I came across a post via NY Times Health Blog about a new study on effectiveness of Chiropractic care, simple exercise/advice and medications for neck pain. As you can expect, I jumped right in to read. You can check it out here yourself before you read this. I will not summarize it per say but do want to give my two (actually 3 or more) cents on how this affects our profession.
#1. Chiropractic Care…manipulation…works!
For those who practice Spinal Manipulation Therapy (SMT), you probably disagree with most higher level evidence, Cochrane reviews (example here), that there is no more benefit of manipulation over mobilizations for neck pain. This individual study did not compare the two in particular but is a great win simply to show improvement with manipulation. Now the study looked at chiropractic care (not to get into very much detail on their manipulation styles, techniques, etc.) so I will just refer to the result as manipulation. Should we as a profession do more SMT?
#2. Medication doesn’t work comparable to SMT and exercise/advice.
Nothing more needs to be said. If you just get this from this article, please share it with your patients. Some of those skulls are just thick though…
#3. Home Exercise with Advice (HEA) works!..but…
The article has a supplemental sheet so the reader can know what exercises were performed (find here). This is great and made it easy for the patients to follow. Don’t get me wrong, research has to be fairly general and cover all bases when it comes to exercise (as you know we have millions of exercises out there…) but wow, I really do not the ones in this study! Some are good, such as retraction and rotation, but who really lies off the edge of plinth and does cervical extension. And maybe I’m biased, but I do not like side-bend or flexion; particularly the way it is shown. Or better yet, lets just move our necks in any direction possible. No-brainer.
To sum, I like this study but am disappointed for our profession for many reasons.
–Annals of Internal Medicine is a highly reputable journal for physicians and guides their choices for patient care. They can now either refer to DC care, print off these exercises for their patients, do not recommend medication and boom, we are not needed. I do not know the numbers (someone out there probably does), but we need to get more physical therapy research into big time journals for other healthcare providers to recognize us.
–NY Times Health Blog is big time. I don’t know how many people go to this site for information, but I know for sure its much more than any physical therapist’s blog. I am sure millions of people read that blog! The consumer can find information out more and more on his/her own and honestly, this site is a great start (I check it out regularly). With Chiropractic and Neck Pain in the title, this shuts us down even more. We are making significant gains in terms of being musculoskeletal specialists, but still not first to go to when pain arises. With neck pain affecting an American ~70% sometime in their life, don’t you think they will continue to undergo DC care?
–Exercises = blah. To be honest, if I wasn’t a physical therapist, I would think “our part” in this study is lame, unchallenging (I mean just move your neck in any direction right?), and simply undermines our profession. We do not need a doctorate as everyone knows to sit up straight, correct? The exercise and advice is what we do! And again, wow, not exciting. What I get from this article is DC care is awesome, stay away from medication, and oh yeh, keep your head moving.