This study clearly shows the superiority of chiropractic spinal manipulation over pharmacologic management of patients suffering from acute and subacute neck pain. However, the findings that chiropractic spinal manipulation and home exercise with advice (HEA) achieved similar results on these patients requires discussion.
The printed words in the article suggest that chiropractic spinal adjusting and home exercise/advice are essentially equal in the management of acute and subacute neck pain. Yet, a careful review of the measured markers presented in the article show that chiropractic adjustments were nearly always superior to those from home exercise/advice. As examples, nine markers are listed for “Portion With Absolute Reduction In Pain”: spinal adjusting was superior in 8 of 9 of the listed markers. Six markers are listed for “Pain Score”: spinal adjusting was superior in 5 of the 6 markers listed.
Additionally, a careful review of the charts presented in the article show that during the randomization, nearly twice as many of the chiropractic group (29.7%) had trauma initiated neck pain compared to the home exercise/advice group (16.5%). Trauma triggered neck pain is always more difficult to manage in both the short and long term as compared to non-trauma triggered neck pain. It appears that the chiropractors had a “tougher” patient draw as compared to the home exercise /advice group. This finding was not discussed in the text of the article.
Although the article states several times that the chiropractic adjustments were given over a period of 12 weeks, the actual range of adjustments was 2-23 with a mean of 15.3. This is slightly more than 1 adjustment per week for 12 weeks. In contrast, the home exercise/advice group was seen only 1 or 2 times, but instructed to do neck exercises at home daily. The exercises consisted of 7 isolated maneuvers that required 3 different positions: sitting, supine head supported, and supine head unsupported. Each maneuver required 10 repetitions, and the patient was instructed to repeat all of the maneuvers 6-8 times per day. Performing the exercise maneuvers as prescribed takes approximately 10 minutes per session. As such, the authors are advocating that patients with acute/subacute neck pain exercise 60-80 minutes per day. This is both impractical and unrealistic.