Neck pain patients

Due to, among other factors, changes in the work place, the prevalence of neck pain has recently surpassed that of low back pain. The value of spinal manipulative therapy in the treatment of neck pain has been established in several clinical trials while at the same time other commonly used methods of treatment such as electro therapeutics and acupuncture have been questioned.

Studies comparing the strength of chronic neck patients and age-matched healthy controls have demonstrated that patient groups have considerably weakened neck muscles. Decreased muscle size and altered muscle fibre composition have also been demonstrated in patients suffering with chronic neck pain. These findings coupled with proprioceptive deficits include reduced postural performance, neck stability and balance. Comprehensive care will require that these deficits are addressed.

Fear avoidance, depression and anxiety have been shown to be among the most important predictors of chronic neck disability. Active care with an emphasis on self-reliance and training has been shown to have a meaningful effect on these psychosocial factors.

The rehabilitation of neck patients in the clinical setting has demonstrated excellent clinical results. It has been clearly shown that clinically supervised training demonstrates superior results than training in fitness centres or at home.

Whiplash Patients

Cervical spine injuries from automobile accidents continue to rise throughout the western world. The period of compensation related to an episode of whiplash trauma has grown from 72 days in 1987 to 95 days in 1988 to 108 days in 1989.

Perhaps the most important contribution from the Quebec Task Force was its diagnostic classification system called Whiplash Associated Disorders (WAD I-IV). As regards the treatment of whiplash disorders the Quebec taskforce recommended manipulation/ mobilisation, early activation, and non- prescription drugs for the initial care of whiplash patients. Exercise therapy is discouraged in the acute phase but is recommended for WAD II and III patients as symptoms subside. For patients that do not respond to initial care, multidisciplinary assessment/ treatment was suggested. The prevention of chronicity is emphasised and the task force recommends "rigorous clinical interventions" in order to prevent the "late whiplash syndrome" which is exceedingly difficult to treat.

There are a number of essential factors necessary for successful rehabilitative results.

Successful rehabilitation requires a minimum of two to three months of active training for successful clinical results. Training should be carried out two to three times per week for a period of one and a half hours per session. Trials that have reported less successful results have not been carried out for a sufficient duration of time.

Unsuccessful trials have as a rule utilised less than required training stimulus. Sufficient stimulus has been most markedly demonstrated in a trial published by Manniche et al. in the British Journal, Lancet. Several other clinical trials have demonstrated similar results.

Supervision

Supervised rehabilitation has been shown to be essential for successful clinical results. Patients with disabling low back pain need professional assistance and encouragement in order to overcome anxiety related to their pain as well as the fear of worsening their condition. Home training programmes demonstrate poor compliance and weak results.

Relative disregard of pain

Providing there are no signs of progressive neurological deficits, short-term pain should be expected and should not deter patients from continuing training . This of course requires qualified staff and continued evaluation of patients.

Predetermined quotas

In order to instill confidence in patients regarding self-sufficiency (both as regards exercise programmes as well as activities of daily living) predetermined quotas should be assigned to each patient. Quotas can naturally be adjusted according to progress, but predetermined goals are a key to successful rehabilitation.

The factors mentioned above form the philosophical basis of our rehabilitative protocols. The actual exercises are designed to reflect daily activities. The focus of our exercises is the restoration of normal functional values such as endurance, co-ordination and flexibility. Most exercises are performed with rehabilitative equipment and this type of low-tech supervised programme has been shown to be as clinically effective as more expensive high-tech programmes.

The staff of our clinic recently further updated their knowledge through participation in rehabilitation seminars with Dr Alan Jordan DC, PhD. University of Odense in Denmark, who has published extensively in the area of clinical rehabilitation. The emphasis of this seminar was practical instruction regarding the assessment and rehabilitation of chronic spinal pain patients. Several of the areas addressed in this seminar have been incorporated in our daily clinical work.

The rehabilitation programs utilised are in accordance with the latest scientific evidence, based upon validated rehabilitation. We monitor progress with validated assessment instruments including pain, disability, medication use, global assessments, workability and so forth. Our assessment and monitoring instruments are identical to those used by international researchers.

While it is obvious that intense supervised rehabilitation is by no means necessary for all patients who have experienced an episode of spinal pain, it is equally obvious that patients already suffering from chronic or recurrent symptoms, and others who are at risk of developing chronic disabilities, should undergo rehabilitative procedures. Proper care involves treatment design in which the size of the intervention reflects the size of the problem.

We are delighted to be able to offer this therapy to patients attending our clinic and would be pleased to answer any questions that you might have in this area.