Manual Therapy Eases Neck Pain, Cheaply

Hands-On Approach Effective, and More Cost-Effective,
than Traditional Treatments

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org

FROM: WebMD

By Jennifer Warner
WebMD Medical News

Reviewed By Brunilda Nazario, MD

April 24, 2003 - A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to a new study.

Neck pain and stiffness is a common health problem, especially among older adults, and affects between 10% and 15% of the population. Although the condition isn't life threatening, it does cause a great deal of pain and disability as well as loss of productivity due to worker absenteeism.

Researchers say a variety of approaches in treating neck pain have been studied with mixed results, but little is known about how the treatments compare in terms of cost as well as effectiveness in relieving neck pain.

In this study, published in the April 26 issue of the British Medical Journal, Dutch researchers compared the cost-effectiveness of treatment with manual therapy, traditional physical therapy, or medical care from a general practitioner among 183 people with neck pain. Costs included both direct health care costs of treatment, such as office visits and drugs, as well as indirect costs like worker absenteeism.

Manual therapy -- practiced in the U.S. by chiropractors, osteopaths, and some physical or massage therapists -- consisted of spinal mobilization of the neck through slow, steady manipulation of the neck muscles, pushing them to the limit of the person's range of motion for a maximum of six, 45-minute sessions.

Physical therapy involved individualized exercise therapy, such as active and passive relaxation exercises, stretching, and functional movement exercises in up to 12, 30-minute sessions.

Routine medical care provided by a general practitioner consisted of a standard consultation with advice about the causes of the condition and potential aggravators and recommendations for self care using heat application, ergonomic considerations, or home exercises. Follow up visits every two weeks were optional.

After seven and 26 weeks, the study found significant improvements in recovery rates in the manual therapy group compared to the others. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group.

Those differences became negligible after 52 weeks follow up, however, and long-term recovery rates were similar across all three groups.

But researcher Ingeborg Korthals, PhD, of the Institute for Research in Extramural Medicine in Amsterdam, Netherlands says the overall expenses encountered by the manual therapy group were only a third of the costs associated with the other groups.

"The biggest cost factor was lower work absenteeism," says Korthals. "Almost no one in the manual therapy group missed work because they recovered so quickly and didn't shop around for other therapies after the treatment ended."

"In the physical therapy group and general practitioner group, the patients shopped around and did other therapies. In fact, a lot of them ended up in manual therapy," says Korthals.

Korthals says they were surprised to find that manual therapy was associated with lower direct and indirect costs because manual therapy is often more expensive than other treatments in the Netherlands. But the major cost-saving factor was that the patients in this group recovered quicker and were happy with the results.

George B. McClelland, DC, spokesman for the American Chiropractic Association, says the type of spinal mobilization used in this study did not involve the high velocity, low amplitude (HVLA) techniques frequently used by chiropractors in the U.S.

"But the mobilization description in the study falls well within the adjustment procedures used by chiropractors," McClelland tells WebMD. "The key here is working the joints through the range of motion but not taking it to the level that brings about an audible sound, or the cracking or popping sound typically associated with HVLA."

The researchers say the type of manual therapy used in the study is also practiced by physical therapists, but the physical therapists in the study were not allowed to include these techniques in their treatment.

"What the patient should understand is that the health care provider -- whether it's a physical therapist, chiropractor, or whomever -- will be able to enable them to get their pain down more quickly with manual therapy than compared to classical approaches with physical therapy or a family practitioner," says McClelland.

Joel Posner, MD, professor of gerontologic research, medicine and public health at Drexel University College of Medicine in Philadelphia, says no one study is going to answer all the questions about manual therapy.

But Posner says these findings show that regardless of cost there is no loss of effectiveness in using manual therapy to treat neck pain, and there seems to be something to gain in terms of making patients feel better sooner.

"Studies like this provide a lesson to all of us in more classical medicine of a willingness to explore techniques that we were never taught in medical school," says Posner. "This is a cautionary tale that we need to broaden our horizons, and there is a danger as physicians if we don't because it throws effective therapies in the hands of others who may also include more dangerous ones."

Posner says people with neck pain who seek relief from manual therapy should look for a qualified professional, if possible one recommended by their health care provider. And if the person who's performing the therapy is not doing slow, steady manipulations on the neck, but is forcing movements or doing short quick manipulations, they should discontinue the therapy.

SOURCES: British Medical Journal, April 26, 2003. Joel Posner, MD, professor of gerontologic research, medicine and public health at Drexel University College of Medicine, Philadelphia. George B. McClelland, DC, executive committee member of the American Chiropractic Association. WebMD Medical News: "Hands-on Approach Best for Neck Pain".