Chiropractic and Neck Pain: Conservative Care of Cervical Pain and Injury

By the American Chiropractic Association

Your neck, also called the cervical spine, begins at the base of the skull and contains seven small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury.

The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have a variety of causes.

Here are some of the most typical causes of neck pain:
Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting “rebound” in the opposite direction is known as whiplash. The sudden “whipping” motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.

Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

· Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
· Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain,as well as numbness, when these nerves are unable to function normally.
· Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Over time, a disc may bulge or herniate, causing tingling, numbness, and pain that runs into the arm.

Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.

Chiropractic Care of Neck Pain
During your visit, your doctor of chiropractic will perform exams to locate the source of your pain and will ask you questions about your current symptoms and remedies you may have already tried. For example:

· When did the pain start?
· What have you done for your neck pain?
· Does the pain radiate or travel to other parts of your body?
· Does anything reduce the pain or make it worse?

Your doctor of chiropractic will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting movement that causes pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.

In some instances, your chiropractor might order tests to help diagnose your condition. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis. A computerized axial tomography scan (CT or CAT scan) or a magnetic resonance imaging test (MRI) can show bulging discs and herniations. If nerve damage is suspected, your doctor may order a special test called electromyography (EMG) to measure how quickly your nerves respond.

Chiropractors are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist. He or she may also ask for permission to inform your family physician of the care you are receiving to ensure that your chiropractic care and medical care are properly coordinated.

Neck Adjustments
A neck adjustment (also known as a cervical manipulation) is a precise procedure applied to the joints of the neck, usually by hand. A neck adjustment works to improve the mobility of the spine and to restore range of motion; it can also increase movement of the adjoining muscles. Patients typically notice an improved ability to turn and tilt the head, and a reduction of pain, soreness, and stiffness.

Of course, your chiropractor will develop a program of care that may combine more than one type of treatment, depending on your personal needs. In addition to manipulation, the treatment plan may include mobilization, massage or rehabilitative exercises, or something else. Doctor Brenda Rooney develops a treatment plan that addresses the specific needs of each patient in her practice.

Research Supporting Chiropractic Care
One of the most recent reviews of scientific literature found evidence that patients with chronic neck pain enrolled in clinical trials reported significant improvement following chiropractic spinal manipulation.

As part of the literature review, published in the March/April 2007 issue of the Journal of Manipulative and Physiological Therapeutics, the researchers reviewed nine previously published trials and found “high-quality evidence” that patients with chronic neck pain showed significant pain-level improvements following spinal manipulation. No trial group was reported as having remained unchanged, and all groups showed positive changes up to 12 weeks post-treatment.

Chiropractic: A Safe Treatment Option

Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches, and other neuromusculoskeletal complaints says the American Chiropractic Association. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects.

The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may sometimes experience mild soreness or aching, just as they do after some forms of exercise. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.1

In addition to being a safe form of treatment, spinal manipulation is incredibly effective, getting patients back on their feet faster than traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in those patients who have been experiencing the symptoms for one year or less. In addition, a study published in the July 15, 2003, edition of the journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications.

Neck Adjustments
Neck pain and some types of headaches are sometimes treated through neck adjustment. Neck adjustment, often called cervical manipulation, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck adjustment is a precise procedure that is generally applied by hand to the joints of the neck. Patients typically notice a reduction in pain, soreness, stiffness, and an improved ability to move the neck.

Neck manipulation is a remarkably safe procedure. Although some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, there is not yet a clear understanding of the connection. While we don’t know the actual incidence of stroke associated with high-velocity upper neck manipulation, the occurrence appears to be rare—1 in 5.85 million manipulations2— based on the clinical reports and scientific studies to date.

To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.

It has also been suggested that sudden, severe upper-neck pain and/or headache, which may indicate a pre-stroke condition, could cause someone to visit a doctor of chiropractic. In addition, some common activities, such as stargazing, rapidly turning the head while driving, and having a shampoo in a hair salon may cause an aneurysm—a widening of an artery resulting from the weakening of the artery walls—of the neck arteries, resulting in stroke. Such events remain very difficult to predict.

It is important for patients to understand the risks associated with some of the most common treatments for neck and back pain—prescription nonsteroidal anti-inflammatory drugs (NSAIDS)—as these options may carry risks significantly greater than those of manipulation. According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.3
Furthermore, surgery for conditions for which manipulation may also be used carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromboembolism.4

Dr. Brenda Rooney obtains very specific information about symptoms from her patients with upper-neck pain or headache. “This will help me provide the safest and most effective treatment,” says Dr. Rooney. "If the issue of stroke concerns you, do not hesitate to discuss it with me. Depending on your clinical condition, instead of manipulation, I may recommend joint mobilization, therapeutic exercise, or soft-tissue techniques.”

Research Ongoing
Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.

All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The American Chiropractic Association points out that the chiropractic profession takes this issue very seriously and engages in training and postgraduate education courses to recognize the risk factors in patients, and to continue rendering treatment in the most effective and responsible manner.

Dr. Rooney is a member of the American Chiropractic Association. For more information about chiropractic and the issues mentioned above, contact Optimal Family Chiropractic, LLC at (973) 584-4888 or visit www.optimalfamilychiropracticllc.com.

References
1. Spine 1997 Feb 15; 435-440.
2. Can Med Assoc J 2001; 165(7):905-906.
3. Am J Gastroenterol 2005;100:1685–1693.
4. Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p. 230-238