Research for neck pain

Integrating Chiropractors

Today we’re going to talking with Dr. William Lawson from Austin, TX about research for neck pain and what research is available for it. While low back gets all of the attention in the research, neck pain has taken a back seat but not today!

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast because I’m the only one that’ll do it.  

Have you taken the time to go to chiropracticforward.com and sign up for our newsletter? It’s important because doing that makes it easier to let you know when the newest episode goes live and we have a ton of ideas around here for the future and we want to be able to let you know about it. An email once per week isn’t going to make you crazy so please go do that so we’re on the same page.  

I also want to let you know about our Facebook page AND our separate Facebook group because they’re important supplements to the podcast. Both are called Chiropractic Forward oddly enough. On the page, we let you all know when a new episode goes live and we share some quotes from the episodes. Through the private Facebook group, we share the papers we went over and lots of time we connect and discuss there so go join up and let’s connect.

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have done the mashed potato all James Brown, 60’s style into Episode #41. You know what that means? It means it’s going to be cooler than usual episode. 

Dr. William Lawson, Austin, TX

That’s because, as I mentioned before, we have a guest with us. Dr. William Lawson hails from Austin, TX and has his Diplomate of American Chiropractic Orthopedists designation. Yes, ladies and gentleman, I brought another DACO to you today. Last week, we had Dr. Brandon Steele, also a DACO, so you may be starting to notice a slight trend. We are going to get into the thick of things with research for neck pain.

I met Dr. Lawson through his involvement in the Texas Chiropractic Association. Dr. Lawson is responsible for getting the DACO program to come to Texas and for having the TCA host the program. He’s responsible in a roundabout way for getting me into this whole DACO mess and I thank him for it. 

A little more about Dr. Lawson

  • Prior to attending Parker College of Chiropractic in Dallas, -Texas, I served in the United States Air Force.
  • Graduated from Parker College of Chiropractic 1993.
  • Designated Doctor with Tx Workers Compensation since 1996
  • He has the Diplomate American Academy of Integrative Medicine, college of pain management, 2000.
  • Dr. Lawson acheived Diplomate American Academy of Pain Management 2001.
  • Diplomate American Board of Chiropractic Orthopedists, 2002
  • Certified in acupuncture, 2004
  • Former hospital privileges Vista Hospital Houston and Pecan Valley Surgical Center in San Antonio.
  • Masters degree from UT Pan American in Health Care Administration, 2015
  • Current Chair of State Affairs with TCA
  • Current VP of Texas Council of Chiropractic Orthopedists.

Welcome to the show Dr. Lawson. Since we are friends, formality seems awkward, if you call me Jeff, I’ll call you what? William or Bill? 

Questions for Dr. Lawson

When did you become a DACO and what was the impetus? What started that journey?

What have you noticed about yourself and about your business in regards to pre-DACO and post-DACO?

Let’s get into the research for neck pain. The first thing I want to say here is that we cannot talk about cervical manipulation without addressing the yoke the medical field has tried to lay on us for generations. That is the myth that chiropractors go around causing strokes in everyone all the time. 

I took three episodes of this podcast to address this myth. The series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes” and are specifically episodes #13, #14, and #15. It’s just common sense talk and, if you have any questions in your mind prior to listening to them, they should all be answered by the time you are done. 

I will link them in the show notes as well as the corresponding YouTube Video and the Blog so that you can get the information in your preferred method. 

PODCAST EPISODES:

BLOG:

YOUTUBE:

https://youtu.be/tRXpG_Ie0Rs

Now that we’ve addressed this craziness, we can get on with how well we take care of our neck pain patients. 

Dr. Lawson, I want to hear from you as much as you want to be heard from so, please….if I cover something that you have some extra info on or you just want to add a comment to, please interrupt me and lay it on us!!

We’ll start with the oldest one we have tee-d up here and go to the most recent. 

This first one is from 2001 and is called “A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain[1].” The lead author is G. Bronfort and, if I recall correctly, his full first name is Gert. If you’ve spent any time listening to our podcast, you’ve probably heard his name. He’s fairly prolific with research papers. 

Why They Did It

Their stated goal for this project was to compare the effectiveness of rehab exercises vs. spinal manipulation for chronic neck pain. This one really focuses on research for neck pain.

What They Found

  • Patient satisfaction was higher spinal manipulation + exercise was superior to spinal manipulation alone
  • There was no statistical difference noted between the two groups
  • However, when combined, exercise + manipulation showed greater gains in all measures of strength, endurance, and range of motion. 

Wrap It Up

The authors concluded, “For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone.”

Dr. Lawson, what’s your take on this study? At this point, it’s 17 years old. Is it relevant still and how?

Next paper, this one’s called, “Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials[2].” It is by H. Vernon, et. al. and was published in the Journal of Manipulative Physiological Therapeutics in 2007. 

Why They Did It

This was a systematic analysis of effectiveness in randomized clinical trials of chronic neck pain. The stipulations here are that the neck pain could not be caused by whiplash and could not include a headache or arm pain. Just straight up chronic neck pain. 

What They Found

Out of 1980 papers, they found 16 to accept and include in this project. 

No trials included trigger point therapy or manual traction

Wrap It Up

“There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks post-treatment. The current evidence does not support a similar level of benefit from massage.”

Dr. Lawson, on this study, for those that don’t know research hierarchy, a randomized clinical trial is some of the more reliable, solid research for neck pain wouldn’t you agree?

The only thing more impactful in the research world than randomized clinical trials are meta-analyses and systematic reviews. Well, this is a systematic review of 16 randomized clinical trials. 

My point being: this is a reliable systematic review. No doubt about it. This is a great paper, Dr. Lawson and I have no idea how it’s escaped me 11 years into this thing. I have other papers by the same group of authors but somehow missed this research for neck pain?

Would you like to add any comments on this paper?

OK, moving on, this paper is called, “Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial[3].” This one comes to us by G. Bronfort, et. al. as well and was published in the Annals of Internal Medicine in 2012. 

This is not my favorite research for neck pain as we’ll talk about after we go through the conclusion. 

Why They Did It

“To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.”

How They Did It

  • It was a randomized controlled trial
  • They used 1 university research center and 1 pain management clinic in Minnesota
  • The sample was 272 people from 18-65 years old having nonspecific neck pain from 2-12 weeks
  • The treatment consisted of 12 weeks of spinal manipulative therapy or home exercise advice. 

What They Found

For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks

Home exercise was superior to medication at 26 weeks

No important differences in pain were found between SMT and HEA at any time point

Wrap It Up

Bronfort concluded, “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.”

As I mentioned, I have covered this research for neck pain before but it’s not my favorite because this is also a paper that I have seen chiropractic detractors use against us. Here’s how: they say that cervical manipulation is extremely risky and, if the outcome of simple exercises at home is just as effective, then what’s the point in cervical manipulation for neck pain?

What would you say in response to this particular argument?

Keepin on keepin on here. This next one is from the Journal of Manipulative Physiological and Therapeutics back in 2014 called “Evidence-based guidelines for the chiropractic treatment of adults with neck pain[4].” This one was done by Bryans, et. al. 

Why They Did It

They wanted to develop evidence-based treatment recommendations for the treatment of nonspecific mechanical neck pain in adults. 

How They Did It

They did a systematic literature search of controlled clinical trials published through December of 2011 and then organized each into strong, moderate, weak, or conflicting)

What They Found

41 randomized controlled trials met the criteria for inclusion. 

Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise combined with modalities. 

Strong recommendations were also made for treating chronic neck pain with stretching, strengthening, and endurance exercises alone. 

Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. 

Wrap It Up

The authors closed by saying, “Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”

Do you feel like this is going a little more in our favor than the Bronfort paper but still leaves a little to be desired? For instance, when we look at low back pain papers, it’s clear. Spinal manipulation is as effective or more effective than anything else out there. Even physical therapy or exercise. We’re not getting that satisfaction so far. Am I wrong?

We’re trucking along here. Next paper titled “Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial[5].” This one was published in European Journal of Physical Rehabilitation Medicine in 2015 and written by A. Lopez-Lopez, et. al. 

Here’s my first question: “Why would you hyphenate the same name?” How can you be Lopez-Lopez and why would you want to say the name twice or make everyone else say the name twice? Isn’t it a bit redundant? Can we just say Lopez and move on?

OK, I get side-tracked sometimes so I have to get myself back on track here and there. Since I’m not familiar with this paper or the authors at all, I want to switch it up a little on this one. 

Dr. Lawson Covers One

I want Dr. Lawson to go over this paper from top to bottom and tell us everything we need to know about this one. I see it’s a randomized controlled trial so it already has my attention. I’m unfamiliar with sustain natural glide (AKA SNAG). Is that term you are familiar with? This research for neck pain is all yours doc. 

Their conclusion was “The results suggest that high velocity/low amplitude and posterior to anterior mobilization groups relieved pain at rest more than SNAG in patients with neck pain.”

Let’s get to our last paper here by Korthalis-de-bos, et. al. It’s called “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial[6].” It was published in the British Medical Journal back in 2003. 

Why They Did It

The authors wanted to evaluate the cost-effectiveness of physical therapy, manual therapy, and care by a general practitioner for patients with neck pain.

How They Did It

  • The project was an economic evaluation alongside a randomized controlled trial.
  • 42 general practitioners recruited 183 neck pain patients
  • The patients were randomly split for treatment by spinal mobilization, physical therapy, or general practitioner care. 

What They Found

The authors wrapped that research for neck pain up by saying, “Manual therapy which consisted of spinal mobilization, is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

I wanted to wrap up our talk with that research for neck pain because, first of all, it’s from the British Medical Journal so it got some weight. Second it’s alongside randomized controlled trials, and third, it’s one of the main ones that cuts through the noise and says very clearly, “mobilizing the spine is more effective and cost less for neck pain than seeing your primary or a physical therapist.”

Is it just me or is it time to move focus from low back pain and put more effort an attention on how effectively we treat neck pain through research for neck pain?

It just makes complete sense to me. If we are so effective for low back pain in the eyes of researchers, why don’t we have the same pile of research for neck pain? Where is all of the research for neck pain? Both are mechanical in origin. If we can affect low back pain, it makes perfect sense that we can affect neck pain. 

Chiropractors see it every single day. I’m not telling you anything. I just get so frustrated at the lack of focus on neck pain, which is part of the reason we’re doing this podcast today. 

Dr. Lawson, what do you have to add here before we sign off?

I want to thank you for joining us on the Chiropractic Forward Podcast. I hope you’ve enjoyed it as much as I have. 

Maybe we talk some DC PhD’s out there into making neck pain their next project. 

Integrating Chiropractors

 

Going forward

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research on neck pain and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact Us

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

https://www.chiropracticforward.com

Social Media Links

https://www.facebook.com/groups/1938461399501889/

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About the author:

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography

1. Bronfort G, A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine (Phila Pa 1976), 2001. 26(7): p. 788-97.

2. Vernon H, H.B., Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther, 2007. 30(6): p. 473-8.

3. Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.

4. Bryans R, Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther, 2014. 37(1): p. 42-63.

5. Lopez-Lopez A, Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med, 2015. 51(2): p. 121-32.

6. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.

 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 030: Integrating Chiropractors – What’s It Going To Take?

CF 020: Chiropractic Evolution or Extinction?

CF 039: Communicating Chiropractic

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