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Spinal Manipulation, Exercise are better than drugs for Neck Pain

January 3, 2012 the Annals of Internal Medicine published a study involving 272 subjects. The study compared 12 weeks of spinal manipulation (SMT), exercise and advice (HEA), and drug therapy.

Pain levels were measured at 2, 4, 8, 12, 26 and 52 weeks. During the twelve weeks the HEA group received at least two hours of advice and exercise instruction.

At all stages of the study spinal manipulation provided more relief than drug therapy. Surprisingly there was no statistically significant difference between the SMT and the HEA groups. Side effects were most prevalent in the drug group (60%) with the most common being gastrointestinal symptom or drowsiness followed by dry mouth, cognitive disturbances, rash, congestion, and disturbed sleep. Side effects were reported in 46% of the HEA group and 40% in the SMT group. Musculoskeletal pain was the most common side effect. Less frequent were tingling, stiffness, headache and joint clicking (crepitus). It should also be noted that the drug therapy group reported even higher levels of medication use after the intervention. Patients reported higher levels of satisfaction in the SMT group. It was not possible to blind people to their therapy, which often is a weakness in trials involving physical intervention, neither was there a control group.

This is again a study comparing isolated techniques rather than a therapeutic approach using two or more proven techniques. I would like to think that most chiropractors provide advice on posture and exercise, and various soft tissue and mobilisation techniques as well as adjusting the spinal facet joints, the pelvis and the peripheral joints.

With both SMT and HEA being equally successful in managing neck pain in this study, one would like to think that a therapeutic approach combining several techniques as is common practice here at Park View Acupuncture and Chiropractic Clinic would be even more beneficial. I am not aware of a specific study confirming this theory but it is a tempting conclusion to draw. However, one problem I experience in clinical practice is that patient compliance with postural advice and exercise is rather poor.

Ref: Ann Intern Med. 2012;156:1-10, 52-53

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