Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such sports injuries, car accidents, or simply sleeping in an awkward position, the vast majority of the time, no direct cause can be identified and thus the term “nonspecific” is used to categorize the neck pain. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck-related symptoms are most likely to respond to chiropractic care before the treatment has started? This issue has been investigated with very favorable results!
The ability to predict a favorable response to treatment has been termed “clinical prediction rules,” which in general are usually made up of combinations of things the patient says and findings from exams. In a large study, researchers analyzed data from about 20,000 patients receiving about 29,000 treatments to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any four of these seven presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder / arm pain; 3. Reduced neck, shoulder, or arm movement; 4. Stiffness; 5. Headaches; 6. Upper/mid-back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness, and light-headedness” in 4-12% of the patients. The “take-home” message here is that it’s far more common to see a favorable response (70-95%) in patients with neck pain than an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.
So, what do chiropractors do when a patient presents with neck pain? First, after gathering preliminary information such as name, address, and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature, and respiration), palpation, range of motion, and both an orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list of treatment options may include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Physical therapy modalities; 3. Posture correction exercises and other exercises/home self-administered therapies; 4. Education about job modifications; 5. Co-management with other healthcare providers if/when needed.
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