Harvard Women's Health Watch

Spinal manipulation and exercise trump drugs for neck pain

Most of us experience neck pain at some point in our lives. It can result from an injury or a condition such as cancer or infection, but the most common cause is overuse or misuse of muscles and ligaments. Today's computer-dominated workplace is especially tough on necks, because we sit so long with our shoulders slumped and heads extended toward monitors. People often recover from an episode of neck pain within a year, but relapses are common, and pain may come and go indefinitely.

There are many ways to treat neck pain, including spinal manipulation (for example, spinal or chiropractic adjustment), medications, exercise, massage, acupuncture, and electrotherapy. Despite considerable study of these treatments, results so far have been inconsistent and difficult to compare, and the quality of research has been uneven. Now, a randomized trial comparing three of these therapies has found that spinal manipulation and simple exercises performed at home are more effective than analgesic medications in relieving neck pain. Results were published in the Jan. 3, 2012, issue of Annals of Internal Medicine. Funding for the trial came from the National Institutes of Health's National Center for Complementary and Alternative Medicine.

The study. Researchers at Northwestern Health Services University and the Minneapolis Research Foundation randomly divided 272 women and men with neck pain into three groups, each receiving 12 weeks of spinal manipulation, medication, or home exercise. Spinal-manipulation therapy involved 15- to 20-minute sessions with experienced chiropractors who used various techniques to align spinal joints, including spinal adjustment (a rapid thrust to move the joint) and spinal mobilization (a slower way of moving the joint). The medication group saw physicians and took nonsteroidal anti-inflammatory drugs and acetaminophen, or, if they didn't respond to these over-the-counter medications, narcotic painkillers. Participants in the home-exercise group were instructed on specific neck and shoulder exercises and told to perform them six to eight times a day. (For a list of these exercises, go to www.health.harvard.edu/181.) They were also given advice on avoiding postures and activities that could aggravate their neck pain. All participants reported on their pain during the trial and at six-month and one-year follow-ups.

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