I've been getting joint manipulation for a neck problem that developed after I slept in the wrong position for too long. Sometimes it seems like it's helping. Other times I feel better for a few days and then it goes right back out again. What do you recommend for patients like me?
There's plenty of evidence from research that joint manipulation is an effective treatment for positional neck pain. But there is more than one way to perform a thrust manipulation of the involved spine.
It's possible that another technique would yield even better results than the one used on you. At the same time, there are other ways to treat mechanical neck pain. For example, sometimes applying heat and/or use electrical stimulation is quite effective. And there are other modalities able to achieve improved pain control and increased function.
As you have discovered, having a positive short-term benefit of treatment is good, but it's not too helpful if the results don't last and you end up in therapy again later. Studies are needed using other treatment strategies and longer time frames to help find optimal ways to manage mechanical neck pain.
Sometimes it just takes a while for the vertebral alignment to settle into a more healthy, normal pattern. In other cases, there are some soft tissue problems that must be addressed. Tight muscles, poor flexibility, nerve impingement or entrapment can add to the problem. The factors contributing to these problems must be identified and eliminated before the pain will go away or the joint manipulation has a long-term favorable result.
Talk with your therapist about your concerns and expectations. Ask if there's anything else you can do personally to improve your situation. Don't be afraid to ask the therapist if there is anything else he or she can do as well to manage the problem.
Javier GonzÃ¡lez-Iglesias, PT, et al. Thoracic Spine Manipulation for the Management of Patients with Neck Pain: A Randomized Clinical Trial. In Journal of Orthopaedic & Sports Physical Therapy. January 2009. Vol. 39. No. 1. Pp. 20-27.
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