Neck Pain under Chiropractic Management: Which Vertebra to Crack?

There are many ways in chiropractic practice to treat neck pain (NP), including spinal manipulation therapy (SMT), education, physical therapy, heat/ice, massage, trigger point therapy, strengthening /stretching exercises (Bryans R?et al, 2014).

Chiro Treatments under The Test

In 2014, 10 chiropratic researchers in Canada published a literature review involving 41 RCTs on the efficacy of chiropractic treatments of non-specific NP. The review concluded (Bryans R et al, 2014):

• SMT: For both acute & chronic NP, SMT is not strongly recommended unless used in combination with exercise, massage, stretching, advice, laser therapy, soft tissue therapy, short wave diathermy.
• Manual therapy: For chronic NP, manual therapy is not recommended unless used in combination with advice, stretching, and exercise.
• Home exercise: For acute NP, home exercise is not recommended unless in combination with advice or training, and for chronic NP, unless with infrared radiation, massage, or other physical therapies.
• Home stretching: Not recommended unless in combination with advice and training.
• Home strengthening & Endurance exercises: Not recommended unless combined with advice, training and supervision.
• Laser: No sufficient evidence that supports a recommendation.
• Massage: No benefit unless combined with self-care, stretching, and/or exercise for chronic NP.
• Transcutaneous nerve stimulation: No sufficient evidence that supports a recommendation.
• Traction: No sufficient evidence that supports a recommendation.
• Trigger point therapy: No sufficient evidence that supports a recommendation.

In summary, no single technique helps unless patients diligently keep doing labor-intensive homework --exercise by themselves. Quite disappointing for patients who are lazy to workout.

If Using SMT, Which Vertebra Joint to Crack?

SMT historically identifies Chiropractic as a profession, although physical therapists & osteopathy doctors use it as well. SMT applies a force on the spine, which has 24 moveable vertebra joints, then which joint is best for NP?

The short answer: No one knows. Notwithstanding in chiropractic education & clinical practice, it is commonly assumed that the outcomes of SMT can be optimized if a force applied to a specific joint.

Put SMT to The Test

A 2021 review by Danish researchers Nim CG et al examined whether SMT applied at a clinically relevant joint is superior to SMT applied “elsewhere” in relation to the clinical outcome. Common sense is that the expertly selected joints should have produced better results. But unfortunately they didn’t.

This review left us a conclusion that it doesn’t matter which vertebra joints are cracked, twisted or popped, as the outcome is always similar.

Deep Thinking

For neck pain, the best way under chiropractic management is: Patients do exercise at their home every day, plus visit clinic once per week for a shot-in-the-dark SMT crack.

Is there a less labor-intensive, but more speedy and reliable Chiro-way to help patients?

The answer is YES. As I am aware, at least a heretic chiropractor's discovery of the magic off-switch for pain pointed to a possibility that most of the troubles experienced by both patients and chiropractic practitioners could be saved.

Interested readers may want to learn more about the amazing discovery by that heretic chiropractor (Read here).

References

Bryans R?et al, Manipulative Physiol Ther. 2014 Jan;37(1):42-63

Kaufman S, How Pain Signals Travel to Your Brain, and How to Block Them In Seconds. Permanently. 2008. www.painneutralization.com

Nim CG et?al. Sci Rep. 2021 Dec;11(1):23415