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Chiropractic Research Review

Comparing Conservative Treatment Approaches for Neck Pain

Each year, millions of dollars are spent on treatment, lost wages and compensation for individuals with neck pain. In fact, approximately 10% to 20% of the population reports having neck pain at any given time.

In spite of these figures, little is known about effective treatments and the natural history of neck pain. Some researchers speculate that patients with chronic neck pain have weak neck muscles and that by strengthening these muscles, decreased pain and increased function may result. This study compared the short and long-term relative efficacy of three conservative treatment approaches for neck pain: spinal manipulation combined with low-technology rehabilitative neck exercise; high-technology MedX rehabilitative neck exercise; or spinal manipulation alone.

One hundred and ninety-one patients with chronic neck pain were randomly assigned to one of the three treatment groups. Main outcome measures were patient-rated neck pain; neck disability; functional health status (SF-36); global improvement; satisfaction with care and medication usage. Other outcome measures included range of motion, muscle strength and endurance.

The results of the study revealed short-term substantial improvements in all three treatment groups. Other findings included the following:

* Patient satisfaction with care was statistically significant for the spinal manipulation combined with low-tech exercise group.

* Spinal manipulation combined with low-tech exercise produced greater range of motion, strength and endurance than spinal manipulation alone.

* Spinal manipulation with low-tech exercise produced more flexion endurance and flexion/rotation strength than the MedX group.

* During long-term follow-up, a greater improvement in patient-rated outcomes was noted for spinal manipulation with exercise and for the MedX group than for spinal manipulation alone.

Conclusion: The use of strengthening exercises for chronic neck pain, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone.

Bronfort G, Evans R, Nelson B, et al. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001:26(7), pp. 788-799.

Chiropractic Research Review

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