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Manual Therapy Eases Neck Pain, Cheaply

Hands-On Approach Effective, and More Cost-Effective, than Traditional Treatments


Korthals says they were surprised to find that manual therapy was associated with lower direct and indirect costs because manual therapy is often more expensive than other treatments in the Netherlands. But the major cost-saving factor was that the patients in this group recovered quicker and were happy with the results.

George B. McClelland, DC, spokesman for the American Chiropractic Association, says the type of spinal mobilization used in this study did not involve the high velocity, low amplitude (HVLA) techniques frequently used by chiropractors in the U.S.

"But the mobilization description in the study falls well within the adjustment procedures used by chiropractors," McClelland tells WebMD. "The key here is working the joints through the range of motion but not taking it to the level that brings about an audible sound, or the cracking or popping sound typically associated with HVLA."

The researchers say the type of manual therapy used in the study is also practiced by physical therapists, but the physical therapists in the study were not allowed to include these techniques in their treatment.

"What the patient should understand is that the health care provider -- whether it's a physical therapist, chiropractor, or whomever -- will be able to enable them to get their pain down more quickly with manual therapy than compared to classical approaches with physical therapy or a family practitioner," says McClelland.

Joel Posner, MD, professor of gerontologic research, medicine and public health at Drexel University College of Medicine in Philadelphia, says no one study is going to answer all the questions about manual therapy.

But Posner says these findings show that regardless of cost there is no loss of effectiveness in using manual therapy to treat neck pain, and there seems to be something to gain in terms of making patients feel better sooner.

"Studies like this provide a lesson to all of us in more classical medicine of a willingness to explore techniques that we were never taught in medical school," says Posner. "This is a cautionary tale that we need to broaden our horizons, and there is a danger as physicians if we don't because it throws effective therapies in the hands of others who may also include more dangerous ones."

Posner says people with neck pain who seek relief from manual therapy should look for a qualified professional, if possible one recommended by their health care provider. And if the person who's performing the therapy is not doing slow, steady manipulations on the neck, but is forcing movements or doing short quick manipulations, they should discontinue the therapy.


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