Alternative therapies for neck sprain
Date First Published:
March 1, 2000
Last Updated:
January 23, 2003
Report by:
Kerstin Hogg, Clinical Research Fellow (Manchester Royal Infirmary)
Search checked by:
Rosemary Morton, Manchester Royal Infirmary
Three-Part Question:
In [adults with neck sprain] does [osteopathy or chiropractic] improve [outcome]?
Clinical Scenario:
A 25 year old female attends the emergency department having been in a rear end shunt. She complains of pain in her neck. On examination she has right sternomastoid tenderness and restricted movement. You diagnose a neck sprain and advise physiotherapy, exercise and anti-inflammatory drugs. She asks you whether she should go and see an osteopath or a chiropractor. You wonder whether there is any evidence for these alternative treatments.
Search Strategy:
Medline using the OVID interface 1966-10/02, Cochrane Library 2002 Issue 3 and hand search of paper references.
Search Details:
[(exp Neck injuries OR exp Neck pain OR neck.mp OR whiplash.mp) AND (exp Osteopathic medicine OR osteopath$.mp OR chirop$.mp)] LIMIT to human AND English.
Outcome:
206 papers were found, of which 13 were relevant. One literature review is not included in the table as all the papers are either represented in another review or described separately. 3 papers were excluded on the basis of having 10 or fewer patients. The remaining 9 papers are shown in the table. Many of the studies also include patients with lower back pain – only the neck pain patients are described in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Spinal manipulation and mobilisation for back and neck pain: a blinded review. Koes BW, Assendlft WJJ, van der Heijden GJMG, et al. Netherlands, 1991 | 5 RCTs all comparing cervical manipulation to a control Total number of patients combined 111 |
Review | Recovery | 3 studies concluded manipulation better than collar and analgesics<br><br>2 Studies showed no significant difference between manipulation and diazepam, a collar and transcutaneous nerve stimulation | Studies rated poor-moderate on methodology scoring |
| The immediate effect of manipulation versus mobilisation on pain and range of motion in the cervical spine: a randomised controlled trial. Cassidy JD, Lopes AA, Yong-Hing K. 1992, Canada | 100 patients with mechanical neck pain One manipulation vs mobilization |
RCT | Mean improvement in pain as measured by visual analogue scale | 17.3 (SD19.5) vs 10.5 (SD 14.8) | Only one treatment with pain score repeated immediately afterwards No long term follow-up Manipulation was not carried out by an osteopath or chiropractor |
| A randomised clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures. Koes BW, Bouter LM, van Mameren H, et al. 1993, Netherlands, | 29 patients with neck pain Physiotherapy (n=17) vs manual therapy n=12 (manipulation and mobilisation) |
RCT | Subjective pain measurement and physical function over 12 months | Both groups improved without any statistical difference between groups | Patients were also assigned to receive treatment by their GP and placebo. These results were not reported Small numbers |
| Cost effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Skargren EI, Oberg BE, Carlsson PG, et al. 1996, Sweden | 70 patients with neck pain Physiotherapy (n=29) or chiropractic (n=41) |
RCT | Subjective pain; Function,general health | Significant improvement in pain, function and general health in both groups | No breakdown of results between back and neck pain patients given for the last 2 outcomes |
| Sick leave | No difference | ||||
| Fulfillment of patient expectation | 41% of chiropractic group vs 24% physiotherapy group | ||||
| All measured until 6 months | |||||
| Chiropractic treatment of chronic whiplash injuries. Woodward MN, Cook JCH, Gargan MF, et al. 1996, UK | 28 patients with chronic “whiplash” syndrome All had chiropractic manipulation |
Retrospective cohort | Disability at baseline and following treatment | 26/28 patients had reduction in disability | Follow-up time period not specified Disability classified by either a chiropractor or by an orthopaedic doctor over the phone No control group |
| The chiropractic outcome study: Pain, functional ability and Satisfaction with care. Verhoef MJ, Page SA, Waddell SC. 1997, Canada | 106 patients with neck pain and 88 with neck and back pain All had chiropractic manipulation |
Prospective cohort | Disability (Neck Disability Index) | Baseline mean score 23.5, mean score at 6 weeks 13.3 p<0.001 | No control group |
| Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. Jordan A, Bendrix T, Nielsen H, et al. 1998, Denmark | 119 patients with neck pain for more than 3 months Intensive training physiotherapy vs chiropractic treatment |
RCT | Self reported pain and disability | All treatment modality groups had improved pain levels and disability scores | All groups underwent intervention No comparison with natural progression of injury |
| Medication use | All groups progressively reduced analgesic intake | ||||
| All of above measured until 12 months | |||||
| Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a non-steroidal anti-inflammatory drug and spinal manipulation. Giles LGF, Muller R. 1999, Australia | 33 patients with neck pain for at least 13 weeks Chiropractor manipulation (n=18), acupuncture (n=7) or medication (n=7) |
RCT | Disability (Neck Disability Index) Measured at 4 weeks | Manipulation group median index score reduced by 10 points p=0.001<br><br>No statistically significant reduction in acupunture or medication group | Very small numbers particularly in acupuncture and medication groups Numbers within table referring to number of patient with neck pain do not add up |
| Pain as measured by visual analogue scale | Manipulation group median pain score reduced by 1.5 points p=0.002<br><br>No statistically significant reduction in acupuncture or medication groups | ||||
| Chiropractic management of mechanical neck and low-back pain: A retrospective, outcome-based analysis. Mcmorland G, Suter E. 1999, Canada | 61 patients presenting to a chiropractice with neck pain. All received chiropractic manipulation | Retrospective cohort | Neck Disability Index score | Reduction in score after 4 weeks of therapy | No statistics displayed 244 patients who did not complete therapy because they got better or worse were excluded No control group |
Author Commentary:
Virtually all of these studies are flawed and the numbers tiny. In particular there are no powerful studies comparing best conventional treatment with best alternative treatments. There were no papers relating directly to osteopathy.
Bottom Line:
Chiropractic therapy is associated with improvement in neck symptoms but there is no evidence to show whether this improvement is greater or worse than that obtained with conventional treatment.
References:
- Koes BW, Assendlft WJJ, van der Heijden GJMG, et al.. Spinal manipulation and mobilisation for back and neck pain: a blinded review.
- Cassidy JD, Lopes AA, Yong-Hing K.. The immediate effect of manipulation versus mobilisation on pain and range of motion in the cervical spine: a randomised controlled trial.
- Koes BW, Bouter LM, van Mameren H, et al.. A randomised clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures.
- Skargren EI, Oberg BE, Carlsson PG, et al.. Cost effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain.
- Woodward MN, Cook JCH, Gargan MF, et al.. Chiropractic treatment of chronic whiplash injuries.
- Verhoef MJ, Page SA, Waddell SC.. The chiropractic outcome study: Pain, functional ability and Satisfaction with care.
- Jordan A, Bendrix T, Nielsen H, et al.. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain.
- Giles LGF, Muller R.. Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a non-steroidal anti-inflammatory drug and spinal manipulation.
- Mcmorland G, Suter E.. Chiropractic management of mechanical neck and low-back pain: A retrospective, outcome-based analysis.