Click goes the neck

Image of Andrew Leaver

Dr Andrew Leaver

A study by the University’s Faculty of Health Sciences, in collaboration with the University of Queensland, has compared common rehabilitation therapies for acute neck pain, with interesting results for those wondering about suitable treatment. According to project leader, Dr Andrew Leaver (pictured here), “Neck manipulation is a highly controversial treatment as there are published studies which demonstrate an increased risk of stroke in patients who receive it. While this appears to be a rare occurrence, and there is still some debate about whether manipulation can cause stroke, patients have a right to make an informed choice.”

Neck manipulation, which involves rapid, small thrusting movements to the spine, producing an audible “click,” is widely used by chiropractors, osteopaths, physiotherapists and other medical practitioners to treat neck pain. According to Dr Leaver, the frequently quoted estimate of serious injury following neck manipulation of one in one million is conservative and does not take into account unreported cases.

“We should also consider the severity of the risk and remember that the condition which people are initially seeking treatment for is a non life-threatening, and mostly self-limiting condition,” he says.

The study was a randomised, controlled trial of 182 primary care physiotherapy, chiropractic and osteopathy clinic patients in Sydney. All had reported non-specific neck pain of less than three months duration and been deemed suitable for treatment with manipulation by the treating practitioner; with blind assessment of the outcome.

“The median number of days to recovery from pain was 47 in the manipulation group and 43 in the mobilisation group,” Leaver says. “Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilisation.”

With around two-thirds of the population suffering from neck pain at some stage in their lives, it’s not uncommon for patients to seek out manipulation based on the belief that it provides more rapid pain relief than other treatments.

The study compared these techniques with that of mobilisation, which involves the use of slow, oscillating movements of the neck joints. All treating practitioners had postgraduate university qualifications and had received specific training in both manipulation and mobilisation.

While both treatments proved effective, the outcomes for the two groups were almost identical.

“It makes us question why patients or practitioners would favour a treatment, which possibly carries risk of catastrophic outcome, over an equally effective one with very few reported complications, despite widespread use.”