experienced a 58% decrease in pain and a 50% decrease in disability. By contrast, patients who received the mobilization treatment only had a 13% decrease in pain and actually showed a 13% increase in disability. In addition, the patients who received the manipulation had increased motion and improved control of their neck muscles compared to the patients in the mobilization group. The researchers concluded that the combination of upper neck and back manipulation was more effective in the first 48 hours of treatment than the mobilization treatment. Potential benefits include less pain, better neck motion, and improved ability to perform daily activities.

Chiropractors have known this for decades! Unfortunately, assimilation by the medical profession is a priority and ultimately relates to greed through political means.

Source: Neck pain: manipulation of your neck and upper back leads to quicker recovery

February 12, 2011

Management of neck pain in Royal Australian Air Force fast jet aircrew

Filed under: Chiropractic,Neck Pain — Administrator @ 5:17 am

Management of neck pain in Royal Australian Air Force fast jet aircrew.

From: Mil Med. 2011 Jan;176(1):106-9.

Military aircrew who fly modern, high performance combat aircraft, commonly called fast jet aircrew routinely operate in altered lateral and gravitational force environment. Both acute neck pain and chronic neck pain are common complaints of fast jet aircrew, often resulting in lost workdays and reduced functional performance. The cause of neck pain in most cases is musculoskeletal injury. Spinal pathology, such as fractures of the cervical vertebrae, stenosis of the spinal canal, disc herniation and premature spinal degeneration have been attributed to exposure to altered gravitational force.

The underlying mechanism of neck pain in fast jet aircrew has been attributed to a combination of altered gravitational force environment, inadequacies of the human neck to tolerate these high loads and adopting head postures that can injure the neck during aerial combat maneuvers. Strategies including prefight stretching, in flight bracing and neck strengthening exercises have been suggested to possibly prevent neck pain in fast jet aircrew, few studies have evaluated the effectiveness of these preventative strategies on reducing the incidence and severity of flight related neck pain.

Little is known about the effective management and rehabilitation of neck pain in fast jet aircrew. Injury management and rehabilitative strategies are, however, well researched in other forms of neck pain and injury including chronic neck pain and whiplash like disorders. This study documents the strategies used by fast jet aircrew to manage and rehabilitate flight related neck pain.

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February 10, 2011

A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain

Filed under: Chiropractic,Chronic Pain,Neck Pain — Administrator @ 4:36 am

A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain

From: BMC Musculoskelet Disord. 2011 Feb 8;12(1):41. [Epub ahead of print]

Non-specific neck pain is frequent, with an annual prevalence estimated to be 30% to 50%. Often persistent or recurrent, neck pain is still being reported by 50% to 85% of patients 1 to 5 years after initial onset. Its course is usually episodic, and improvement is of variable degrees between episodes, but complete recovery is unusual for most patients. Manual therapy (mobilisation or manipulation), exercise intervention, low level laser therapy and, to a lesser extent, acupuncture, are more effective than no treatment, sham, or alternative interventions to stop episodes of neck pain. None of these strategies is, however, superior to any other. Evidence also indicates that supervised exercises with or without manual therapy are better than usual or no care and that a multimodal care approach combining exercise with manual therapy seems to be beneficial for non-specific chronic neck pain. Based on care episodes of 6 to 8 weeks with various blends of non-invasive interventions, no particular course of care improves the prognosis or appreciably affects the natural history of neck disorder or its recurrence. Evidence for the effectiveness of neck pain prevention strategies is therefore lacking.

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September 7, 2010

The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain – A randomized controlled trial

Filed under: Chiropractic,Neck Pain — Administrator @ 9:13 am

The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain – A randomized controlled trial

From: Man Ther. 2010 Aug 31. [Epub ahead of print]

Neck pain is a common musculoskeletal disorder in the general population. In Saskatchewan, Canada, Cote et al. reported that the age-standardized lifetime prevalence of neck pain was 66.7%. In a telephone survey performed in Hong Kong, Chiu and Leung reported that the lifetime prevalence of neck pain was 65.4% and the 12-month prevalence was 53.6% (41.0% in male, 59.0% in female). Neck pain is costly in terms of treatment, individual suffering, and time lost to work absentee.

Growing evidence has confirmed that the use of manipulation with exercise or the use of mobilization with exercise in treating neck pain has better clinical outcomes than other major and common modalities.

Owing to the intrinsic biomechanical linkage with the cervical spine, disturbances in the biomechanics of the thoracic spine could be a primary contributor to neck pain. Flynn et al. reported that with the use of thoracic manipulation, there was immediate improvement in neck pain. However the lack of comparative group in this trial renders the cause-and-effect relationship inconclusive. Many clinicians have intuitively adopted the use of thoracic manipulation to treat neck pain patients, although there is a lack of scientific evidence. Cleland et al. reported that thoracic spine is the area that is most often manipulated.

There are studies investigating the effect of thoracic manipulation in treating acute and subacute mechanical neck pain, but to date, no studies have investigated the effect in patients with chronic neck pain. In a randomized controlled trial, Cleland et al. demonstrated an immediate analgesic effect in patients with mechanical neck pain. However the study was limited to a short-term follow-up and the effects on disability and physical impairments e.g. cervical range of motion was not evaluated.

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August 31, 2010

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Filed under: Chiropractic,Neck Pain — Administrator @ 2:20 pm

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

From: Arch Phys Med Rehabil. 2010 Sep;91(9):1313-1318

To determine whether neck manipulation is more effective for neck pain than mobilization, a randomized controlled trial with blind assessment of outcome was undertaken by the authors. The setting was Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks, from which the number of days taken to recover from the episode of neck pain.

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization. The authors concluded that neck manipulation is not appreciably more effective than mobilization. The authors further noted that the use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

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July 15, 2010

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

Filed under: Chiropractic,Whiplash — Administrator @ 3:02 pm

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

From: Work. 2010;35(3):369-94

The literature relevant to the treatment of Whiplash Associated Disorders is extensive and heterogeneous. A Participatory Action Research approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of whiplash associated disorders clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to whiplash associated disorders interventions was conducted followed by a review of the evidence.

The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of whiplash associated disorders intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with whiplash associated disorders is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the whiplash associated disorders-plus model.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash associated disorders. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The whiplash associated disorders-plus model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to whiplash associated disorders. Furthermore, the whiplash associated disorders-plus model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of whiplash associated disorders.

April 16, 2010

Chiropractic claims in the English-speaking world

Filed under: Back Pain,Chiropractic,Headaches,Neck Pain,Whiplash — Administrator @ 2:54 am

Chiropractic claims in the English-speaking world.

From: N Z Med J. 2010 Apr 9;123(1312):36-44

Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache, migraine, infant colic, colic, ear infection, earache, otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).

A review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.

The authors found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache, migraine. Unsubstantiated claims were made about asthma, ear infection, earache, otitis media, neck pain.

The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. The authors suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

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April 7, 2010

A systematic review of chiropractic management of adults with Whiplash Associated Disorders: recommendations for advancing evidence based practice and research

Filed under: Chiropractic,Whiplash — Administrator @ 2:56 am

A systematic review of chiropractic management of adults with Whiplash Associated Disorders: recommendations for advancing evidence based practice and research.

From: Work. 2010;35(3):369-94

The literature relevant to the treatment of Whiplash Associated Disorders is extensive and heterogeneous. A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of Whiplash Associated Disorder clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to Whiplash Associated Disorders interventions was conducted followed by a review of the evidence.

The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of Whiplash Associated Disorder intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with Whiplash Associated Disorders is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the Whiplash Associated Disorders-Plus Model.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of Whiplash Associated Disorders. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The Whiplash Associated Disorders-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to Whiplash Associated Disorders. Furthermore, the Whiplash Associated Disorders-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of Whiplash Associated Disorders.

March 31, 2010

The Effect of Spinal Manipulation on the Efficacy of a Rehabilitation Protocol for Patients With Chronic Neck Pain: A Pilot Study

Filed under: Chiropractic,Chronic Pain,Neck Pain — Administrator @ 3:46 am

The Effect of Spinal Manipulation on the Efficacy of a Rehabilitation Protocol for Patients With Chronic Neck Pain: A Pilot Study.

From: J Manipulative Physiol Ther. 2010 March – April;33(3):168-177.

Chronic neck pain is a common problem in modern, industrialized countries. It has been estimated that 67% of people will experience neck pain at some point in their lives. A proportion of these individuals with neck pain do not experience complete resolution of their pain and disability, which can turn into a more complex chronic pain syndrome. What is not well understood is what causes neck pain to become chronic. An emerging school of thought in the mechanism of chronicity in nonspecific neck pain is that it is related to abnormal muscle recruitment patterns, which may put the spine at greater risk of further injury. Impaired neuromuscular function in patients with chronic neck pain is becoming increasingly recognized, most notably, an impaired ability to activate the neck flexor muscles during rapid limb movements and an impaired ability to relax the neck extensor muscles.

The solution proposed in previous research has been based on the idea of using specific exercise strategies to improve these impaired neuromuscular patterns. Recent research indicates that both exercise and chiropractic care involving spinal manipulation may also be able to improve these impaired neuromuscular patterns. Chiropractic techniques appear to be able to help normalize altered patterns of muscle recruitment and sequencing observed in the presence of musculoskeletal impairments and pain.

Contemporary research into the pathogenesis of nonspecific neck pain relates to the manifestation of abnormal muscle recruitment patterns. Impaired neuromuscular function in patients with chronic neck pain is becoming increasingly recognized, most notably the impaired activation of the neck flexor muscles during rapid upper limb movement. An additional measure that may be used for impaired neuromuscular function is the cervical flexion-relaxation response, a measure of the ability to relax the cervical extensors at full forward flexion. There is a lack of evidence for how commonly used interventions for chronic neck pain, such as spinal manipulation or exercise, may change these measures of impaired neuromuscular function in the neck.

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