July 10, 2006

NeuroScience Insights for Health Care Professionals

The physicians and staff of The Neuroscience Group are providing this physician and provider communication to help you stay abreast of issues and updates in the dynamic field of neurosciences, with the goal of helping you provide better overall healthcare services to your patients.

Non-surgical Interventions for Back and Neck Pain

Back and neck pain top the list of most common complaints for which patients seek care from a multitude of providers-primary care practitioners, chiropractors, massage therapists, physical therapists and neurosurgeons. In addition to in-depth diagnostic screening, surgical interventions, injections and counseling, effective manual therapy and osteopathic care are additional treatment options available through the Neuroscience Group. Manipulative care and physical therapy are used to address clinical concerns such as pain, headaches, weakness, numbness, scoliosis, balance or dizziness problems and pre and post surgery concerns.

Multiple studies have been conducted and reported in the literature supporting both surgical and non-surgical approaches to back and neck pain. The following studies have helped to demonstrate the efficacy of manual therapy for back and neck pain. Hoving, JL et al (Ann Intern Med 136:713-722, 2002) conducted a randomized, controlled trial in an outpatient setting in the Netherlands for 183 patients who had nonspecific neck pain for at least 2 weeks. Interventions included 6 weeks of manual therapy 1x/week, physical therapy (exercise therapy) twice a week or continued care of a general practitioner (analgesics, counseling and education). At 7 weeks manual therapy outscored the other interventions on most outcome measures. Physical therapy scored better than continued care but the differences were not statistically significant. . Bronfort, G et al’s (Spine. 26(7): 788-797, 2001) randomized, parallel-group clinical trail compared the relative efficacy of rehabilitative neck exercise and spinal manipulation for management of chronic neck pain. This study reported that for chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation in the form of a high-technology MedXC program, appeared more beneficial that the use of spinal manipulation alone.

In another study Golby, LJ et al (Spine. 31(10): 1083-1093, 2006) reported on a randomized, single blind controlled trial comparing a 10-week manual therapy spine stabilization rehabilitation program with a minimal intervention control group. Data collected at 3, 6, 12, and 24 months showed statistically significant improvement at 6months for pain reduction and dysfunction. And a 1-year in medication and disability. Both manual therapy and spinal stabilization were significantly effective in pain reduction in comparison to active control. Giles and Mueller (Spine. 28(14): 1490-1502, 2003) reported on a randomized controlled clinical trial comparing medication, needle acupuncture and spinal manipulation for managing chronic (> 13 weeks duration) spinal pain. Using the Oswestry Back Pain Disability Index, the Neck Disability index and the short-form SF 36, the investigators found that manipulation achieved the best overall results. Hsieh, Chang-Yu et. al. al (Spine. 27(11); 1142-1148, 2002) reported on a randomized clinical trail that compared the effectiveness of three manual treatments and back school. Their results found that combined joint manipulation and myofascial therapy was as effective as either therapy alone. Back school was as effective as three manual treatments. Aggressive nonsurgical treatment for lumbar scoliosis has also been studies. Simotas, A. et. Al (Spine. 25(2): 197, 2000) reported that aggressive nonoperative treatment for spinal stenosis was a reasonable option for some patients.

Manual therapy visits, conducted by an experienced and highly trained manual therapist at the Neuroscience Group clinic sites, typically last approximately 45 minutes. The physical therapist reviews the HPI and evaluates spine mechanics, flexibility, strength, posture, body mechanics, soft tissue mobility, etc. in order to determine the best course of treatment. Treatment may include joint and spine mobilization and manipulation, stretching of tight muscles, strengthening and re-education of weak or “under used” muscles, soft tissue mobilization and release, as well as appropriate use of modalities such as traction. Additionally patients may receive cranio-sacral treatment. Patients will also receive a home exercise program and in-depth education to compliment treatment sessions.

The Neuroscience Group is assessing patient outcomes for both surgical and non-surgical back pain treatments. Tracy Galione, Director of Clinical Care is coordinating data collection for this study.

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