Manipulation, Exercise or Medication for Acute/Subacute Neck Pain

To kick the year off, there was an article published in the Annals of Internal Medicine journal on January 3, 2012 that was picked up by the New York Times that looked at the efficacy of spinal manipulation, home exercise and medication on acute and subacute neck pain in the short and long term. So here are the results from that study.

It was a randomised controlled study of 272 people between 18-65 years old. who had non specific neck pain of 2-12 weeks duration.
Those 272 people were then split up randomly into 3 different groups, those being treated with spinal manipulation, those being treated with home exercises and those being treated by medication.
  • Those in the spinal manipulation group received adjustments to the neck and thoracic (middle back) over a 12 week period.
  • Those in the medication group received non-steroidal anti inflammatories as a first line intervention, if these failed or the participate couldn’t tolerate them they were prescribed narcotic drugs and muscle relaxants.
  • Those in the home exercise group received two one hour sessions spread over 2 weeks, one on one and were instructed to perform a certain set of tailored exercises at 5-10 repetitions 6-8 times per day.
The results were as follows:
For pain relief spinal manipulation had a statistically significant advantage over medication at 8, 12, 26 and 52 weeks. By 12 weeks 57% of people reported a 75% reduction in pain and by 52 weeks 53% of people still reported a 75% reduction in pain.
Home exercises were also superior to medication at 26 weeks. By 12 weeks 48% of people reported a 75% reduction in pain.
Only 33% of the medication group had experienced a 75% reduction in pain by 12 weeks, and by 52 weeks only 38% had a 75% reduction in pain.
One concern that did arise out of the study, as commented on by one of the leading authors Dr. Bronfort, “the people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later.”
If you have acute or subacute non specific neck pain, spinal manipulation and exercises should be part of your first line intervention.
To read the article in full it can be found here Annals