Chronic Neck Pain

Chronic Neck Pain and Spinal Manipulation

In the United States, 54% of people have experienced neck pain in the past 6 months and 70% of Americans will have neck pain at some point in their lives. Neck pain can be a result of trauma, age-related disorders, systemic disorders, or inadequate movement patterns. It is associated with movement limitations, headaches, temporomandibular disorders, and radiating pain into the upper extremities. Neck pain often becomes a chronic condition, meaning it lasts longer than the expected healing time or has an unknown underlying cause. Chronic neck pain can also lead to difficulties performing functional activities such as working at a desk, driving, lifting, reaching, or dressing.

Chronic neck pain can be managed conservatively or surgically depending on severity, onset, and nature of pain. Physical therapy is considered a conservative approach, meaning the treatments are non-invasive. Physical therapy treatments typically include therapeutic exercises, postural re-education, home exercise programs, manual therapy, and modalities.

Spinal manipulation is a type of manual therapy used to address motion limitations in the spine. The proposed mechanism for pain relief from spinal manipulation is multifactorial and includes enhancement of the joint chemical environment, promotion of natural tissue repair, and inhibition of pain in the central nervous system. This treatment technique can also improve mobility which helps address functional limitations and decrease difficulty with daily activities.

Common targets for manipulation for neck pain include the upper cervical spine, mid-cervical spine, cervicothoracic junction, and thoracic spine. Studies have shown manipulation combined with exercise to be capable of producing statistically significant decreases in neck pain. Recent literature suggests that spinal manipulations for neck pain are most effective when they are performed on the thoracic region. This area is also called the mid back and is closely linked to pain and mobility limitations in the neck! Be sure to ask your physical therapist if thoracic manipulations could help control your neck pain!

References:

1. Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2008;38(9):1e34.

2. Crawford JR, Khan RJ, Varley GW. Early outcome and management following soft tissue injuries of the neck-a randomized controlled trial. Injury. 2004;35:891-895. http://dx.doi.org/10.1016/j.injury.2004.01.011

3. Spitzer WO, Leblanc FE, Dupuis M. Scientific approach to the assessment and management of activity related spinal disorders. Spine 1987;7:S1-59.

4. Jette AM, Smith K, Haley SM, Davis KD. Physical therapy episodes of care for patients with low back pain. Phys Ther. 1994;74:101-110; discussion 110-105.

5. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57:656 – 665.

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