:dropcap_open:I:dropcap_close: talk to a lot of chiropractors from all across the country. My business (Matlin Mfg. Inc.) brings me into contact with doctors from a very wide range of backgrounds and techniques. The number of techniques and therapeutic modalities used by chiropractors is extremely varied. But almost without exception, the vast majority of chiropractors still center much of their treatment 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 differences we might observe between chiropractors of differing backgrounds, there remains this one thing which the vast majority of us seem to have in common.I’ve also noticed one more thing chiropractors tend to have in common. As a group, chiropractors tend to not be lacking at all in confidence as to the value of their adjustments. By far, most chiropractors tend to strongly ‘believe” in the value of the adjustment. And most of the time, that’s probably a good thing. This month’s covered article supports the value of your adjustments compared to medications and home exercise. But beyond the author’s published conclusions, I think you might find this paper thought provoking in terms of where the profession (and your practice) may be headed in the future.
The Facts:
- This study examined 272 patients (ages 18-65) who suffered from neck pain for two-twelve weeks.
- Patients were randomly assigned into one of three treatment groups which received either 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 term.
- The primary outcome measured in the study was pain. Assessments were made at 2, 4, 8, 12, 26 and 52 weeks using a numerical scale from zero (no pain) to 10 (highest severity).
- Secondary outcomes measured included self reported disability, general satisfaction, use of medications, 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.
Take Home:
Chiropractic care (SMT) proved most 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
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 pain relief may be the only thing many third parties are paying attention to. 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 out the cheapest method available. I submit that if the profession hopes to survive and prosper, we are increasingly going to be challenged to show exactly how we 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.
Reference:
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: http://www.ncbi.nlm.nih.gov/pubmed/22213489
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.