Quebec Task Force Report
In 1995 the Quebec task force found that there was very little evidence to support any particular treatment methods for the care of whiplash-associated disorders. Based on limited evidence and reasoning by analogy, it is the Task Force consensus that the use of nonsteroidal anti-inflammatory agents and analgesics, short term manipulation and mobilization by trained persons, and active exercises are useful in Grade II and III WAD, but prolonged use of soft collars, rest or inactivity probably prolongs disability in WAD Spitzer WO, Skovron ML et al (1995) Scientific Monograph of the Quebec Task Force on Whiplash Associated Disorders: Refining Whiplash and its Management, Spine 20:8s.
Chiropractic & Osteopathy 2008 (Nov 17); 16 (1): 15 ~ FULL TEXT
This case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma Chronic Neck Pain patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness.
What Causes Chronic Neck Pain?
North American Spine Society
It is usually not possible to know the exact cause of neck pain in the
days or weeks after a car accident. We know the muscles and ligaments
get strained and are probably inflamed, but they usually heal within six
to ten weeks. Pain that lasts longer (than 6–10 weeks) is usually due to deeper problems such as injury to the disc or facet joint, or both. Read more here.
Conservative Management of Mechanical Neck Disorders:
A Systematic Review
J Rheumatol 2007 (May); 34 (5): 1083–1102
In a review of 88 unique RCTs, the authors found that “Exercise combined with mobilization/manipulation,
exercise alone, and intramuscular lidocaine for chronic MND;
intravenous glucocorticoid for acute whiplash associated disorders; and
low-level laser therapy demonstrated either intermediate or longterm benefits.
Optimal dosage of effective techniques and prognostic indicators for
responders to care should be explored in future research.”
J Manipulative Physiol Ther 2007 (Mar); 30 (3): 215–227
There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks posttreatment. The current evidence does not support a similar level of benefit from massage.
Return to Work After Two Years of Total Disability: A Case Report
J Occup Rehabil 2006 (Jun 3)
This paper describes the conservative management of a patient who was disabled from work for 2 years, using an integrated approach including chiropractic manipulation, pain education, restricted duty and clear communications among all parties involved. After 15 weeks, the patient returned to her previous occupation as a nurse, first part time, and subsequently full time. There are more articles like this in the CASE STUDIES Section.
J Manipulative Physiol Ther 2006 (Feb); 29 (2): 100–106
There was no difference between the treatment patients and the control
subjects at the beginning with regard to age, sex, subjective pain
intensity, range of motion, and HRA. At the 5-week follow-up, the
treatment patients showed significant reductions in pain and improvement
of all HRA aspects measured whereas the control subjects did not show
any reduction in pain and improvement in only one HRA aspect. The
results of this study suggest that chiropractic care can be effective
in influencing the complex process of proprioceptive sensibility and
pain of cervical origin. Short, specific chiropractic treatment programs with proper patient information may alter the course of chronic cervical pain.
Exercises for Mechanical Neck Disorders
Cochrane Database Syst Rev 2005 (Jul 20); 3: CD004250
The evidence summarised in this systematic review indicates that specific exercises may be effective for the treatment of acute and chronic MND, with or without headache. To be of benefit, a stretching and strengthening exercise program should concentrate on the musculature of the cervical, shoulder-thoracic area, or both. A multimodal care approach of exercise, combined with mobilisation or manipulation for subacute and chronic MND with or without headache, reduced pain, improved function, and global perceived effect in the short and long term.
Chronic Pain in Persons With Neuromuscular Disease
Clin J Pain 2005 (Jan); 21 (1): 18–26
In this paper, researchers in a medical school rehabilitation
department were interested in finding out what treatments were most
effective at reducing pain for neuromuscular diseases (like amyotrophic
lateral sclerosis and myotonic muscular dystrophies). Interestingly, chiropractic
scored the highest relief rating (7.33 out of 10), scoring higher than
the relief provided by these medical treatments: nerve blocks (6.75) or
Opioid analgesics (6.37). WOW!!!
Spine Journal (of the North American Spine Society) 2004 (May); 4 (3): 335–356
Our data synthesis suggests that recommendations can be made with some
confidence regarding the use of SMT and/or MOB as a viable option for
the treatment of both low back pain and neck pain. There have been few
high-quality trials distinguishing between acute and chronic patients,
and most are limited to shorter-term follow-up. Future trials should
examine well-defined subgroups of patients, further address the value of
SMT and MOB for acute patients, establish optimal number of treatment
visits and consider the cost-effectiveness of care.
Chiropractic Management of Intractable Chronic Whiplash Syndrome
Clinical Chiropractic 2004 (Mar): 7 (1): 16–23
The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post-isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, no headaches and unrestricted cervical spine range of motion. At 4 months follow-up, the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain.
Spine 2003 (Jul 15); 28 (14): 1490–1502
The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (3%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 23% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension.
British Medical Journal 2003 (Apr 26); 326 (7395): 911 ~ FULL TEXT
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 this study. After seven and 26 weeks, they found significant improvements in recovery rates in the manual therapy group compared to the other 2 groups. 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. You may also enjoy this WebMD review titled: Manual Therapy Eases Neck Pain, Cheaply: Hands-On Approach Effective, and More Cost-Effective, than Traditional Treatments .
Spine 2002 (Nov 1); 27 (21): 2383–2389
The results of this study demonstrate an advantage of spinal
manipulation combined with low-tech rehabilitative exercise and MedX
rehabilitative exercise versus spinal manipulation alone over two years
and are similar in magnitude to those observed after one-year follow-up.
These results suggest that treatments including supervised
rehabilitative exercise should be considered for chronic neck pain
sufferers. Further studies are needed to examine the cost effectiveness
of these therapies and how spinal manipulation compares to no treatment
or minimal intervention.
J Manipulative Physiol Ther 2001 (May); 24 (4): 260–271
The results of this clinical trial indicate that both instrumental
(MFMA) manipulation and manual (HVLA) manipulation have beneficial
effects associated with reducing pain and disability and improving
cervical range of motion in this patient population. A randomized,
controlled clinical trial in a similar patient base with a larger sample
size is necessary to verify the clinical relevance of these findings.
Clinical Study on Manipulative Treatment of Derangement of the Atlantoaxial Joint
J Tradit Chin Med 1999 (Dec); 19 (4): 273–278
The derangement of the atlantoaxial joint is one of main cervical
sources of dizziness and headache, which were based on the observation
on the anatomy of the upper cervical vertebrae, analysis of X-ray film
of the atlantoaxial joint, and the manipulative treatment in 35 patients
with cervical spondylosis.
Spinal Pain Syndromes:Nociceptive, Neuropathic, and Psychologic Mechanisms
J Manipulative Physiol Ther 1999 (Sep); 22 (7): 458–472
Although the treatment of neuropathic pain is difficult, sufficient
evidence in the literature demonstrates that the treatment of
nociceptive pain should be multimodal and involve spinal manipulation,
muscle lengthening/stretching, trigger point therapy, rehabilitation
exercises, electrical modalities, a variety of nutritional factors, and
mental/emotional support.
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 376–381
The consistency of the results provides, in spite of several discussed
shortcomings of this pilot study, evidence that in patients with chronic
spinal pain syndromes spinal manipulation, if not contraindicated,
results in greater improvement than acupuncture and medicine.
J Manipulative Physiol Ther 1998 (May); 21 (4): 267–280 ~ FULL TEXT
Joint complex dysfunction should be included in the differential diagnosis of pain and visceral symptoms because joint complex dysfunction can often generate symptoms which are similar to those produced by true visceral disease. You may also enjoy this response from another chiropractic researcher.
J Manipulative Physiol Ther 1997 (Feb); 20 (2): 80–85
Subjects receiving manipulation demonstrated a mean reduction in visual
analogue scores of 44%, along with a 41% improvement in mean scores for
the head repositioning skill. In comparison, a 9% mean reduction in
visual analogue scores and a 12% improvement in head repositioning
scores was observed for the stretching group. The difference in the
outcomes of the head repositioning skill scores was significant (p <
or = .05).
Chronic Cervical Zygapophysial Joint Pain After Whiplash: A Placebo–Controlled Prevalence Study
SPINE 1996 (Aug 1); 21 (15): 1737–1744
The prevalence of cervical zygapophysial joint pain after whiplash has
been studied by means of comparative local anesthetic blocks. The
concern is that such blocks may be compromised by placebo responses and
that prevalence estimates based on such blocks may exaggerate the
importance of this condition. In this study, sixty-eight consecutive
patients referred for chronic neck pain after whiplash were studied.
Those who did not experience pain relief together with the patients with
dominant neck pain proceeded to undergo placebo-controlled local
anesthetic blocks. Two different local anesthetics and a placebo
injection of normal saline were administered in random order and under
double-blindfolded conditions. A positive diagnosis was made if the
patient’s pain was completely and reproducibly relieved by each local
anesthetic but not by the placebo injection. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (93% confidence interval, 46%, 73%).
The Prevalence of Chronic Cervical Zygapophysial Joint Pain
After Whiplash
Spine Journal 1995 ( Jan 1); 20 (1): 20–26
In a significant proportion of patients with whiplash, chronic,
refractory neck pain develops. Provisional data suggest many of these
patients have zygapophysial joint pain, but the diagnosis has been
established by single, uncontrolled diagnostic block. In this study,
fifty consecutive, referred patients with chronic neck pain after
whiplash injury were studied using double-blind, controlled, diagnostic
blocks of the cervical zygapophysial joints. On separate occasions, the
joint was blocked with either lignocaine or bupivacaine in random order.
A positive diagnosis was made only if both blocks relieved the
patient’s pain and bupivacaine provided longer relief. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.
Pain 1993 (Mar); 52 (3): 259–285
Peripheral tissue damage or nerve injury often leads to pathological
pain processes, such as spontaneous pain, hyperalgesia and allodynia,
that persist for years or decades after all possible tissue healing has
occurred. Although peripheral neural mechanisms, such as nociceptor
sensitization and neuroma formation, contribute to these pathological
pain processes, recent evidence indicates that changes in central neural
function may also play a significant role.
The next year research was published confirming the findings of the Quebec Task Force. They found that cervical manipulation and mobilization were effective, safe and appropriate for many categories of patients with head and neck pain. Coulter ID, Hurwitz EL, et al. (1996) The Appropriateness of Manipulation and Mobilization of the Cervical Spine, RAND Santa Monica, California, Document No. MR-781-CR In 1996 two studies on neck pain found that today there is better evidence for the effectiveness of manipulation than any other treatment for chronic neck pain. Hurwitz EL, Aker PD etal. Manipulation and Mobilization of the Cervical Spine, Spine, 1996; 21(15):1746–1760. Aker PD, Gross A et al. Conservative Management of Mechanical Neck Pain: Systematic Overview and Meta–Analysis. Br Med J 1996;313:1291–1296.