talk to a lot of chiropractors across the country. My business, Matlin Manufacturing Inc., brings me into contact with doctors with a wide range of backgrounds and techniques. The number of techniques and therapeutic modalities used by chiropractors is extremely varied. Almost without exception, the vast majority of chiropractors I’ve spoken with still center much of their treatments for spinal pain around the use of spinal manipulation. Manual manipulation of the spine is most often rendered in the form of high-velocity/low-amplitude (HVLA) adjustments. So in spite of all the observed differences between chiropractors of varying backgrounds, this one commonality seems to remain for the majority of doctors.
I’ve also noticed something else chiropractors have in common. As a group, chiropractors tend to be confident in value of their adjustments. By far, most chiropractors strongly “believe” in the value of the adjustment, and most of the time, that’s probably a good thing. The article covered this month supports the value of adjustments compared to using medications and home exercise. Beyond the author’s published conclusions, though, I think you might find this paper to be thought provoking in terms of where the profession and your practice may be headed in the future.
- This study examined 272 patients (ages 18-65) who suffered from neck pain for 2 to 12 weeks.
- Patients were randomly assigned to one of three treatment groups that received spinal manipulative therapy (SMT), medication (M), or home exercise (HE) with advice.
- The authors sought to determine the relative effectiveness of the three different types of care for both acute and subacute neck pain in both the short and long terms.
- The primary outcome measured in the study was pain. Assessments were made at weeks 2, 4, 8, 12, 26 and 52 by using a numerical scale from zero (no pain) to 10 (highest severity).
- Secondary outcomes measured included self-reported disability, general satisfaction, use of medications, and general health status as reported on a health survey.
- Spinal adjustments (SMT) were “diversified” type manipulation delivered over a 12-week period by experienced chiropractors.
- The specific spinal level to be adjusted was left to the discretion of the provider as determined by “palpation of the spine and associated musculature and the participant’s response to treatment.” Treatment also included advice to “stay active or modify activity” as determined by the practitioner.
- Medical treatment (M) provided by a licensed physician included NSAIDs, narcotics, and/or muscle relaxants as determined to be necessary by the physician.
- Home exercise with advice (HE) was provided in two separate one-hour sessions in a university outpatient setting. The program included “simple self-mobilization exercise” of neck and shoulders.
Chiropractic care (SMT) proved more effective than medication both in terms of pain and in most of the secondary outcomes. Home exercise with advice (HE) was a very close second and actually produced “similar short- and long-term outcomes.” In fact, the HE group actually showed the most improvement in terms of spinal motion. Patients in the medication group fared the worst and a number of patients in the M group reported using higher levels of pain medication by the end of the study.
Home exercise with advice (HE) was a very close second and actually produced “similar short- and long-term outcomes.
Many chiropractors utilize both manipulation and exercise. The authors make note of the limited difference in outcomes for the HE group and took pains to point out that “the potential for cost savings over both SMT and medication interventions is noteworthy.”
Obviously it's neat to have evidence supporting the chiropractic adjustment over NSAIDS, pain meds and muscle relaxers. But readers should take note. This paper also highlights the comparable outcomes and significant cost savings of active care/home care programs. Doctors who fail to provide exercise plans for acute/subacute spinal pain may well find their care plans in the cross hairs as plan administrators look continually to cut costs.
The study also made me consider that all too often many third parties are only paying attention to pain relief. Unfortunately, that’s also the case with many chiropractors who simply adjust until patients feel better and then “rinse and repeat” whenever another exacerbation occurs. If all we do is relieve pain, then we can hardly blame interested third parties for seeking the cheapest method available. I submit that if the profession hopes to survive and prosper, then chiropractors increasingly will be challenged to show exactly how to produce improved clinical outcomes above and beyond the resolution of pain.
Special thanks to our Chiropractic Sciences Contributor Roger Coleman, DC for this interesting article.
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1 Pt 1):1-10.
Link to Abstract:
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.