Neck Pain – which treatment works best?

Neck Pain:  Manipulation vs. Mobilization – What’s Better?

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint using various methods such as figure 8, side to side, front to back and /or combinations of any of these movements. In the neck, gentle to firm manual traction or pulling, when applied to the cervical spine, stretches the joint and disk spaces and can be included during MOB.

Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide).

Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.

As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.

Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic, as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function!

In our clinic (Denver Chiropractic Center) we’ve found that the best approach uses BOTH. Mobilization in the form of Active Release Technique combined with safe and gentle (never forced) adjustments – also known as spinal manipulation – get better results in a shorter time frame.

Call us at 303.300.0424 if you want to get rid of your neck pain. We’re here to help.

Low Back Pain or Hip Arthritis: Which One is it? How the Active Release doctors at Denver Chiropractic Center can help you

Low back pain (LBP) can have many causes. Our job is to identify the main pain generator(s) and manage the patient accordingly. This requires a careful history, examination, and a short trial of treatment with conservative methods, like Active Release Techniques Soft Tissue Treatment.

When first presenting for care, the patient tells us about their complaint in the history portion of our evaluation. Here, we not only ask about the main reason for their appointment or, what’s bothering them now but also their past history. We also discuss old injuries such as slips and falls, sports injuries that date back to high school, motor vehicle induced injuries, as well as family history (we ask if family members have or have had low back trouble since it’s been reported that there is a genetic link identified for osteoarthritis).

We also inquire about the patient’s current activity level and how well those activates are tolerated, often using tools completed by the patient that can be scored and compared periodically during care to track the benefits of treatment. When we finally return to the primary complaint history, we ask about the location, mechanism of injury, notable changes in the course of the condition, the onset date, pain related activities that increase or decrease pain, the quality of pain, radiation patterns, severity levels (such as a 0-10 scale), and timing issues such as, worse in the mornings vs. evenings.

When patients say, “…I have low back pain,” they may point to anywhere between the lower rib cage and their hip area. In other words, everyone interprets where their low back is located differently. So, when differentiating between low back pain and hip pain, one would think that the patient would either point to their low back or their hip, right? Well, where does hip osteoarthritis usually hurt? That’s what makes it so hard! The pain location can vary and move around in the same patient anywhere in the pelvic region including the groin (which is common), to the side of the pelvis, to the buttocks, the sacrum and in the low back.

To make it even more challenging, degenerative or injured disks in the lower lumbar spine can refer pain directly into the hip area and also create localized low back pain. In fact, patients often have BOTH conditions simultaneously. Usually, during examination, we move the hip in the socket and feel for reduced motion and watch for pain patterns in certain positions. When comparing the two sides, we both can feel, “…a difference between the two.”

The osteoarthritic (OA) hip is comparably more tight and painful with rotation movements. For example, the patient is seated with their leg crossed, trying to touch their knee to their opposite shoulder. In the OA hip patient, they may only be able to get it half way there compared to the other side and often complain of groin pain. The “ultimate test” is the x-ray that reveals the loss of the joint space – the “cartilage interval” – which narrows on the OA hip side.

How often is hip OA found? In a recent article, after reviewing 2000 patient files and 1000 x-rays of patients 40 years or older, 19% (~1 out of 5) demonstrated x-ray findings of hip OA. THAT’S A LOT!  At Denver Chiropractic Center, management of hip OA includes mobilization, manipulation, stretching the muscles surrounding the hip joint with Active Release Techniques, exercise/stretch instruction, nutritional strategies and others. If/when the time comes, we will help set up a referral to the orthopedic surgeon for joint replacement, as any “quarterback” of your care should.

In our experience, using Active Release Techniques to manages the soft tissues (muscles, tendons) that are associated with the hip joint –and there are a lot of them – is the best option to both manage the pain and stiffness in the hip joint.

It all starts with the initial exam. To schedule yours (or schedule one for someone that you care about), call us at 303.300.0424.

Our 14th Anniversary and This Week’s 1-Page Health News

Those of you who want these weekly 1-Page Health News emails sent directly to your email can go to denverback.com and fill out the little form on the upper left part of the page.

May marks another year for Denver Chiropractic Center. For those of you keeping score, that’s 14 years down, and now in our 15th year.

Last week was the busiest week we’ve ever had. Ever. And we’d like to thank you. Your trust, support and referrals are what make our existence and growth as a business possible. We look forward to being here to help you for a few more decades. Once again, thanks.

We’d also like to wish all the moms out there a Happy Mothers Day.

Here’s this week’s 1-Page Health News:

Mental Attitude: Berry Good News. Men who regularly consume foods rich in flavonoids (such as berries, apples, certain vegetables, tea and red wine) may significantly reduce their risk for developing Parkinson’s disease. Flavonoids are naturally occurring, bioactive compounds present in many plant-based foods and drinks. Neurology, April 2012

Health Alert: Stressed? The risk for coronary heart disease and stroke increases by 30% in a person whose partner has cancer. The cause is probably the negative stress to which the cancer patient’s partner is exposed. Previous studies show that stress can affect the nervous system, blood pressure, and inflammation, increasing the risk of developing coronary heart disease and stroke. Centre for Primary Healthcare Research in Malmö, April 2012

Diet: Pain Relief. The supplement Methylsulfonylmethane gave osteoarthritis patients relief from symptoms of pain and physical dysfunction. Osteoarthritis Cartilage, 2008 Exercise: Being Fit. Improving or maintaining physical fitness appears to help obese and overweight children reach a healthy weight. During a four-year study, obese and overweight girls and boys who achieved fitness were 2.5 to 5 times more likely to reach a healthy weight than those who stayed underfit. Obesity, April 2012

Active Release Techniques: Sciatica. Many people with sciatica are worried that it’s coming from a ruptured disc. While this is sometimes true, in most cases, muscles are pressuring the sciatic nerve and causing symptoms down the back of the leg. The piriformis is a likely suspect, as are the hamstrings. Using Active Release Techniques to relieve the tension in these muscles can take the pressure off of the nerve and fix the problem.

Wellness/Prevention: Obesity and Watching TV. In a study of obesity among European children, Dr. Yannis Manios, Assistant Professor at Harokopio University in Athens, writes, “We found that many countries are lacking clear guidelines on healthy eating and active play. However, there is good evidence linking sedentary behavior (like TV watching) with subsequent obesity. Obesity Reviews, March 2012 (Um, this is not brilliant work.)

Quote: “Simple diet is best; for many dishes bring many diseases; and rich sauces are worse than heaping several meats upon each other.” ~ Pliny

An update on Miss Keri (after the bike crash) and this week’s 1-Page Health News from your Denver Active Release Providers at Denver Chiropractic Center

Miss Keri here at the office wanted to say thanks to everyone for the concern after her “meeting” with the concrete wall while on her bike last week. Her nasty injury required a little attention from a wound care nurse to make sure it doesn’t leave a scar, but she’s on the mend. Once again thanks for your concern.

That last email about her bike crash received the highest open response of any email we’ve ever sent. And here’s this week’s 1-page health news.

Mental Attitude: Meditation. Adults with memory impairment and memory loss may benefit from mantra-based meditation (12 minutes of meditation per day for 8 weeks). Mantra-based meditation has demonstrated a positive effect on patients’ emotional responses to stress, fatigue and anxiety. Findings revealed a substantial increase in cerebral blood flow in the patients’ prefrontal, superior frontal, and superior parietal cortices, and also better cognitive function. Journal of Alternative and Complementary Medicine, March 2012

Health Alert: Diabetics And Stroke. 26 million Americans have diabetes, and more than half are younger than 65. The longer you have diabetes, the higher your risk for stroke. Compared to people without diabetes (after considering other factors such as age, smoking history, physical activity, history of heart disease, blood pressure and cholesterol), the risk of stroke increased 70% in people with diabetes for less than 5 years, 80% in people with diabetes for 5-10 years and three-fold in people with diabetes for 10 years or more. American Heart Association, March 2012

Diet: Seeing Things? Hungry people see food-related words more clearly than people who’ve just eaten. This change in vision happens at the earliest perceptual stages, before higher parts of the brain have a chance to change the messages coming from the eyes. Psychological Science, March 2012 Exercise: Good Reasons. Exercise helps to alleviate low-back pain, helps to reduce the amount of insulin required to control blood sugar levels in Type I (insulin-dependent) diabetics and improves mental alertness. Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: Hold Your Head Up! “Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.” ~Rene Cailliet M.D., famous medical author and former Director of the Department of Physical Medicine and Rehabilitation at the University of Southern California

Wellness/Prevention: Avoid Absenteeism. The US is losing $226 billion per year due to employee absenteeism. A worker is less likely to take sick leave if their supervisor offers support (lightened work load or stress management training) when an employee is experiencing psychosomatic stress symptoms. The worker feels inclined to reciprocate the supportive treatment by keeping their work effort high. European Journal of Work and Organizational Psychology, January 2012

Quote: “Anything is possible. You can be told that you have a 90% chance or a 50% chance or a 1% chance, but you have to believe, and you have to fight.” ~ Lance Armstrong

Is it sciatica or Low Back Pain? How can Denver Chiropractic Center help you with Active Release Techniques?

Low back pain (LBP) can be localized and contained to only the low back area or, it can radiate pain down the leg. This distinction is important as LBP is often less complicated and carries a more favorable prognosis for complete recovery. In fact, a large part of our history and examination is focused on this differentiation. This month’s Health Update is going to look at the different types of leg pain that can occur with different LBP conditions.

We’ve all heard of the word “sciatica” and it (usually) is loosely used to describe everything from LBP arising from the joints in the back, the sacroiliac joint, from the muscles of the low back as well as a pinched nerve from a ruptured disk. Strictly speaking, the term “sciatica” should ONLY be used when the sciatic nerve is pinched; causing pain that radiates down the leg.

The sciatic nerve is made up of five smaller nerves (L4, 5, S1, 2, 3) that arise from the spine and join together to form one large nerve (about the size of our pinky) called the sciatic nerve – like five small rivers merging into one BIG river. Sciatica occurs when any one of the small nerves (L4-S3) or, when the sciatic nerve itself, gets compressed or irritated.

This can be, and often is caused from a lumbar disk herniation (the “ruptured disk”).  A term called “pseudosciatica” (a non-disk cause) includes a pinch from the piriformis muscle where the nerve passes through the pelvis (in the “cheek” or, the buttocks), which has been commonly referred to as “wallet sciatica” as sitting on the wallet in the back pocket is often the cause.

When this occurs, the term “peripheral neuropathy” or “ peripheral nerve entrapment” is the most accurate term to use. Direct trauma like a bruise to the buttocks from falling or hitting the nerve during an injection into the buttocks can also trigger “sciatica.”

The symptoms of sciatica include low back pain, buttocks pain, back of the thigh, calf and/or foot pain and/or numbness-tingling. If the nerve is compressed hard enough, muscle weakness can occur making it hard to stand up on the tip toes creating a limp when walking. In the clinic, we will raise the straight leg and if pinched, sharp pain can occur with as little as 20-30° due to the nerve being stretched as the leg is raised.

If pain occurs anywhere between 30 and 70° of elevation of either the same side leg and/or the opposite leg, this constitutes a positive test for sciatica (better termed, “nerve root tension”). When a disk is herniated into the nerve, bending the spine backwards can move the disk away and off the nerve resulting in relief, which is very diagnostic of a herniated disk. Having a patient walk on their toes and then heels and watching for foot drop as well as testing the reflexes, the sensation with a sharp object, and testing the reflexes at the knee and Achilles tendon can give us clues if there is nerve damage.

At our clinic we’ve gone beyond simple traditional chiropractic adjustments to “align the spine.” We use more advanced techniques, like Active Release Techniques to address the pressure that the muscles can exert on the sciatic nerve. We will also use motion-restoring spinal adjustments to restore healthy mobility to the spine. By utilizing these advanced techniques, we are usually able to get excellent results for our patients with low back pain and sciatica in a relatively short period of time.

It all starts with the initial exam. Call us to schedule yours 303.300.0424. We’re here to help you!

Miss Keri’s Bike Crash and This Week’s 1-Page Health News

Our awesome office manager Keri (my kids call her Miss Keri) was run off of the Cherry Creek bike trail and into a concrete half wall this weekend. Another cyclist was going too fast in the other direction, was too far over to his left, and basically forced Keri to choose between colliding with him or scraping the wall.

She chose the wall and this morning is sporting a nasty wound on her right arm. Of course, this guy didn’t bother to stop (maybe he was on his way to do Rocket Surgery). The message- be careful out there. A whole lot of morons are legally loose on our streets.

Of course, Miss Keri is tough as nails and never misses work, so she’s here today- bandaged up & ready to help you.

Here’s this week’s 1-Page Health News.

Mental Attitude: Get Your Sleep! Older adults with poor sleep habits have an altered immune system response to stress that may increase their risk for mental and physical health problems. Stress leads to significantly larger increases in a marker of inflammation in poor sleepers compared to good sleepers; a marker associated with poor health outcomes and death. Poor sleepers report more depressive symptoms, more loneliness and more global perceived stress relative to good sleepers. As people age, a gradual decline in the immune system occurs, along with an increase in inflammation. Heightened inflammation increases the risk for cardiovascular disease, diabetes and other illnesses, as well as psychiatric problems. American Journal of Geriatric Psychiatry, March 2012

Health Alert: Slow Down — You Move Too Fast? People who are considered ambitious, attend the best colleges and universities, have prestigious careers and earn high salaries don’t necessarily lead more successful lives. Ambition has its positive effects (in terms of career success, it certainly does) but ambitious people are only slightly happier than their less- ambitious counterparts and they actually live somewhat shorter lives. Journal of Applied Psychology, March 2012 Diet: Fish Oil. Six weeks of supplementation with fish oil significantly increased lean mass and decreased fat mass in test subjects. International Journal of Sport Nutrition and Exercise Metabolism, October 2010

Exercise: Good Reasons. Exercise helps you maintain proper muscle balance, reduces the rate and severity of medical complications associated with hypertension, helps alleviate menstrual symptoms and lowers your heart rate response to submaximal physical exertion. Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: Adjustment or Microdiskectomy for Sciatica? 60% of patients with sciatica (symptoms of unilateral lumbar radiculopathy secondary to lumbar disk herniation at L3-4, L4-5, or L5-S1) who had failed other medical management (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) benefited from spinal manipulation to the same degree as if they underwent surgical intervention. JMPT, October 2010

Wellness/Prevention: Dark Chocolate Good For The Heart. A flavonoid called epicatechin, found in dark chocolate, enhances mitochondria structure in people with advanced heart failure and type 2 diabetes. Mitochondria are cellular structures that provide the energy a cell requires in order to move, divide, and contract. Both heart failure and type 2 diabetes impair these cells, resulting in abnormalities in skeletal muscle. In individuals with diabetes and heart failure, these abnormalities in the heart and skeletal muscle cause decreased functional capacity, resulting in difficulty walking even short distances, shortness of breath, and a lack of energy. Clinical and Translational Science, March 2012

Quote: “Common sense is the collection of prejudices acquired by age eighteen.” ~ Albert Einstein

Neck Pain: Manipulation vs. Mobilization – What’s Better?

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint or muscle using various methods such as stretching.

Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide).

Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.

As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.

Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic, as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function!

In our clinic (Denver Chiropractic Center) we’ve found that the best approach uses BOTH. Mobilization in the form of Active Release Technique combined with safe and gentle (never forced) adjustments get better results in a shorter time frame. It all starts with the initial exam, so call us to schedule yours – 303.300.0424.

Maintenance Care for Chronic Low Back Pain

When people think of chiropractic, they immediately think of low back pain and are often surprised to find out that chiropractic can benefit many conditions such as carpal tunnel syndrome, tennis elbow, rotator cuff tears, as well as hip, knee, and ankle conditions.  There is also research support for manipulation (a key component of chiropractic) and its role in managing “somatovisceral” related conditions such as pneumonia, dizziness, stage 1 hypertension, PMS, asthma, colic, and bed wetting.

Research clearly shows that chiropractic manipulation out performs other forms of treatment for acute, subacute and chronic low back pain. But, the question remains, can “maintenance chiropractic” PREVENT problems down the road? Ironically, two medical doctors in August of 2011 published an article in a leading medical journal (SPINE) entitled, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” The study’s objective was to determine if treating chronic low back pain patients (pain >6 months) after a course of 12 treatments in the first month would do better, the same or worse if treatments were continued at 2-week intervals for an additional 9 months. They compared 3 groups of patients: 1.) 12 treatments of “sham” (placebo) manipulation over a 1-month period. 2.) 12 treatment of “real” spinal manipulative therapy (SMT) for 1 month but no treatments for the subsequent 9 months. 3.) The same as #2 but with treatments every 2 weeks over the next 9 months. To determine the differences between these 3 groups, the authors measured pain and disability scores (using questionnaires), generic health status (questionnaire), and back-specific patient satisfaction (questionnaire) at 1, 4, 7 and 10-month intervals.

The results showed that groups 2 (SMT for 1 month only) and 3 (SMT for 1 month + every 2 weeks for 9 months) had significantly lower pain and disability scores than the 1st group (sham/placebo group) at the end of the 1st month or, 12 visits. However, only group 3 (treatments were continued for 9 months at 2 week intervals) showed more improvement in pain and disability scores at 10 months. Equally important, the scores for the non-maintained group 2 patients returned to near their pre-treatment levels by month 10!

The authors concluded that not only is spinal manipulative therapy effective for chronic low back pain, but more importantly, REGULAR ADJUSTMENTS EVERY 2 WEEKS after the initial course of concentrated care (3x/week for 4 weeks) was needed, “…to obtain long-term benefit,” suggesting that, “…maintenance SM after the initial intensive manipulative therapy,” is appropriate care to obtain long-term results.

This study FINALLY supports the recommendations made by chiropractors for many years –regular adjustments are beneficial to obtain a higher quality of life, less pain and less disability! While this study didn’t include Active Release Technique, we have observed that combining ART with adjustments is much more effective than adjustments alone. If you’re dealing with back pain, call us. We can help 303.300.0424.

The Whiplash Syndrome: Posture and Exercise

Whiplash can result from a number of causes, not just from motor vehicle accidents.  A fall on the ice or a slippery floor, from a sports related injury, or even at the county fair on one of those rides that throws you around can result in the same type of injury. Whiplash occurs when the head is literally “whipped” either forwards and backwards or from side to side. It can include hitting the head but often does not.

Symptoms vary considerably and therefore the term, “whiplash associated disorders” or WAD has been adopted, based on the clinical presentation of the patient and on the specific tissues injured. Common symptoms include neck pain, loss of motion, headache and sometimes arm pain or numbness resulting in difficulty driving, working, sleeping and concentrating.

Active Release Techniques and adjustments of the neck can be highly effective in the treatment of whiplash associated disorder, and hence, Chiropractic is often the recommended first order of treatment for patients suffering from this condition. We have previously discussed the steps involved when presenting to a chiropractic clinic, from taking a detailed history and performing a thorough physical examination, and well as the many types of treatment options that exist.

Exercise is one of the most important forms of treatment as they can and should be performed multiple times a day as directed by us, so that a return to normal function with no pain can occur as quickly as possible. Presented here are a few VERY EFFECTIVE exercises that we frequently give to patients suffering from WAD:

1 Posture Correction A. Arch the back.

B. Retract the shoulders and tuck in the chin. Hold for 10-30 sec. & repeat.
2 Chin Retractions A. Sit properly.

B. Place your finger next to the chin.

C. Retract head & hold 10 sec. & repeat.
3 Neck Strength

Exercises

 A. Rotate RT using 10% Max.

B. Repeat to LT hold 5 sec.

 Repeat this moving the head Forwards, backwards, & sideways in a similar way!*
  • For #3, ALWAYS apply a push or resistance with your hand through the FULL range of comfortable motion in that plane. That means, in one direction let the head “win” (like in arm wrestling) and when moving in the opposite direction, let the hand “win,” (but don’t let up pushing with the head).  In other words, you are ALWAYS resisting against the movement in both directions moving as far as you can in both directions.

We work with patients who’ve been in car accidents and work accidents, and accept all auto insurance, including Med Pay. We also take most major health insurance plans. Are treatment plans are focused on solving the problem, not extending the case. If you’re suffering from accident injuries, call us today at 303.300.0424. We can help.

Neck Pain & Headaches & The “Power of Placebo”

We have all heard about the “placebo effect” and the “power of positive thinking.” A placebo, according to Wikipedia, is “…a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient.” When a placebo is used, it will sometimes have a perceived beneficial effect. When this occurs, it is referred to as “the placebo effect.” Placebos are commonly used in research where one group will be given the “real” treatment, another a “placebo” and a third group will be given nothing at all.  The evaluators are usually blinded as to who received which of the 3 approaches. The group receiving the placebo is carefully compared to the other 2 groups (the real treatment group and the no treatment group). Common placebos include inert tablets (sugar pills), sham treatment (which may include surgery, detuned electrical stimulation, sham acupuncture, sham manipulation, and many more). What is compelling and interesting is that the placebo often has a surprisingly positive effect on the patient’s symptoms and because of this, research is quite extensive trying to figure out why even placebos can benefit patients.

The phrase, “…the power of positive thinking” has also been around a long time. Again, studies have shown that when a patient’s treatment plan is presented in a detailed fashion with a “positive spin” compared to when the health care provider seems skeptical that it might help, the results favor the positive presentation. Call it what you will – the power of positive thinking, faith, hope – it does appear to be an important part of the formula to obtain a positive outcome from treatment, any treatment.

When considering the placebo effect of chiropractic, specifically cervical manipulation and its effect on neck pain and headache, a landmark study published by medical doctors revealed significantly greater benefits of cervical manipulation for acute, as well as subacute and even chronic (pain > 3 months) neck pain when compared to other forms of treatment (muscle relaxants or “usual medical care”). They reported that the highest quality study demonstrated that spinal manipulation benefits patients with tension-type headaches. They also reported that the complication rate for cervical spine manipulation is low, estimated to be between 5-10 per 10 million manipulations. Another very supportive study looked at the immediate effects from only one cervical spine manipulation (CSM) using objective instruments that measured pain (algometry) and strength (grip strength dynamometer) on patients with elbow tendonitis pain (lateral epicondylitis). The patients received either CSM or a “sham” method they refer to as “manual contact intervention” or MCI. The “real” treatment group (CSM) showed a significant increase in grip strength and reduced pain compared to the MCI/sham group.

The “take-home” message here is clear. Cervical spine manipulation was found to be superior to sham manual treatment (placebo), as well as muscle relaxers, or “usual medical care” for neck pain and headaches. Second, cervical manipulation clearly out performed the placebo effect in patients with elbow pain.

While this study did not specifically include Active Release Techniques, we’ve found that combining ART with manipulation is far more effective than only doing adjustments. If you have neck pain or headaches, call us at 303.300.0424 to schedule your first treatment. We can help you.