Figure 1. (side view) The neck region is called the cervical spine. Protected within the bones of the cervical spine are the spinal cord and nerves. The seven cervical bones (vertebrae) are numbered C1 to C7. Each bone is separated and cushioned by shock-absorbing discs. The spinal nerves pass through bony canals to branch out to the neck and arms.
Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief than a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.[115] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.[116] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[117] limited to low level evidence supporting chiropractic management of shoulder pain[118] and limited or fair evidence supporting chiropractic management of leg conditions.[119]
Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered.[101] There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathy[102] and acute lumbar disc herniation with associated radiculopathy.[103] There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.[102]
A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[158] Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."[158]
Doctors who treat neck pain can include general medicine physicians, including family medicine doctors and internists, as well as orthopedists, rheumatologists, neurosurgeons, neurologists, ENT specialists, emergency physicians, physiatrists, and chiropractors. Other ancillary health professionals who treat neck pain include physical therapists, massage therapists, and acupuncturists.
Generally, you can expect to fill out paperwork or a questionnaire explaining your health history, reason for your visit, surgical and family history, any pain you are feeling or any previous injuries you may have. At my appointment, there was a case manager that came in to explain who I would be meeting with and how the appointment would go. This made me much more comfortable about the whole process—I actually felt at ease and excited to keep working through the next steps! Here is an example of the type of forms you will be asked to fill out.
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