Manipulation of the Cervical Spine
A randomized controlled trial of manipulation of the cervical spine was carried out on 52 patients in general practice, and the results were assessed symptomatically and goniometrically for three weeks. Manipulation produced a significant immediate improvement in symptoms in those with pain or stiffness in the neck, and pain/paraesthesia in the shoulder, and a nearly significant improvement in those with pain/paraesthesia in the arm/hand. Manipulation also produced a significant increase in measured rotation that was maintained for three weeks and an immediate improvement in lateral flexion that was not maintained.
Pain and/or stiffness in the neck or pain referred to the head, shoulder, arm or hand are presentations of common neck disorders. The pathology of these conditions is uncertain and some probable causes are: minor subluxations of intervertebral facet joints, derangements of intervertebral discs with secondary osteoarthritis of the interarticular joints, or meniscoid entrapment in the upper cervical apophyseal joints straining the joint capsule. Manipulation for these conditions is controversial, and this study tries to assess its effectiveness.
Subjects were selected, were assessed by doctors A and B, and were divided into either the treatment or control group. The treatment group was treated by manipulation and/or injection (if the neck was too painful) and was asked to return for further treatment at Dr. A’s discretion. Both groups were treated with axapropazone. They were all instructed not to tell Dr. B whether they had been manipulated or not. Patients then returned to Dr. B who again recorded their symptoms and measured their neck movements via a goniometer.
Results showed that among patients initially affected with a symptom, the proportion showing immediate improvement after manipulation was greater than the corresponding proportion in controls; the difference reached significance for neck pain and neck stiffness and shoulder pain/paraesthesia. Manipulation also produced a highly significant immediate improvement in rotation and lateral flexion. The improved rotation was maintained at one and three weeks, but the lateral flexion improvement did not last. However, more than half the control group experienced improved symptoms despite no measured improvement in movement, confirming clinical impression.
Journal of the Royal College of General Practitioners 1983; 33:574-579.