Cervical Pain

Common ICD-9 codes: 723.1, 847.1, 722.0, 721.0, 723.4, 722.4, 724.9, ect.

Neck pain and whiplash-associated disorders (WAD) affect a large number of individuals

(Approximately 12-70% of the population in a given year).

Recently the Bone and Joint Decade 2000-2010 Task Force on Neck Pain (Spine 2008;33[4s]suppl.15:S5-S7) released their findings on treatments for neck pain.

Among the highlights were:

  • Most neck pain becomes chronic and symptoms do not completely resolve
  • Between 50 and 85% of patients will experience neck pain one to five years later
  • Nonsurgical treatments appear to be more beneficial than usual care, sham, or alternative interventions, but none of the active treatments were clearly superior to any other in the short or long term. Manual therapy, mobilization, exercises, low-level laser therapy, educational videos, and perhaps acupuncture appeared to be helpful
  • When choosing treatments to relieve WAD grades I and II neck pain, patients and their clinicians should consider the potential side effects and personal preferences regarding treatment options
  • Neurologic Mechanism, Why manipulation works

    It is established neurologically (Wyke 1985, Kirkalady-Willis and Cassidy 1985) that when a chiropractor adjusts (specific directional spinal manipulation) the joints of the region of pain and/or spasm, that there is a depolarization of the mechanoreceptors that are located in the facet joint capsular ligaments, and that the cycle of pain and/or spasm can be neurologically aborted. This is why many patients feel better after they receive specific joint manipulation from a chiropractor following an episode of increased pain and/or spasm.1

    Simply put: increasing mechanoreception and proprioception (touch and joint motion) inhibits/decreases nociception (PAIN).

    Cervical Manipulation Risk Factors

    When the correct manipulation technique is paired with the appropriately selected patient, spinal manipulation is a very safe procedure. There are relative and absolute contraindications to spinal manipulation that have been identified in the physical medicine literature. The most common side effect experienced by patients receiving spinal manipulation is short-tem soreness in the area of the treatment.

    The most concerning potential complications from spinal manipulation in the cervical spine is vertebral basilar artery injury (VBAI).The reported incidence of VBAI in the literature runs from 1:300,0002 to 1:11,000,000.3

    A history of spinal surgery, osteoporosis, healed fracture, disc herniation without significant or progressive neurologic deficit, scoliosis, chronic arthopathies, degenerative changes, some acute injuries and joint instability are not absolute contraindications to treatment.

    Absolute contraindications: severe or progressive neurologic deficit, infections or malignancies, acute bone demineralization, acute fracture/dislocation and acute arthropathies.

    A contraindication to spinal manipulation in one region of the spine rarely precludes treatment in another region. If techniques cannot be modified to accommodate the patient's condition, manipulation is withheld.

    Treatment

    The Journal of Family Practice published the following guidelines to consider when selecting a chiropractor:

    • Treats mainly musculoskeletal disorders
    • Does not radiograph every patient
    • Willing to be clinically observed
    • Positive feedback from patients
    • Communicates with the referring physician
    • Administers reasonable treatment programs

    We will take great care when adjusting your patient. There are a variety of technical procedures for adjusting the cervical spine, of which we choose the best technique that fits the case presentation. If any cervical pain patients do not respond to the first few treatments, I will let you know. Six to eight adjustments in the first two weeks would not be unusual. This frequency would be rare for a patient in the second month of care.

    References



    1. Wyke, B.D., Articular neurology and manipulative therapy, Aspects of Manipulative Therapy, Churchill Livingstone, 1980, pp.72-77.


    2. Gutmann, G. "Injuries to the vertebral artery caused by manual therapy." Manual Medicine 1983; volume 21.

    3. Hosek, R.S., et al. "Cervical manipulation." JAMA 1981; 245(9).

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