Chiropractic Care for Neck Pain

Chiropractic offers a treatment option for neck (cervical) pain that is utilized by millions of patients. Chiropractors are doctors who specialize in the care of non-surgical conditions of the neck with gentle, time-saving approaches that address the mechanical (how the spine moves) and neurological (nerve-related) causes of neck pain.

Why Consult a Chiropractor
Chiropractors are rigorously trained to diagnosis the different types of neck conditions and to then recommend specific treatment approaches for those conditions.

Chiropractors are specialists in spinal manipulation—an active, hands-on care that returns motion to the spine. With a return of normal spinal mechanics, muscles relax and pain is resolved. Restricted spinal motion—meaning that the spine doesn't move as easily as it should—can cause neck pain.

Chiropractic has developed a number of treatment approaches in addition to traditional spinal adjustments. These treatment approaches help chiropractors to address a wide range of neck pain conditions.

Neck conditions that respond to chiropractic care include:

• cervical sprain injuries
• spinal joint restriction syndromes
• facet joint sprain
• "whiplash" sprain injuries
• cervical disc injuries that don't require surgery
• acute torticollis (when the neck muscles stay contracted and can actually cause the neck to stay in a twisted position) and stiff neck
• degenerative joint syndrome of the neck
• various types of chronic neck pain

Before deciding which approach or approaches to try for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your pain.

How a Chiropractor Diagnoses Neck Pain
Even if you go to the chiropractor complaining of neck pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It's important to examine the entire spine because even though it's just your neck that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation, diagnostic techniques unique to chiropractic. Motion and static palpation is an examination by means of touch. The chiropractor will feel for tenderness, tightness, and how well each spinal joint moves. (You can read a more in-depth article on motion and static palpation here.)

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

You'll also go through your past medical history with the chiropractor, in addition to having a complete physical. Your chiropractor may order imaging tests (e.g., x-rays or MRIs) to help him or her diagnose the exact cause of your neck pain.

All these steps in the diagnostic process will give your chiropractor more information about your neck pain. The examination will enable your chiropractor to create an effective treatment plan.

Possible Chiropractic Treatment Approaches for Neck Pain
The exact treatment plan depends on your diagnosis. Your chiropractor may use a combination of spinal manipulation, manual techniques, and therapy instruments.

A brief note about spinal manipulation: Spinal manipulation is a safe approach to treating neck pain. A recent review of literature addressing the question of the relationship between spinal manipulation and stroke concluded that manipulation was not a significant factor in causing strokes (1).

Some spinal manipulation techniques are:

• specific spinal manipulation: The chiropractor identifies the joints that are restricted or show abnormal motion (also known as subluxations) and returns motion to the joint with a gentle thrusting technique. This gentle thrusting rapidly stretches soft tissue and stimulates the nervous system to return normal motion to the spine. This technique is good for cervical joint restrictions and movement abnormalities.
• flexion-distraction technique: This is a gentle, non-thrusting type of manipulation used to treat bulging or herniated discs. However, before deciding to treat a cervical disc injury, a chiropractor will first rule out a surgical problem—if he or she believes the problem is better treated by surgery, then you'll be referred to a surgeon.
  
  Flexion-distraction is still hands-on, utilizing a specialized table to assist the chiropractor, but uses a pumping action on the disc instead of direct force.
• instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

The chiropractor may also use manual therapy to treat injured soft tissues such as ligaments and muscles. Some examples of manual therapies are:

• trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. Then he or she puts direct pressure (using the fingers) on these points to relieve the tension.
• manual joint stretching and resistance techniques
• therapeutic massage
• instrument-assisted soft tissue therapy: The chiropractor uses special instruments to diagnose and treat areas of dysfunction (also called restrictions) in the muscles. He or she will perform repeated strokes of the instrument over the area(s) of restriction.

In addition to spinal manipulation and manual techniques, the chiropractor may use various instruments to treat muscle inflammation. These modalities are used to relax the muscles. Some examples are:

• ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.
• inferential electrical stimulation: This uses a low frequency electrical current to stimulate your muscles.

To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.

How Chiropractic Helps Patients with Neck Pain
A chiropractor may help you return to your normal activities quickly so that you can enjoy your daily life without pain. He or she will work to address the underlying mechanical (how the spine moves) or neurological (nerve-related) causes of your neck pain.

Prevention and Whole Person Care
Chiropractors are "whole person" doctors who view neck pain as unique to each patient. Therefore, they don't focus on just your neck pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to neck pain, so you need to address them if you really want to relieve your pain).

Prevention is integral to long-term health, and chiropractors strongly emphasize it. If you can learn how to prevent neck pain by using good mechanics and maintaining good posture, you'll be doing your body a favor that will last for years. This focus on prevention and self-care is another example of how chiropractors look at the whole person, not just at the pain.

Reference

1. Cassidy J, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver F, Bondy S. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Spine. 2008;33(4S): S176-S183.