When a patient comes into a chiropractic office complaining of non-incapacitating, non-traumatic neck pain, there are three things the doctor of chiropractic (DC) should always remember:
1) Chances are good this isn’t the first time the patient has experienced this pain.
2) Chances are even better it won’t be the last.
3) If it’s just a stiff neck, and not seriously incapacitating or due to recent severe trauma, it’s likely to get better on its own in about three days. With treatment, however, it’s likely to get better in about … 72 hours.
“It’s often a self-limiting problem,” says Pete Fernandez DC, a Seminole, Fla., doctor of chiropractic, practice consultant, and the author of 20 books, including Neck Pain, Neck Pain, You Don’t Want It, You Don’t Need It. “I’m sure this will cause a stir, but I’ve found that a much easier way of treating this problem (torticollis)—a way that makes the patients happy and doesn’t hurt them—is, don’t treat it.”
Neck pain remains one of the most widely suffered maladies of modern life. Depending on the definition of just what constitutes “neck pain,” up to an estimated 71.5 percent of the general population will experience the problem in a given year. For most, it will not seriously affect their normal routines.
A New Model
“You’re not helpless,” assures Dr. Scott Haldeman, clinical professor in the Department of Neurology at the University of California at Irvine and adjunct professor in the Department of Epidemiology at the University of California at Los Angeles. “You just have to realize that you have limitations, and then treat patients with neck pain according to the most current clinical guidelines and teach them how to reduce their pain through proper lifestyle steps. There’s a lot you can do. But you have to change the classically-taught decision-making paradigm on how to manage neck pain.”
Dr. Haldeman is uniquely qualified to speak to this issue. He is both a medical doctor and a doctor of chiropractic. He suggests the best first step for any health care provider who sees patients with neck pain is to spend time reading the results of the Neck Pain Task Force. “This is where every spine-care clinician should start his or her search on what to do,” says Dr. Haldeman, who chaired the task force.
The task force, a multinational, multimilliondollar venture sponsored by the United Nations/ World Health Organization Decade of the Bone and Joint Initiative, met for eight years, 2002-2010, reviewed more than 1,200 scientific articles and conducted original research projects. The results were published in three peer-reviewed journals: European Spine Journal, Journal of Manipulative and Physiological Therapeutics and Spine.
“It’s the most widely published task force on any spinal condition, ever,” Dr. Haldeman says. “Wherever you go after that, the first thing you realize is that we’re dealing with a new model of neck pain. Much of what all of us learned about neck pain, we can throw out the window. We must realize that it’s not a curable disease. It’s a chronic recurring condition.”
Once a patient presents with neck pain, it’s crucial to screen for serious pathology, Dr. Haldeman says. He agrees with Dr. Fernandez that for minor neck pain—a simple stiff neck, such as seen in torticollis— most people get better in a few days without treatment, though manipulation, anti-inflammatories and possibly acupuncture can bring some pain relief. But screening is critical.
“If I’m dealing with neck pain that is just intermittent, that’s just starting, it gets treated one way. If it’s severe or incapacitating, it gets treated another,” he says. Neck pain that is only slightly incapacitating, but that raises no red flags for serious pathology or nerve injury and is confined solely to the neck, can often be successfully treated in the short term. But, Dr. Haldeman warns, there are no guarantees, and some sufferers never obtain complete relief.
Dr. Haldeman cites three common mistakes practitioners often make: not screening properly, ordering too many tests and then interpreting them incorrectly, and prolonging treatments that aren’t working.
“It a patient doesn’t respond within two to four weeks, then the current treatment that is being offered isn’t working and shouldn’t be continued,” he says.
Dr. Fernandez says once a doctor has identified the cause of the problem, and knows that it is a condition that can be managed by a DC—not a disease or a broken bone—that is causing the pain, the first objective is pain relief, reduction of swelling if there is any and reduction of spasms the patient may be experiencing.
“Knock out the pain, knock out the swelling, knock out the spasm. Then the patient is ready to go into any kind of corrective or rehabilitative care,” he says.
Dr. Fernandez likes to prescribe exercises to patients with simple stiff necks and torticollis to relieve spastic muscles. He suggests the patient turn his or her head as far as possible to the nonpainful side, then place a finger on the jaw and help turn it another half-inch. Then slowly bring the chin around to the painful side. Do this about three times, each time slowly increasing the range of motion to the painful side.
“Then you let an hour go by and you do it again,” he says.
Finally, he prescribes manganese phytate to relax the tissues, Vitamin E to increase circulation and bromelain to reduce inflammation, each taken four times a day.
“Then I put them in a soft cervical collar, and the patient will sigh a large sigh of relief,” he says. “I tell them to call me in three days and tell me if they have any pain. If they do, they come back and proceed to a more extensive treatment. But 99 percent don’t need to.”
Almost as important as treating the patient’s pain is simultaneously lowering the patient’s expectations, Dr. Fernandez says. “They expect to get well immediately,” he says. “While a chiropractor is extremely well trained, the body has to have a chance to heal, and a doctor has to have a chance to correct the problem. Every now and then a doctor gets lucky and treats a patient once or twice and it’s all gone. But that’s not the norm.”
The most efficient neck therapy is preventive, doctors say. By talking to patients about risk factors, and activities that can increase or decrease neck-pain symptoms, doctors can help many patients avoid neck problems before they ever develop.
“Most of us simply don’t spend enough time talking to patients about risk factors,” Dr. Haldeman says.
Dr. Fernandez advises offering regular neck-pain prevention and relief classes to patients. “If a patient comes in with pain, and I fix their neck, then they go home and sleep on their stomach for eight hours, they’ll wring their neck back out of place. They need to know what kind of pillow to sleep on, what kind of mattress to buy. They need to know what they should and shouldn’t do, like using rearview mirrors instead of turning their head around and looking at traffic behind them. They need to think about how they can change their activities of daily living to take better care of themselves.”