One of the most common causes of trips to the family doctor is for neck pain. Many times the symptoms seem to show up without any cause at all; other times it is the result of a motor vehicle accident, sleeping in a less than optimal position, or being visited by characters from Twilight or True Blood. Fortunately, a study published in The Annals of Internal Medicine that compares three different treatments for neck pain gives guidance as to the best ways to treat it, and shows that performing light neck exercise or receiving spinal manipulation relieves cervical pain more effectively than relying on medication.

The study is one of the few head-to-head comparisons of various treatments for neck pain, and though it is a problem that affects three quarters of Americans at some point in their lives, it has had no proven, first-line treatment. While many people seek out spinal manipulation by Chiropractors, Osteopaths, or Physical Therapists, the evidence supporting its usefulness has been limited.

But the new research, done by Dr. Gert Bronfort at Northwestern Health Sciences University, found that spinal manipulation or simple neck exercises prescribed by a Physical Therapist done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.

Neck Exercises, pain medication and spinal manipulation were all already popular options, but Dr. Bronfort was inspired to carry out an analysis because so little head-to-head research exists. “There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.

To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.

We had to fire this guy.It wasn't that he was a bad clinician or anything.

One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with Physical Therapists who gave them instructions on simple, gentle neck exercises that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day.

After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the neck exercises prescribed by Physical Therapists reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.

A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the neck exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.

Dr. Bronfort said it was a “big surprise” to see that the neck exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.” Those of us harping about the effectiveness of appropriate exercises in treating pain thought it was good news as well.

In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”

He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.” Another concern with limiting treatment to passive options such as medication--or surgery without exhausting conservative measures first--is that in most non-traumatic cases an underlying cause of neck pain is poor posture or muscular balance. Medications may mask the pain and surgery may correct a mechanical problem, but the underlying cause remains.

The types of neck exercises will vary from person to person and injury to injury. In the case of whiplash following a motor vehicle accident, stretching of the strained muscles will probably be performed in a very limited fashion, if at all, especially at first. If posture is the problem, a combination of stretching and strengthening imbalanced muscles will be implemented, as well as subtle postural exercises. If it is a case of waking up one morning after sleeping ‘wrong’, spinal manipulation may be performed before being followed up with certain stability exercises. In the case of a nocturnal visitor with unusually pointed canine teeth, my favorite remedy is better than all of the above: a nice, big Italian meal with lots of Garlic.

Neck Pain--Do Neck Exercises help: YES! (Exception: Puncture Wounds)