As both a Chiropractor and Registered Massage Therapist, one of the skills that my patients appreciate is the ability to recommend chiropractic care vs massage therapy for their current complaint. Ensuring patients receive the right care at the right time means people recover more quickly and return to regular activities sooner.
In the case of neck pain, the answer may not always be immediately clear, but a recent award winning systematic review is helping to shed further light on the subject.
Nonspecific or mechanical neck pain (neck pain not related to a specific injury or pathology such as whiplash) is reported to have a 30-50% prevalence. Due to the episodic or recurrent nature of neck pain, 50-85% of patients report recurring pain in the 1-5 years following the initial episode. The scale of the effect of neck pain is enormous, and many patients will consult a chiropractor or massage therapist for advice or treatment during their recovery. As such, the Canadian Chiropractic Association and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards Clinical Practice Guideline Project sought to develop evidence based guidelines to assist practitioners in making evidence informed treatment decisions in the best interests of their patients. The first guideline was published in 2004, and in January of 2014, that guideline was updated to reflect the more robust and current research, incorporating randomized controlled trials from January of 2004-2011.
Details:
- This Review excluded acupuncture, surgery, invasive analgesics, injections, psychological interventions and medications, focusing on determining which interventions typically available in a chiropractic, massage therapy or physical therapy clinic have the best evidentiary support.
- Outcome measures evaluated included neck pain, disability, cervical range of motion, activities of daily living, quality of life and time to recovery.
- 2 patient groups were considered – those with acute or recent neck pain, and those with chronic or persistent neck pain.
- This review included only high quality, low risk of bias randomized controlled trials.
Results:
Treatments were administered at a frequency of 2-7 times per week and for durations of 2-12 weeks depending on the type of treatment. Multimodal treatments include additional interventions, such as education, heat/ice, modalities, etc.
So what does this mean?
- Chronic neck pain responds well to multimodal interventions that include varying combinations of manipulation, mobilization, massage and exercise. Some interventions such as mobilization and exercise (consisting of stretching programs and strengthening programs) have good supporting evidence of working on their own.
- The evidence supporting neck manipulation alone for the treatment of chronic neck pain exists, however is not strong. Treatment for chronic neck pain should incorporate multiple treatment options customized to the patient.
- Acute neck pain responds well to multimodal interventions including manipulation and mobilization. There appears to be some evidence for exercise as an intervention alone, however patients seem to recover better when multimodal approaches are used.
- Good evidence was not found in the literature for the use of most physical therapy modalities (ie. ultrasound, laser) as a standalone treatment.
So should I get a massage or an adjustment if my neck hurts?
Well, the short answer appears to be “both“. This isn’t to say that you should be attending MORE appointments per week, but that your treatment sessions should include a variety of interventions that should include manipulation/mobilization, massage therapy, home care AND exercise/stretching instruction. Click here for more information on chiropractic care and massage therapy at MiltonBackDoc.
Is there anything else I should know about this Clinical Practice Guideline?
Not all treatments were able to be assessed by this level of study (systematic reviews of randomized controlled trials). While the quality of the research is excellent, it relies on having large groups of patients to study with common treatments/interventions. This leaves the potential to miss out smaller, more personalized or unique techniques that chiropractors and massage therapists are practicing in the community. In addition, the grouping of all mobilization or massage techniques doesn’t account for the individual variability in practitioner styles or experiences. True evidence informed practice includes the incorporation not only of the best available research evidence, but also the practitioner’s individual experiences and successes.
What this study does tell us is that neck pain should respond to treatment in a period of 2-12 weeks. If you have actively engaged in a multimodal treatment plan for 4-12 weeks and have not seen results, it is likely time to get a second opinion and try another therapy combination or consult your family doctor for further investigation.
