Neck Pain

By Ray Fosterrlf@mt-rushmore.net

 

Neck pain is a very common, and at times a most distressing symptom that can be very chronic. Neck pain may begin with no trauma and no apparent reason. Neck pain is one of the most common symptoms that are experienced following an automobile accident, particularly a rear end motor vehicle accident.

Q1 Neck pain seems to be a diagnostic problem if it can start with no apparent cause. What would be the cause of spontaneous or no known cause of neck pain?

There are a number of causes given for these neck pains that just seem to start with no known reason. The cause cited is related to the age of the individual. A child with neck pain most likely has a viral muscular infection or what is sometimes called popularly "A crick in the neck". My current understanding of these sudden and usually short lived pains in the neck – and sometimes in other parts of the body such as a shoulder or knee or ankle – is a viral infection of the muscles, or joint.

Q2 What is the treatment of this sudden, unexplained neck pain?

Local heat is what I have found is the most effective treatment for a viral infection. Viruses cannot tolerate heat much above 102 degrees Fahrenheit. A prolonged hot shower for 10 minutes or so will usually kill any viral infection in the neck or other joint. Ending the shower with cold is always a good idea.

Q3 What are some of the more common causes of neck pain in which we can identify the cause for the pain?

This depends upon the age of a person. Children may develop neck pain associated with carrying a heavy back pack. The American Chiropractic Association suggests that a child’s loaded backpack should weigh no more than 5% to 10% of what the person carrying it weighs. Heavier loads will prompt the wearer to bend forward -- in an effort to support the weight on his or her back -- rather than from the shoulders. This can lead to back and neck pain. (2) Wear both shoulder straps, one over each shoulder. Slinging a backpack over one shoulder shifts all the weight to one side of the body. This can cause muscle spasms, and neck and back pain. (3) Cut the slack in the straps. Adjust the shoulder straps so the pack does not dangle, since that can also cause back strain and pain. (4) Choose a bag with padded shoulder straps. "Not only will they be more comfortable than non-padded straps, but they will also help prevent the straps from digging into the shoulders,"

Q4 What are the common causes of neck pain without trauma in older people?

Arthritis of the joints of the neck is probably the commonest cause of non-trauma related neck pain in people 50 years old and older. As the joints get old, dried up and stiff, the inflammation of repair is accompanied by pain.

Q5 What joints are there in the neck that can get dried up and stiff with age?

The neck connects the body and head together. The head weighs about 20 – 30 lbs or so in the adult and is attached to the much bigger mass in the rest of the body. This means that there are a lots of forces that concentrate in the neck. These forces are absorbed by seven segments of bone that are called the cervical spine. Between each segment of bone is a cushion joint called an intervertebral disc. This disc material is gelly in consistency in children and tends to get stiffer and harder as it dried up through life. The drier and stiffer the intevertebral discs are the less they are able to absorb and dissapate the forces across the neck. This means that more energy is passed on to the facet joints.

Q6 I can understand the intervertebral joints between the vertebral bodies, but what are the facet joints?

There are bony pillars called feet that stand on the back side of the verbetral bodies on either side of the spinal cold. Covering the spinal cord is a bony roof and between each section of this bony roof that protects the spinal cord from behind, are projections for muscles to attach to called spines. The midline spine that sticks out behind does not have any joint associated with it, but the lateral or sidewise projecting spines have a joint on each side that articulates with the bony roof above and below. These joints are called facet joints. There are two facet joints, one on each side, at every level of the cervical spine except between the first and second cervical vertebrae.

Q7 What is the deal with the first and second cervical vertebrae? Why don’t they have facet joints?

The body is always balancing two opposing forces and demands or needs. It is very handy to be able to turn your neck, especially in traffic to take a look at your mirror blind spots. If there were no facet joints between any of the cervical vertebrae we could probably turn our necks around a couple of times and have more neck turning ability than an owl. However we would probably put our spinal cord and the arteries in our neck at risk were we able to turn our necks around so far or much more than 180 degrees. The facet joints give us a lot or stability to our neck. However stability is gained at the price of ranged of motion. If we had facet joints at every level of our cervical spines, including the first and second, we could probably not turn our necks more than 10 or 15 – maybe 20 degrees in our youth. It is the lack of facet joints between the first and second cervical vertebrae that lets us look close to 90 degrees each way without turning our whole body.

Q8 How is arthritis in the neck diagnosed?

The usual and customary is with a history of neck pain in an over than 50 year old person and xray changes of arthritis.

 Q9 What is the cause of arthritis?

It is fairly reliably believed that it is decrease in blood flow that is associated with arthritis in addition to a family history. Whether the family history is associated with the decreased blood flow or the arthritis or both can be argued.

Q10 What are the causes of decrease blood flow other than family history?

Blood flow is related to several factors. Such simple considerations as clothing and body covering affects blood flow. Keeping the neck covered tends to decrease pain in the neck and increase blood flow. General exercise such as walking increases blood flow to all parts of the body. Deep breathing increases blood flow. Not only is air drawn into the chest with a deep inspiration, but so is blood. Good posture and deep breathing increases blood flow as well as good oxygenation of the blood. One of the most important factors in good blood flow is an unrefined plant based diet. Animal source foods are fiber and vitamin deficient and almost pure fat and protein. The standard American diet contains excess fat and protein and is deficient in fiber and vitamins. The lack of exercise, the standard American diet and lack of drinking enough water are probably the big three causes of the epidemic of blood flow problems that we have that are the root cause of the epidemics of diabetes, arthritis, heart disease, and arthritis that we currently see in the United States.

Q11 What is the best treatment for arthritis?

Pain is the factor that is most motivational about arthritis. The things that decrease pain is what people with arthritis want to know about. The simple and effective things that will give you the most pain relief and the least side negative effects for the treatment of neck pain are:

  1. Wear a scarf of a turtle neck garment to keep your neck warm.
  2. Give yourself self directed physical therapy in the form of hot and cold showers or hot and cold compresses to the neck. For most parts of the body we recommend 3 minutes hot and 1 minute cold - or 30 seconds cold if doing the treatment in the shower. For the neck, more cold works better for most people than more heat. So for the neck use equal time for hot and cold say 1 minute each or even reverse the time pattern giving the neck more cold and less time for hot. End with cold then keep the neck warm by keeping it covered.
  3. Use a pin or clip-on neck pillow that does not fall off at night and will support the neck no matter what your position is at night. Special clip or snap on neck pillows can be made or purchased from specialty outlets.
  4. A gentle range of motion of the neck at least once a day helps overcome stiffness. Chiropractic treatment is found helpful by many people.
  5. An anti-inflammatory diet is one of the most important treatments of neck pain. Pain is associated with inflammation. To turn off the inflammation chemically with drugs gives pain relief but interrupts the body's healing process and tends to prolong the healing time. Antiinflammatory drugs on the market today are hard on the stomach and are not an infrequent cause of bleeding. Sometimes the bleeding can be so severe as to require hospitalization.

Q12 What is an anti-inflammatory diet?

Avacados, olives, nuts and seeds eg sesamee and sunflower or any of your seeds are high in fat wich contain the chemical messenger called prostaglandins. These prostaglandins from plant fats turn down inflammation. This is an anti-inflammatory diet. Animal fats have prostaglandins that increase inflammation in the body. So to make a switch from animal foods to plant foods will have a double effect on decreasing inflammatory conditions in the body.

 Q13 Is arthritis the most common cause of neck pain in people over 50 years of age?

Trauma, rear end car accidents and other causes of trauma often light up a pre-existing arthritis that was not causing pain until the trauma. Probably most neck pain in over 50 year olds are associated with arthritis with or without associated trauma.

Q14 What is the next most common cause of neck pain after arthritis, with or without trauma?

There are a number of conditions that are not uncommon that involve neck pain as part of their picture. Jaw pain for whatever reason - perhaps a tooth ache can be associated with neck pain. Fibromyositis, tendonitis, and generalized arthritis can involve the neck in pain. Muscle tension associated with stress is a very common cause of neck pain.

Q15 Lets take the treatment for those conditions one at a time. What is the best treatment for Jaw pain causing neck pain?

It depends on the cause of the jaw pain. An infected tooth is best treated by a dentist. Local charcoal powder or cloves locally on the tooth while the dental appointment is being arranged will give relief.

Q16 What is the best way to get charcoal to a sore tooth?

Put a charcoal tablet next to the sore tooth and just keep it there is the best way to apply charcoal to a sore tooth. Carrying charcoal tablets in your medicine cabinet is a very good idea.

Q17 What is the treatment for fibromyositis or tendonitis?

Fibromyositis and tendonitis tend to be widespread inflammatory conditions affecting wider areas of the body. If the tendonitis is very localized, it can be addressed locally with hot and cold physical therapy applications of a heating pad and ice or in a hot and cold shower. If the area of the body affected is too diffuse or large to use local treatments, a shower may work. Diet that is antiinflammatory that we just discussed will be helpful as well as deep breathing, good posture, and gentle exercise like walking, swimming or cycling will be very beneficial.

 Q18 What can be done for stress or tension causing neck pain?

The best plan for tension or stress is to identify the cause of the stress or tension and deal with those causes directly rather than dealing with the symptoms. It is awesome what effect prayer can have in apparently incurable problems that give stress in life. Sometimes it is appropriate to confront people involved in causing you stress. Sometimes it is amazing how communications can clear up very complex problems. Forgiveness is a great stress releaver. Jesus has taught us to pray, "Forgive us our debts as we forgive our debtors." Unless we forgive others that have done wrong to us, we are cutting ourselves off from the channel of God's forgiveness.

Q19 Having done all we can to handle the cause of stress, is there anything else we can do to minimize the effects of stress causing neck pain?

Yes there are a number of things that will help to relieve stress no matter what the cause is.

  1. Vitamine B complex supplements will have the effect of calming your nerves and helping you cope with stress better.
  2. Exercise such as walking one or two miles a day, five days a week will greatly reduce the effect of stress.
  3. Good posture and deep breathing will have a very beneficial effect. Good posture increases a positive self-image. Sit, stand, and walk like royalty and you will feel more like royalty. This also greatly increases your brain blood flow that will decrease stress.
  4. Drink 2 quarts of water between meals. This will also increase your brain blood flow which will decrease stress.

Q20 What is the role of surgery for neck pain?

Pain that is caused by pressure on a nerve traveling between your spinal cord in the neck to your arms and hands will give pain along the distribution of the nerve. Surgery to remove the pressure on the nerve is rational treatment and should be considered where that is the cause of pain.

Q21. Is surgery the only effective treatment for nerve pain in the neck?

While surgery may be indicated as we mentioned above, many times traction, local treatment such as keeping the neck warm and an anti-inflammatory diet that we mentioned earlier, can sometimes give so much relief that surgery can be delayed or avoided sometimes completely.

Q22 What is your advice about manipulation treatment for neck pain?

NECK PAIN - Manipulation

Thirty-five patients with neck pain for a minimum of 12 weeks and an average age of 10 years visited 1 of 24 community chiropractors 12 times over a 6 week period compared to a control group of 34 subjects who visited a nurse and received acetaminophen at 500 mg 4 times a day. Patients in both groups did range of motion and strengthening exercises and were advised to use a heating pad. At the end of 6 weeks of treatment patients treated by manipulation reported significant improvements in their neck pain and function with better range of motion and strength. Those who were treated medically had no real changes. Contraindications to manipulations included osteoporosis, bleeding disorders, an unstable cervical spine and cancer. "Manipulation Beats Acetaminophen For Neck Pain," Baker, Barbara, Family Practice News, June 1, 1996;14. (Address: Barbara Baker, Family Practice News, 12230 Wilkins Avenue, Rockville, MD 20852 U.S.A.) 25062 [ost]

Q23 What effect does society have on neck pain?

Patient's view of whiplash influences symptoms

NEW YORK, Mar 12 (Reuters Health) -- The likelihood that pain will linger after a whiplash injury may be linked to the expectations of the patient, a study suggests. In Lithuania -- where there are no expectations of long-term disability or financial gain linked to whiplash -- people do not appear to experience any lingering problems with such injuries, according to a report in the March issue of the Journal of Neurology, Neurosurgery and Psychiatry. A team of Lithuanian and Norwegian researchers asked 210 victims of rear-end collisions in Kaunas, Lithuania, about neck and headache pain after the accident, at 2 months, and at 1 year later. Immediately after the accident 47% of the people did have pain, which lasted about 3 days. "In no case did the neck pain persist beyond 17 days," according to Dr. Harald Schrader, University Hospital in Trondheim, Norway, and colleagues. "The median duration of headache was 4.5 hours and no one had accident-induced headache beyond 20 days." Local customs seem to influence whiplash symptoms, according to an editorial by Dr. J.M.S. Pearce, a neurologist at Hull Royal Infirmary, UK. "In a country where there is no expectation of symptoms or disability, and where a minority of car drivers are insured for personal injury, acute pain after whiplash is frequent but short lasting and self-limiting," he writes. The study findings call into question the validity of "chronic whiplash syndrome," he suggests. "If the pathogenesis or mechanism of what is termed 'chronic whiplash syndrome' cannot be shown, then its existence is doubtful. Further opinion is pure conjecture, best avoided in science, best decided by the Courts." SOURCE: Journal of Neurology, Neurosurgery and Psychiatry 1999;66:273-276, 279-283. Copyright 1999 Excite Inc.

Q24 What effect does posture have on neck pain?

Many Health Problems Linked to Poor Posture.

SYLVIA WOOD c.1999 Albany Times Union ALBANY, N.Y. -- ``Stand up straight! Don't slouch.'' Like many of us, Kate Marchesiello heard those admonishments from her mother while growing up. ``Posture was important for my mother, not to have rounded shoulders and to hold my head up high and to have a presence when you walk in the room,'' said Marchesiello, who lives in Glenville, N.Y. In case your mother hasn't reminded you recently, good posture is still important, and especially for adults. ``The No. 1 cause of neck and back pain is poor posture,'' said Janice Novak, a Minnesota-based health education consultant and author of a new book, ``Posture, Get it Straight!'' Today's sedentary lifestyle often aggravates many poor-posture problems. With many people spending eight or more hours at a desk every day, typing at computers and answering the phone, it's easier than ever to slump and slouch. ``We've become a nation of professional sitters,'' Novak said. ``Everywhere I go, I see people rubbing their neck and shifting in their seats.'' Novak tells people that by simply standing up straight, they can instantly slim down their waistline by an inch or more, akin to losing 10 pounds. Good posture can also add the illusion of greater height. Her explanation, highlighted in her book, makes sense. ``When the upper back slumps forward, it presses the rib cage down on the abdominal organs,'' she writes. ``The belly protrudes, making the waistline appear larger than it is.'' Such a stance is not only unattractive, it can also take its toll in other ways, including a gradual loosening and weakening of abdominal and back muscles. ``One of the more common causes of back pain is because our stomach and abdominal muscles are out of shape,'' said Dr. Robert Leupold, an orthopedic surgeon with Schenectady Regional Orthopedic Associates in upstate New York. Leupold likens our middles to a barrel: ``If you take away the stays in the front and the back, the whole barrel falls apart.'' Not all posture problems, however, can be fixed by paying attention to how we stand or sit. In some cases, especially with fast-growing teen-agers, there may be structural problems in the spine that cause a hump or round back and curvature. Although most schools offer scoliosis screening, parents should also be on the lookout for problems. ``If they notice any deviations, they should have it checked,'' Leupold said. Marchesiello is especially aware of her posture as the executive director of the Kripalu Yoga Center in Albany, which offers yoga and wellness instruction. In yoga, good posture is essential to allow the proper alignment of muscles and organs. Such an alignment improves both circulation and energy, Marchesiello said. ``We talk about pressing your feet into the earth and the crown of your head up to the heavens,'' she said. Even if you slouched through childhood and haven't given posture a second thought since you left home, Novak emphasizes that it's never too late to make improvements. ``No matter how bad people think their posture is or how long they've had poor posture, they can change it,'' she said. If you work at a desk, here are some simple tips: - Make sure your computer monitor isn't too low. ``Eyes need to be mid-level with the screen,'' she said. - If you're on the phone a lot, invest in a headset. ``Keeping the phone receiver between your neck and shoulder will shorten those muscles,'' she said. ``It's all these little things that cause us tremendous problems.'' By paying a little attention to your posture throughout the day, Novak said, the benefits not only include less back pain, but a healthier and more confident appearance. ``I usually am perceived as being younger than I am, if I must say so myself,'' she said.

Salon Hair-Washing May Harm Necks.

TRENTON, N.J. (AP) -- There's a new peril amid the chemicals, scissors and razors at the hair salon: the sinks where customers get their hair washed. People with neck problems risk developing a painful condition from leaning their heads back over the sink, according to researchers at New Jersey Medical School in Newark. The researchers have even given it a name: Salon Sink Radiculopathy, or injury to nerve roots leading from the spinal cord to the extremities. ``This is a newly recognized phenomenon,'' Dr. Patrick M. Foye said. It is a risk mainly for people with problems such as arthritis or neck injuries from traffic, work or sports accidents, he said. Other researchers previously have reported people suffering strokes at hair salons when they lean back for a shampoo. Experts recommend padding the sink edge with towels, having your hair washed face down -- or washing your hair at home before a visit to the salon. Pain specialists at New Jersey Medical School have spotted nearly a dozen patients with the problem since first diagnosing it several months ago. ``I wouldn't recommend having your hair washed in a beauty salon to anyone,'' said one patient, 50-year-old Michael Werner of Bloomfield. He said he suffered so much pain a day after getting his hair washed before a haircut six months ago that he couldn't move his neck. Mable Graham, a 60-year-old South Plainfield billing clerk who developed a pinched neck nerve from a computer-related work injury, said one of her twice-a-month beauty parlor visits worsened the problem. ``I was amazed to know that just lying in a chair in a beauty parlor could cause these kinds of problems,'' she said. ``I noticed when I picked my head up out of the sink, the pain was more severe.'' Salon-sink nerve injury generally causes pain radiating from the neck down one or both arms. It is usually treatable with medication and therapy, but surgery may be necessary. Dr. Faye Chiou-Tan, assistant chief of physical medicine and rehabilitation at Baylor College of Medicine in Houston, said doctors should warn patients with pinched nerves that leaning their heads back in a hair salon sink can worsen their injuries. ``The patients need to advocate for themselves and say, `I'm serious. Don't put me in this position,''' she said.

Comprehensive Program Can Overcome Chronic Whiplash: Two-Thirds of Patients Returned to Full-Time Work.

Feb. 29, 2000 (Ithaca, N.Y.) -- About 10% of patients who suffer whiplash injuries have chronic, severe neck pain, and many are unable to work or enjoy normal activities. Dutch researchers report in a recent issue of Spine that a four-week treatment program helped most participants regain normal function and return to work. Most no longer even needed pain-relieving drugs. The program, which is similar to that used in many U.S. pain management clinics, includes physical therapy and exercise training, counseling, sports, group therapy, and help from an occupational therapist. After completing it, 65% of patients were able to return to full-time work and 92% were able to work at least half time, researcher Alexander A. Vendrig, PhD, tells WebMD. Before beginning the program, all 26 patients had pain for at least six months after a whiplash injury, and all were at least partially unable to work. Their average time out of work had been over a year. Although Vendrig expected his program to help patients get back to work, he tells WebMD that he was surprised to find that more than half of them needed no pain relievers or other treatment (such as physical therapy) after completing it. He suspects this is because the comprehensive approach helps patients break bad "pain behavior" cycles and regain normal function. For example, a patient recovering from whiplash may avoid normal neck movement. This can cause muscle wasting and decreased blood flow, which can lead to more neck pain. Vendrig's program uses "graded activity" to help patients learn new ways of moving and dealing with neck pain. This can help correct bad habits and restore muscle strength and endurance. The program includes education, and sports such as swimming and squash to help build endurance and confidence. An occupational therapist helps the patients plan their return to work and make any changes needed in the workplace. Joel R. Saper, MD, who reviewed the study for WebMD, says the findings support a comprehensive approach to whiplash treatment. "The patients in this study had whiplash-related problems for at least six months, and a large percentage of them had beneficial responses to this treatment program," Saper says. "That in itself is important, even in a [pilot] study like this one." Saper is director of the Michigan Head-Pain and Neurological Institute in Ann Arbor. Whiplash is never a simple problem, Saper says. It may involve spinal nerve roots, joints, soft tissue injury, behavioral components, and emotional and psychological elements. Saper tells WebMD that all of these areas should be considered, which is why one-dimensional approaches to whiplash pain, such as pain-relieving injections, often do not produce lasting improvement. The promising results Vendrig reports in the pilot study still must be confirmed in larger groups of patients. Vendrig's program is now being compared to conventional whiplash treatment in a larger clinical trial. Copyright 2000 Healtheon/WebMD.

 Early Mobilization Improves Pain And Disability After Whiplash Injury.

URL: Der Schmerz 2002 Vol 16 Issue 1 pp 15-21. "Results of early mobilisation of acute whiplash injuries" Early mobilization should be the new standard for managing whiplash injury. It is, say German researchers, superior to the standard therapy regarding pain intensity and disability. Both diagnostic evaluation and therapeutic management of acute neck pain following whiplash injury are considered frequent, yet unsolved clinical problems. Previous studies have suggested that physiotherapy was beneficial in managing these injuries, therefore preventing the problems of long-lasting symptoms and disability. To determine its management, researchers from two specialist departments at the Philipps University in Marburg assessed the effects of early active mobilization as opposed to standard therapy using a soft cervical collar. Participants included 168 patients with whiplash injury who enrolled into a randomized clinical trial between August 1997 and February 2000. Eighty-one patients, 31 male and 50 female (average age 28 - 78 years), were randomly assigned to the standard therapy group and given a soft cervical collar. The second group of 87 patients, 31 male, 56 female (average age 29 - 62 years), were assigned to early mobilization and treated with physiotherapy. During a one-week period, participating patients documented pain and disability twice (baseline and six week follow-up) by diary using numeric rating scales ranging from 0 to 10. The standard therapy group reported an initial pain intensity (4.75), similar to disability (4.76). Neither were there any noticeable differences between initial pain (4.50) and disability (4.39) in the early mobilization participants. However, mean pain intensity, reported by the standard therapy group after six weeks, was 2.66 and disability was 2.40. By comparison, the significant difference between the two groups was indicated with the early mobilization participants reporting a mean pain intensity of 1.44 and mean disability 1.29. Copyright © 1999 P\S\L Consulting Group Inc. Obesity, Weight Loss Influence Lipolytic Capacity Of Fat Cells Only In Women. Journal of Clinical Endocrinology & Metabolism 2002; 87(2):764-771. "Major Gender Differences in the Lipolytic Capacity of Abdominal Subcutaneous Fat Cells in Obesity Observed before and after Long-Term Weight Reduction" Adipocyte lipolytic capacity is influenced by obesity and weight reduction in women, probably due to changes in fat cell size. This is not seen in men, however. The differences between the sexes are not related to the amount of hormone-sensitive lipase protein in adipocytes, say Swedish investigators. The researchers prospectively studied the influence of obesity on the lipolytic capacity of isolated subcutaneous fat cells in 13 otherwise healthy obese women and 10 otherwise healthy obese men before weight reduction by bariatric surgery and two and three years afterwards. Non-obese women (n=25) and men (n=17) without a family history of obesity served as controls. Lipolytic capacity was determined after stimulation at different steps of the lipolytic cascade with noradrenaline, isoprenaline, forskolin and (Bu)2AMP. After bariatric surgery, there was a marked and similar reduction of 40 percent in body mass index and fat cell volume in both sexes. Before weight loss, lipolytic capacity per cell was elevated in obese women and fell to normal levels after weight reduction at two years and three years. However, lipolytic capacity per fat cell surface area did not change in obese women. In obese men, lipolytic capacity per cell was almost the same as in lean men and was not influenced by weight reduction. Lipolytic capacity was significantly related to fat cell size in women but not in men. The protein content of hormone-sensitive lipase, which determines lipolytic capacity, was significantly lower in obese men and women and increased slightly after weight reduction in men only. Copyright © 1999 P\S\L Consulting Group Inc. Linus Pauling's work online. Oregon State University library has scanned Linus Pauling's 46 handwritten notebooks, and has posted them at:http://osulibrary.orst.edu/specialcollections/rnb/index.html

Hands-on Approach Best for Neck Pain: Manual Therapy Beats Medication and Rest in Study.

May 20, 2002 -- A popular but little-studied method of easing neck pain by moving the patient's neck in specific ways may be more effective than traditional physical therapy or a physician's care. A new study shows manual therapy -- practiced in the U.S. by chiropractors, osteopaths, and some physical and massage therapists -- was best in improving neck mobility and reducing pain. Neck pain is common health problem, especially among older adults, and affects between 10% and 15% of the population. Although a variety of therapies are used to treat the condition, few studies have compared their effectiveness. In this study, researchers compared three common treatments for neck pain in 183 patients with chronic neck pain: continued, routine care by a doctor (usually pain medications and rest), manual therapy, and physical therapy. Manual therapy consisted of a trained specialist manipulating the patient's neck, while physical therapy involved use of a trained therapist who assisted the patient in performing a series of active exercises. After 7 weeks of treatment, 68.3% of the patients in the manual therapy group said they felt either completely recovered or much improved compared with 50.8% of the patients in the physical therapy group and 35.9% of the patients under their doctor's care alone. We found that manual therapy was more effective than continued care, and our results consistently favored manual therapy on almost all outcome measures, writes study author Jan Lucas Hoving, PhD, and colleagues from Cabrini Medical Centre in Victoria, Australia. Although physical therapy scored slightly better than continued care, most of the differences were not statistically significant. Their complete report appears in the May 21 issue of the Annals of Internal Medicine. Disability levels improved among all three groups, but there were no significant differences between the groups. Range of motion improved more among the manual and physical therapy groups. And patients receiving manual therapy had fewer absences from work than the others. In an editorial that accompanies the study, Joel Posner, MD, and Catherine Glew, MD, of MCP Hahnemann University in Philadelphia, say the findings are encouraging but more research is needed. Given the widespread used of manual therapy and the paucity of controlled studies, the study by Hoving and coworkers is not without importance, they write. But they point out that since the manual therapy approach used in the study was self-described as eclectic, it's difficult to know which aspects were effective and which were not. Copyright 2002 WebMD Inc.