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Neck Pain: Manipulation Plus Exercise Better
Than Either Alone
Neck pain afflicts roughly 70% of adults at
some point in their lives; for nearly 14%, the
pain is chronic. This randomized clinical trial
studied the effectiveness of spinal manipulation
alone compared to the combination of spinal
manipulation plus rehabilitative exercises and
to a high-tech rehabilitative exercise program
for treating neck pain. The study involved 20-
to 65-year-old subjects with mechanical neck
pain of at least 12 weeks duration. All patients
completed 20 one-hour appointments over an
11-week period. The 191 patients were randomized
into three groups, as follows:
* Spinal Manipulation Therapy (SMT) Alone:
Spinal manipulation and light soft-tissue
massage from experienced chiropractic
clinicians.
* Manipulation Plus Rehabilitative Exercise:
Spinal manipulation as described above, plus
rehabilitative exercise from trained exercise
therapists. Sessions included warm-up,
stretching and dynamic neck exercises consisting
of extension, flexion and rotation movements
while wearing headgear with 1.25- to 10-pound
weight attachments.
* MedX Rehabilitative Exercise: Warm-up
stretching exercise and neck exercises using a
variable resistance, cervical extension and
rotation machine, designed by the MedX
Corporation of Ocala, Fla.
Subjects were evaluated by self-report
questionnaires, neck range of motion, neck
strength and neck muscle endurance at baseline
and five and 11 weeks after beginning treatment.
At three, six, 12 and 24 months following
treatment, subjects completed self-report
questionnaires, such as the Neck Disability
Index and the SF-36 D form, on pain,
satisfaction with care and disability.
Satisfaction was determined on a seven-point
scale, ranging from "completely satisfied" to
"completely dissatisfied."
Patient-rated pain differed between groups,
in favor of the two exercise groups. SMT plus
exercise provided greater satisfaction than SMT
alone or MedX exercises, however. The advantage
of both SMT/exercise and MedX over manipulation
alone continued over the two-year follow-up
period. Overall, the exercise groups benefited
more regarding pain, disability, improvement and
health status.
The researchers admit that the pain results
fall slightly short of clinical significance,
yet note that clinically significant differences
favoring SMT plus exercise over both other
treatments were seen for patient satisfaction.
Evans R, Bronfort G, et al. Two-year
follow-up of a randomized clinical trial of
spinal manipulation and two types of exercise
for patients with chronic neck pain. Spine
2002:27(21), pp. 2383-2389.
www.spinejournal.com
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