Neck
Pain – Can Chiropractic Really Help?
Neck pain is a very common problem
affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain
such as arising from a sports injury, a car accident or “sleeping crooked,” the
vast majority of the time, no direct cause can be identified and thus the term
nonspecific is applied. There are many symptoms associated with patients
complaining of neck pain and many of these symptoms can be confused with other
conditions. Wouldn’t it be nice to know
what neck related symptoms are most likely to respond to chiropractic manipulation
before the treatment has started? This
issue has been investigated with very favorable results!
The ability to predict a favorable
response to treatment has been termed, “clinical prediction rules” which in
general, are usually made up of combinations of things the patient says and findings
from exams. In a large study, data from about 20,000 patients receiving about
29,000 treatments, was collected and analyzed to find out what complaints
responded well to chiropractic treatment.
The results showed that the presence of any 4 of these 7 presenting
complaints predicted an immediate improvement in 70-95% of the patients: 1.
Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4.
Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting
symptom. Items not associated with a
favorable immediate response included “numbness, tingling upper limbs,” and
“fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far
more common to see a favorable response (70-95%) of the patients compared to an
unfavorable response (4-12%), supporting the observation that most patients
with neck complaints will respond favorably to chiropractic treatment.
So, what do we do as chiropractors
when a patient presents with neck pain?
First, after gathering preliminary information such as name, address and
insurance information, a history of the presenting complaint is taken. This
consists of information including what started the neck complaint (if you
know), when it started, what makes it worse, what makes it better, the quality
of pain (aches, stiff, numb, etc.), the location and if there is radiating
complaints, the severity (0-10 pain scale), timing (such as worse in the
morning, evening, etc.), and if there have been prior episodes. Various
questionnaires are included that are scored so improvement down the road can be
tracked and a past history that includes a medication list, past injuries or
illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse,
height, weight, temperature and respiration), palpation, range of motion,
orthopedic and neurological examination.
X-ray and/or other “special tests” may also be included, when needed. A
review of all the findings are discussed and after permission to treat is
granted, a chiropractic adjustment may then be rendered. A list treatment options may include:
1.
Adjustments;
2.
Soft
tissue therapy (trigger point stimulation, myofascial release);
3.
Physical
therapy modalities;
4.
Posture
correction exercises and other exercises/home self-administered therapies;
5.
Education
about job modifications;
6.
Co-management
with other health care providers if/when needed.
The preceding was reproduced with the permission of Dr. Ben Altodonna and The Practice Alliance.