Home exercises as good as spinal manipulation for stiff neck

By Lilian Anekwe

BMJ Group News

What do we know already?

Neck pain is very common. It may cause pain, stiffness, and difficulty moving, and often gets better on its own.

Neck pain that lasts longer or gets worse may need treatment. There are lots of different types of treatment and we need more research about what works best.

Randomised controlled trials are one of the best types of study to establish which treatments work best.

This new study included 272 people aged 18 to 65 with neck pain for at least two weeks, and who had not received any treatment in the previous three months.

The people in the study were randomly assigned to one of three groups given different treatments for 12 weeks.

One group was given spinal manipulation by a chiropractor. This involved sessions lasting 15 to 20 minutes during which a chiropractor examined their spine, then performed spinal manipulation involving quick movements and thrusts of particular joints, or slower rotations of joints.

Another group had two one-hour sessions with a physiotherapist during which they were shown exercises and gentle controlled movements to do at home, to increase their mobility. People in this group were told to perform the exercises for five to ten repetitions between six and eight times a day.

A third group were prescribed painkillers, mainly paracetamol or drugs called non-steroidal anti-inflammatory drugs (NSAIDs). If these did not work they were offered stronger narcotic medications or drugs to relax the muscles.

What does the new study say?

After 12 weeks people given exercise or spinal manipulation rated their pain as having improved more than people given medication. Some 32 percent of people in the spinal manipulation group said their pain had 100 percent improved, compared with 30 percent in the home exercise group and 13 percent in the medication group.

The proportions were broadly the same after 26 weeks (37 percent in the spinal manipulation group, 35 percent in the home exercise group, and 19 percent in the medication group) and after a year. The differences between the results for exercise and spinal manipulation were small enough to be down to chance.

Four people in every ten of the group given spinal manipulation experienced side effects, mainly joint pain but also stiffness, headaches, and a tingling or numb sensation. This was slightly less than in the home exercise group, in which around five people in every ten experienced side effects. Six in every ten people in the medication group had side effects, most commonly stomach upsets and drowsiness.

How reliable is the research?

Trials that are designed, like this one, to compare groups of people who are randomly assigned to different treatments are a good and usually reliable way to compare the effects of different interventions.