We have patients coming in every working day with episodes of neck pain. These are either acute ones, the ones who can't move, or chronic ones, whose who can move but are limited in some way.

Neck pan can be split into 3 broad categories:
- Acute pain – uncomplicated
- Acute neck pain – complicated. This involved compression of the spinal cord in the cervical spine. Patients reported an improvement of up to 70% for pain and disability following chiropractic care in a trial carried out by Donald Murphy of Rhode Island.
- Sub-acute and chronic neck pain.

And these patients, coming into C1 Chiropractic Health Centre,with any one of these levels of neck pain are not alone:

Incidence
Hill and co-workers report that in the UK many as 31% of adults have had neck pain in the last month and 48% of neck pain patients report persistent pain a year later. (Hill J, Lewis M et al. (2004) Predicting Persistent Neck Pain. Spine 29:1648-1654).

But what causes it:

Liebenson, Skaggs et al say that it is ‘difficult to pinpoint the specific pain-generating tissue’ of neck pain and even if you can the reasons why ‘are often elusive’. Additionally, up to 71% of patients who have chronic pain following whiplash have undetected vertebral end plate fractures at the spinal levels associated with the pain that were overlooked on standard medical imaging. (Michael Freedman Dec 2001).

So how is it best treated:
Cleland et al. have shown that manipulation of the thoracic spine produces immediate analgesic effects in patients with mechanical neck pain. (Cleland JA, Childs JD et al. (2005) Immediate Effects of Thoracic Manipulation in Patients with Neck Pain: A Randomized Clinical Trail, Manipulative Therapy 10:127-135).

Liebenson recommends manual therapy and rehabilitation exercises supported by one of the strongest research trials in this field carried out by Bronfort, Evans et al. In this trial 191 patients were split into three groups:
• Spinal manipulation and low-tech exercise,
• MedX exercise – receiving dynamic progressive resistance exercises on MedX machines,
• Spinal manipulation.
Outcomes were measured at 5 and 11 weeks and 3,6 and 12 months after the trial. At the one year follow up the group that were receiving exercises and manipulation did significantly better than the group doing manipulation alone. This study suggests that patients with chronic neck pain often have weak neck muscles and that the best practice for these patients should combine manipulation with exercise.

In a literature review published by Hurwitz, Aker et al. in Spine and Aker, Gross et al. in the British Medical Journal the authors reported that manipulation and mobilization were both more effective than muscle relaxants and usual medical care in providing pain relief for patients with sub-acute or chronic neck pain. In a new study (2003) in Spine, Giles and Muller compared acupuncture, joint manipulation and standard medication (NSAIDs). Patients in the acupuncture and medications groups had no significant improvement during the trial on any of the outcome measures and the manipulation group showed significant improvement on all measures with no patient made worse or experiencing side effects. Giles and Muller then followed up their patients a year later and reported that the manipulation group gained ‘significant broad-based beneficial…long-term outcomes’.

In a great study by Haneline at Palmer College of Chiropractic, 79% of the patients improved to the point they had only minimal or minor restriction of movement and their satisfaction rates were an astounding 94% - and I suspect few trials can report the same, with 70% indicating they were very satisfied.

When asked which provider helped the most 83% replied the chiropractor.

Couldn't agree more