Fortunately chiropractic doctors specialize in the care of the spine and get a great deal of training on the neck. We are trained how to find problems there and how to care for them with methods tailored to the neck.

Inside we review a landmark study, seven years in the making and some 220 pages long, that looked at all remedies for neck pain found in the literature. For the vast majority of people with neck pain, it found that neck adjustments (manipulation or mobilization) are safe, effective, and appropriate.

Importantly they conducted new research on the safety of chiropractic care for neck pain and found the risks of medical care are equal to or higher than the risks of chiropractic care. Check out the details inside.

If your neck hurts call us. We can help.

The respected journal Spine recently published the most comprehensive report on neck pain ever developed.

The 220-page report was seven years in the making by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders,1 which was an initiative of the United Nations and the World Health Organization. This multidisciplinary task force was led by a neurologist, who is both a medical and chiropractic doctor, and involved the work of more than 50 renowned researchers from 9 countries and 19 different disciplines. There were medical doctors, chiropractic doctors, PhD researchers, and many with multiple degrees who analyzed over 1000 studies and did new original research as well. Their report offers the most current, expert, and authoritative perspective on neck pain available and will affect the way neck pain is handled worldwide.

One of the key findings is that manipulation and mobilization are safe, effective and appropriate treatment approaches for most patients with disabling neck pain (grades 1 and 2 – see below).2 Another key finding, resulting from the new research the Task Force did, was that they could find no evidence of any increased risk of stroke associated with chiropractic adjustments to the neck compared to medical care. There had been some previous reports that suggested chiropractic care of the neck caused an increased risk of a very rare type of stroke but this new study refutes that convincingly. (See adjoining article at far right)

Neck pain alone (without disability) was reported in anywhere from 12% to 71% of the population. If you add disability the number drops to estimates from 1.7% to 11.5% of the whole population in any year. From 11% to 14.1% of workers reported activities limited by neck pain each year.3 That is an enormous number of people. Perhaps you are one. If not you likely know someone who suffers with neck pain.

You can’t do anything about some risk factors for neck pain. Your risk is higher if neck pain runs in your family (genetics), if you are older (age) and if you are female (gender). Then there are car accidents and other blows to the body that can cause neck pain and whiplash injuries are typical of these. You may not be able to prevent accidents but you may be able to lower risk of neck injury by, for instance, making sure your car headrest is centered on your head and not too far back. Then there are risks that you can certainly do something about. Smoking and exposure to second hand smoke both increased risk.4

Risks in the workplace were listed as things that could be changed too but despite this they found no workplace interventions that reduced the number of workers with neck pain. Still these workplace risks included repetitive and precision work, high quantity job demands, sedentary work position, poor workstation design and work posture, low physical capacity, job insecurity, and low social support at work.5

Perhaps the most surprising finding was that they found no increased risk of neck pain from common degenerative changes in the cervical spine6 (the neck). This might include things like bone spurs that sometimes grow on the spine as you age or other bone changes like narrowing of openings (stenosis) or discs degeneration. These changes often show up on x-rays and other imaging scans but they found no evidence that they were associated with neck pain. In the past such degenerative changes have been prime suspects as the cause of neck pain and were often the target of surgery and injections as a result but the task force found no basis for this.

They graded neck pain into four levels. Grade 4 problems are serious but also relatively rare and so these are specifically absent in grades 1 through 3.

• Grade 1 has only minor interferences with activities of daily living if any at all. You have neck pain but can still function.
• Grade 2 causes major interference with daily living. You need pain relief and professional help to prevent long-term disability.
• Grade 3 adds to the pain and disability of grade 2 with signs of nerve involvement, like muscle weakness, and decreased deep tendon reflexes. Because the nerve root at the spine may be affected symptoms may show up in an extremity that the nerve serves, perhaps causing pain or weakness in your arm (called radiculopathy).
• Grade 4 is the most severe level where there are signs of major structural problems like bone fractures, damage to the spinal cord itself, tumors, or widespread disease. This grade is very uncommon and if you were not already at an emergency room or trauma center, you would be referred to a medical specialist.

Grades 1 and 2 account for the vast majority of all neck pain patients. They found that effective care included manipulation (which includes chiropractic adjustments), mobilization, massage, exercise, education, acupuncture, analgesics (pain medications) and low-level laser therapy.7 They found that patient expectations for any of these were important. If you expect good results it helps. They also found the most effective of these focused on regaining function. Chiropractic care usually involves a mixture of these especially using adjustments, massage, mobilization, exercise, and education and our focus is always on restoring function. So chiropractic care fits ideally within the recommendations of this Task Force.

Treatments that they found unlikely to help and not supported by the evidence for grades 1 and 2 included surgery, most injection therapies (including steroid injections into the facet joints), collars, ultrasound, electrical muscle stimulation, transcutaneous electrical nerve stimulation (TENS) or radio-frequency treatments (neurotomy).8

Grade 3 neck pain is so uncommon9 compared to grades 1 and 2 that there is much less research on this type of neck pain. There is so little research on non-surgical interventions that they made no comment specifically for or against chiropractic care for grade 3. They found steroid injections may offer short-term relief of radiculopathy but had no long-term benefit nor did they reduce rates of surgery. For persistent radiculopathy they found surgery offered short-term benefits but they found no evidence of long-term improvement with surgery. They suggested surgery be used cautiously after trials of conservative care.10 Chiropractic care would be a good choice for conservative care prior to considering surgery. Indeed, in a recent study, 27 patients with neck pain and spinal cord compression in the neck confirmed on MRI (magnetic resonance imaging) received an average 12 visits of chiropractic care. They averaged improvements of 70% in pain and disability11 and they all avoided surgery.

If you are a rare case that comes to us with grade 4 neck pain, we will refer you to a specialist who can help you. But for the other three grades of neck pain, chiropractic care may be your best choice.

1. S. Haldeman, et al., “The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary,” February 15, 2008, Spine, Vol. 33, No. 4S.
2. D. Chapman-Smith, “BJD Neck Pain Task Force Report,” March 2008, The Chiropractic Report, Harmony Printing Ltd., Toronto, Vol. 22, No. 2, p. 1
3. S. Haldeman, Op. Cit., p. S5.
4. Ibid.
5. P. Cote, et al., “The Burden & Determinants of Neck Pain in Workers: Results of the Bone & Joint Decade 2000-2010 Task Force on Neck pain and Its Associated Disorders,” February 15, 2008, Spine, Vol. 33 No. 4S, p. S60.
6. S. Haldeman, Op. Cit., p. S5.
7. D. Chapman Smith, Op. Cit., p. 6.
8. Ibid.
9. One estimate found grade 3 with disc herniation and radiculopathy occurs only once per year in 18,181 persons. S. Hogg-Johnson, et al., The Burden & Determinants of Neck Pain in the General Population: Results of the Bone & Joint Decade 2000-2010 Task Force on Neck pain and Its Associated Disorders,” February 15, 2008, Spine, Vol. 33 No. 4S, p. S39.
10. D. Chapman Smith, Op. Cit., p. 7.
11. D. Murphy, et al., “Manipulation in the Presence of Cervical Spinal Cord Compression: A Case Series,” 2006, Journal of Manipulative and Physiological Therapeutics, Vol. 29, pp. 236-244 (as reported by D. Chapman Smith, Ibid., p. 8).

Perhaps the most important finding of the Task Force on Neck Pain, (See main article) was that chiropractic care to the neck is no more risky than traditional medical care.

and does not cause a very rare type of stroke called vertebrobasilar artery (VBA) stroke where an artery in the neck tears or ruptures. Even though these are extremely rare compared to more typical strokes that occur in the heart or brain, there were some past studies that suggested these VBA strokes were more likely after chiropractic adjustments to the neck (but they never asked if they are also more likely after seeing a medical doctor). Even a rare stroke is one too many and so there has been some very negative publicity, even billboards in a few states, claiming chiropractic care can injure you as a result. The Task Force published two new studies that clearly refute this.

The first study looked at ten years (1993 to 2002) for all VBA strokes admitted to Ontario hospitals. There were only 818 of these rare strokes (from any cause) over the ten years among 10 million persons.1 They compared these cases against four matched controls for each case. They found that for stroke victims under age 45, the risk of these rare strokes was about three times higher no matter if they saw a primary care provider or a chiropractic doctor compared to the controls.2 For persons older than 45 years, their risk was only greater after visiting a primary care provider. There was no increased risk after seeing a chiropractic doctor for the older folks.3

The study showed that people about to have this rare type of stroke often get neck pain or headache first and seek professional help. The key is that the stroke is already developing or underway. Neither sort of doctor is the cause of it. So they concluded, “We found no evidence of excess risk of VBA stroke associated (with) chiropractic care compared to primary care.”4 (emphasis ours)

A rare person who had their neck adjusted before this kind of stroke might jump to the conclusion that the adjustment caused it because the adjustment is a hands on movement of the neck. Medication prescribed by a medical doctor before their stroke might not seem to be as connected. In fact neither is the cause. Certainly these strokes are rare and hard to detect, and unlikely to be spotted by either kind of doctor, but if anything this study shows their association is higher with primary care providers for those over 45.

In the second study they found that while still rare, the incidence of VBA stroke rose dramatically in Saskatchewan and substantially in Ontario in the year 2000 but the rate of chiropractic utilization did not increase significantly in either place during that year. Again they concluded, “VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.”5

There will still be some people who don’t hear about these studies that will probably still claim adjustments to the neck are risky. It is simply not true according to this; the most current and prestigious research available.

1. D. Cassidy, et al., “Risk of Vertebrobasilar Artery Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study,” February 15, 2008, Spine, Vol. 33, No. 4S, pp. 176-183. (8.18 per million persons in any year).
2. Ibid.
3. Ibid.
4. Ibid., p. 176.
5. E. Boyle, et al., “Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces,” February 15, 2008, Spine, Vol. 33, No. 4S, pp. 170-175.

Men or women who had ever been regular tea drinkers were found in a recent study to have a 30% lower risk of developing the two most common forms of skin cancers (squamous cell or basal cell carcinoma). Lifetime tea drinkers showed even stronger protection.1 Even a couple of cups a day offered some protection, so here is just one more reason to drink tea daily.

1. May 2007, Journal of the American Academy of Dermatology (as reported by B. Sutton, “DC On-Line”, August 27, 2007, Dynamic Chiropractic, Vol. 25, No. 18, p. 34).

Dextromethorphan is supposed to be a cough suppressant and is widely found in over the counter cough and cold remedies but it may not do much good. A recent study on children’s nighttime cough and sleep quality during upper respiratory infections compared a honey flavored cough syrup containing Dextromethorphan (DM) against a similar sized dose of just honey, or nothing at all. Cough frequency and severity were considered along with sleep quality for both the child and the parent. They found “honey was the most effective treatment for all of the outcomes related to cough, child sleep, and parent sleep.”1 (emphasis ours) Even though the raw scores for DM was slightly better than nothing, they found “DM was not significantly better than no treatment for any study outcome.”2

It is good for parents to know there are better options than over the counter drugs for coughs. We must caution however that infants less than a year old should not be given honey, as their digestive systems are not yet able to handle botulism bacteria occasionally found in honey that is harmless for older children and adults with stronger stomach acid.

1. I. Paul, et al., “Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents,” December 2007, Archives of Pediatric & Adolescent Medicine, Vol. 161, No. 12, p. 1143, http://archpedi.ama-assn.org/cgi/reprint/161/12/1140 (as also reported by B. Sutton, “DC Online,” January 29, 2008, Dynamic Chiropractic, Vol. 26, No. 3, p. 24).
2. Ibid.