Manipulation for Neck Pain
TREATMENT FOR NECK PAIN
R E S C U R RISK: 5/5
Manipulation of the neck is a remarkably safe procedure, particularly in comparison to other treatments used for neck pain and related conditions. Some M.D.’s have cautioned that there might be an increased risk of stroke and even death associated with neck manipulation, but even the more conservative estimates put that risk at less than one in 100,000. So how rare are these events? A study by a major chiropractic malpractice carrier in Canada found that VAD will occur in 1 in 8 million chiropractic office visits, 1 in 5.85 million cervical adjustments, and once in nearly 50 chiropractic careers.
By comparison, the risk of bleeding to death from NSAIDs is 2-3 per 100,000.
Some M.D.s have cautioned patients not to have their necks manipulated, but that recommendation is not supported by widely accepted current scientific evidence.
Hawk C. The Praeger Handbook of Chiropractic Health Care. Santa Barabara CA: ABC-CLIO; 2017.
Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ: Canadian Medical Association Journal. 2001;165(7):905-906
Cassidy JD, Boyle E, Côté P, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. European Spine Journal. 2008;17(Suppl 1):176-183.
Virtually all national treatment guidelines recommend at least a trial of manipulation for neck related disorders, including whiplash, though there are times when it may not be appropriate. While manipulation is effective, current research on neck pain recommends “multi-modal care,” typically manipulation, exercise and other treatments used together.
SELF CARE: 1/5
While some people do self- manipulation, we don’t recommend it. See a professional.
Manipulation, most commonly provided by chiropractors, is covered by most insurance plans, and typically costs between $25-60 per session. National guidelines recommend trial of care, that is, 6-12 visits with a reevaluation after the trial to ensure treatment is helping. If there is no improvement after 12 visits, it’s time to move on!
Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ: Canadian Medical Association Journal. 2001;165(7):905-906.
Lanas A, Perez-Aisa MA, Feu F, Ponce J, Saperas E, Santolaria S wt al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 2005 Aug;100(8):1685-93
Bussières AE, Stewart G, Al-Zoubi F. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39(8):523-564.e27. doi: 10.1016/j.jmpt.2016.08.007.
USEFULNESS (overall rating): 4/5
Chiropractic care is safe, effective and relatively inexpensive. Recent systematic reviews (the highest level of research) recommend spinal manipulation and mobilization for neck pain and whiplash injuries.
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