Scientific Evidence for Physical Therapy to Treat Neck PainPhysical therapists, like everyone else in the health care field, are working hard to find ways to treat patients safely and effectively. Instead of treatment as usual, therapists are striving to find scientific evidence to support (or refute) current treatment approaches.
One of the ways this is done is to compare treatment of a common problem (e.g., acute neck pain as in this study) using one type of therapy versus another. In this study, the use of electro/thermal therapy is compared with thoracic manipulation (joint thrust).
A previous study by the same authors showed evidence that thoracic spine manipulation combined with other treatment is more effective than electro/thermal therapy alone. The results were reported in terms of short-term improvement. Specifically, improvements in neck range-of-motion, pain, and function were observed at the time of immediate follow-up. No long-term studies have been done in this area.
So, taking the same model used in the previous study, the physical therapists repeated the experiment. This time, they compared two groups of acute neck pain patients using the same treatment and reporting on the same results for a longer period (up to four weeks). Repeating results from a previous study helps validate the treatment as an effective way to manage neck pain.
Everyone in both treatment groups had neck pain lasting less than one month. That meets the criteria for acute pain. Everyone was screened carefully for a serious medical cause of their neck pain such as a tumor, infection, or fracture. Certain patient groups were excluded (e.g., fibromyalgia patients, anyone who had a recent spinal manipulation, or anyone with osteoporosis). Only patients between the ages of 18 and 45 were allowed to participate.
Forty-five patients were selected and randomly assigned to one of two groups. The first group received five electro/thermal therapy sessions over a three-week period. This treatment consisted of 15 minutes of superficial heat to the neck area using an infrared lamp. This was followed by electrical nerve stimulation applied with electrodes on either side of the spine at the C7 (seventh cervical vertebra) level.
The second group had the same electro/thermal therapy treatment and three (once a week for three weeks) thoracic spine thrust manipulations. The thrust manipulation was done with the patient in a seated position, arms folded across the chest. The therapist stood behind the patient and applied an upward distraction manipulation by grasping under the patient's elbows and lifting. One physical therapist administered all of the treatments to all of the patients.
The results concurred with the first study done as well as other independent studies (i.e., not this group of researchers) in this same area of research. Patients improved more with the manipulation procedure (combined with the heat and electrotherapy) than with just heat and electrotherapy alone (nonthrust group). There was a greater reduction in neck pain, better function, and improved neck range of motion. And the results were maintained for the full four weeks of follow-up.
The results of this study represent a step in the right direction. With shrinking health care dollars, the goal of finding the right treatment for each patient or groups of patients has never been more important.
But as the authors point out, this first step must be followed by many others. For example, there is more than one way to perform a thrust manipulation of the thoracic spine. It's possible that another technique would yield even better results than the one used in this study. At the same time, there are other ways to apply heat and/or use electrical stimulation to treat neck pain. Perhaps there's a better way to use this modality for improved pain control and increased function.
And finally, having a positive short-term benefit of treatment is good, but it's not too helpful if the results don't last and the patient ends up in therapy again later for the same problem. Future studies using other treatment strategies and longer time frames will be extremely helpful in finding optimal ways to manage mechanical neck pain.
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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