Spinal manipulation for a member with a “neck crick”
© Dr. Michael D. Jacobson, D.O. Do not reproduce this article without permission.
A CHM member wrote: My husband has had a neck crick for over 10 days. He hasn’t taken off any work and is a framer/construction worker. Would a neck brace help while he is at work? He hasn’t had a fever with it. Also, no headaches, confusion, or any other symptoms. I can feel some knots in his neck, but I figured this was normal with a neck crick.
One of our doctor friends suggested we go to a walk-in orthopedic clinic. We have a chiropractor in town that I think is pretty good, but I think my husband is nervous about a chiropractor doing anything to his neck. His brother had a bad experience with a chiropractor treating a neck crick.
What would you recommend?
Dr. Jacobson’s response: As an osteopathic doctor, or D.O., my preference is to get manipulative therapy—or what chiropractors refer to as an adjustment—if a neck motion problem presents itself. It’s usually one of the quickest ways to restore freedom of motion. Therefore, whoever performs good spinal manipulation—such as a D.O. or D.C. (chiropractor)—would probably be a good choice (Editor’s note: The CHM Guidelines state that bills for chiropractic treatment or testing supporting chiropractic treatment are ineligible for sharing.) Neck braces, however, usually aren’t very effective for this condition, but it may be worth a try if a quick test of support brings comfort.
Additionally, I want to address your comments about your brother-in-law’s poor experience with manipulative therapy. There are a few reports of complications to neck adjustments, especially when high velocity low amplitude (HVLA) is used. HVLA involves the physician applying a quick, short thrust to the patient’s spine to free a restriction. This is usually associated with a popping or cracking noise. If the treatment is too vigorous or there is an underlying vulnerability, injury is a possibility.
A 2017 Copenhagen (Denmark) study examined over 100 articles to determine the incidence of serious adverse events associated with spinal manipulative therapy (SMT). Of the 118 review articles with data, 46 percent expressed that SMT was safe, 13 percent stated that it was harmful, and the remaining 42 percent were neutral. The studies that seemed to be of the highest quality were more likely to conclude that SMT was safe. However, the 13 reviews that contained predictive data, estimated that the incidence of serious adverse advents was somewhere between one in 20,000 and one in 250 million manipulations. While those low-risk numbers may be reassuring, the relatively rare significant adverse effects include stroke, headache, and tearing of the vertebral artery—a medical and possibly surgical emergency.
After reviewing the studies, I believe that chiropractic and osteopathic manipulation are safe treatment options. In fact, they’re probably much safer than many procedures we practice in medicine and surgery. Furthermore, it has stood the test of time. Osteopathic manipulation, which preceded chiropractic care by over 20 years, has been around since Dr. Andrew Taylor Still, M.D., announced it in Kirksville, Mo., in 1877. It has been present in some form for millennia.
If the relatively small risk of HVLA still makes patients uncomfortable, there are many other types of manipulative techniques. My osteopathic education included training in other approaches that don’t involve any thrusting, cracking or popping. These include direct and indirect techniques, intermittent muscle contraction, stretching and holding muscles in order to relieve spasm, fascial release and counterstrain—a personal favorite. In addition, conventional physical therapy offers many options: active (such as exercises or stretching) or passive (such as ice, heat, hydro/water therapy, and others).
A patient of mine, a pastor, was so “stoved up” with a neck crick that he couldn’t turn his neck in any direction or to any degree without significant pain. Since he didn’t own a hot tub, I had him heat the baptistery water as hot as he could tolerate and sit on a stool with the water up to his chin! He was able to experience enough muscle relaxation that he could turn his head without pain. This greatly accelerated his recovery.
Medications can only provide temporary symptom relief, which is why I prefer passive therapy when the motion restriction is acute or severe, then active physical medicine techniques that address the mobility problem.