Manual Therapy Eases Neck Pain, Cheaply

April 24, 2003 - A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to a new study.

Neck pain and stiffness is a common health problem, especially among older adults, and affects between 10% and 15% of the population. Although the condition isn't life threatening, it does cause a great deal of pain and disability as well as loss of productivity due to worker absenteeism.

Researchers say a variety of approaches in treating neck pain have been studied with mixed results, but little is known about how the treatments compare in terms of cost as well as effectiveness in relieving neck pain.

In this study, published in the April 26 issue of the British Medical Journal, Dutch researchers compared the cost-effectiveness of treatment with manual therapy, traditional physical therapy, or medical care from a general practitioner among 183 people with neck pain. Costs included both direct health care costs of treatment, such as office visits and drugs, as well as indirect costs like worker absenteeism.

Manual therapy -- practiced in the U.S. by chiropractors, osteopaths, and some physical or massage therapists -- consisted of spinal mobilization of the neck through slow, steady manipulation of the neck muscles, pushing them to the limit of the person's range of motion for a maximum of six, 45-minute sessions.

Physical therapy involved individualized exercise therapy, such as active and passive relaxation exercises, stretching, and functional movement exercises in up to 12, 30-minute sessions.

Routine medical care provided by a general practitioner consisted of a standard consultation with advice about the causes of the condition and potential aggravators and recommendations for self care using heat application, ergonomic considerations, or home exercises. Follow up visits every two weeks were optional.

After seven and 26 weeks, the study found significant improvements in recovery rates in the manual therapy group compared to the others. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group.

Those differences became negligible after 52 weeks follow up, however, and long-term recovery rates were similar across all three groups.

But researcher Ingeborg Korthals, PhD, of the Institute for Research in Extramural Medicine in Amsterdam, Netherlands says the overall expenses encountered by the manual therapy group were only a third of the costs associated with the other groups.

"The biggest cost factor was lower work absenteeism," says Korthals. "Almost no one in the manual therapy group missed work because they recovered so quickly and didn't shop around for other therapies after the treatment ended."

"In the physical therapy group and general practitioner group, the patients shopped around and did other therapies. In fact, a lot of them ended up in manual therapy," says Korthals.