What’s the best treatment for neck and back pain?



The cycle of dysfunction (see diagram) can be addressed in several different ways.  Recent scientific investigations show that a single type of treatment is not nearly as effective as an integrated treatment plan. The benefit of an integrated treatment plan is the application of the correct therapy at the correct time. Over the past decade, researchers have investigated the effectiveness of spinal manipulation, rehabilitative exercises, anti-inflammatory medications, and advice to stay active. While some individuals can be successful with any single treatment, research indicates that spinal manipulation may be more effective than advice and medication alone. Also, spinal manipulation in conjunction with rehabilitative exercise is most beneficial for persistent mechanical neck pain with or without headache. Oral anti-inflammatory medication can be a useful additional treatment to minimize pain and inflammation during treatment. Additionally, research has shown that a pinched nerve resulting in difficult arm or leg pain may respond well to a course of manipulation and injection of medication into the area of mechanical dysfunction. There is certainly a shift in the management of spine pain toward using multiple therapies at specific times through the treatment plan. Following the best evidence will result in better patient satisfaction, improved outcomes, and less cost.

Spine manipulation restores mobility at specific joints in the spine by manually applying a controlled force into joints that have become restricted in their movement. As previously discussed, mechanical dysfunction of a spine joint results in an imbalance of motion. The muscles and nerves always are affected by joint motion restriction. A course of several manipulations acts to increase the motion of a previously restricted spine joint and balance the motion of the spine.

It is clear that neck and back pain are very prevalent in our society. Many do not seek treatment, thinking that pain is a fact of life or that pain is normal. Yet the pain limits activity and can result in significant disability. Given the successes of an integrated treatment approach for mechanical spine pain, many are adopting a proactive attitude toward their spine health.

– The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine. 2008 33(4S) S5-S7.
– Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003 12(2)149-65.
– The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 26(4)213-19.
– Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Med J 2003 326(7395)911. Efficacy of spinal manipulation and mobilization for low back pain and neck pain. Spine J 2004 4(3)
– A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine 2004 29(14)1541-8.
– Spinal manipulation post epidural injection for lumbar and cervical radiculopathy: a retrospective case series. J Manipulative Physiol Ther 2004 27(7)449-56.


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