Back and Neck Pain

MECHANICAL BACK PAIN

Mechanical back pain is pain in the anatomic region of the back for which it is impossible to identify a specific pathologic cause of pain. It can include back pain with or without, pain in the lower limbs, which may or may not interfere with activities of daily living.

Chiropractors treat mechanical back pain using a package of care that may incude manual therapies, exercise, rehabilitation, acupuncture and therapeutic advice.

There is considerable evidence to support this approach to patient care:

National Institute for Health and Clinical Excellence. Early Management of persistent non-specific low back pain. 2009 May.

Airaksinen O, Brox JI, Cedraschic C, Hildebrandt J Klaber-Moffett J, Kovacs F et al:, et al. : Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006, 15 Suppl 2: S169-S191

Van Tulder M, Becker A, Bekkering T, et al. The COST B13 Working group on guidelines for the management of acute low back pain in primary care. Eur Guidelines for the management of acute non-specific low back pain in primary care. Eur Spine J 2006 Mar; 15 supp 2: S169-91.

Department of Health. Musculoskeletal Services Framework for England and Wales. 12 July 2006

DISC PROBLEMS

As regulated health professionals specialising in the diagnosis, treatment and management of musculoskeletal disorders, chiropractors are educated and qualified to treat intervertebral disc disorders, which may include sciatic symptoms of pain, sensory change and muscle weakness.

Chiropractors utilise a range of treatment and management interventions for intervertebral disc disorders. These depend upon the severity of the condition and any associated neurological symptoms. Chiropractors are educated and qualified to assess patients using orthopaedic and neurological tests, palpation and other physical assessment tools. Assessment may also include the use of diagnostic imaging including x-ray and MRI.

Chiropractors use a range of treatment interventions for intervertebral disc disorders including manual therapy, acupuncture techniques, electrotherapy, exercise prescription, therapeutic advice, patient education strategies and onward referral where indicated. They frequently work with orthopaedic and neurosurgical colleagues in managing disc injuries and may refer back to the general practitioner for appropriate analgesia.

Chiropractors recognise that not all disc injuries are suitable for spinal manipulation and, although rare, adverse events have been described in the literature. However, there is evidence to support this approach as a safe and effective treatment intervention for mild-moderate disc lesions.

Documented evidence includes the following:

Cassidy JD, Thiel HW, Kirkaldy-Willis WH. Side posture manipulation for lumbar intervertebral disc herniation. J Manipulative Physiol Ther 1993 Feb; 16(2): 96-103.

Quon JA, Cassidy JD, O’Connor SM, Kirkaldy-Willis WH. Lumbar intervertebral disc herniation. J Manipulative Physiol Ther. 1989 Jun; 12(3): 220-7

Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations:
a systematic review and risk assessment. J Manipulative Physiol Ther 2004 Mar-Apr; 27(3): 197-210

MECHANICAL NECK PAIN

Mechanical neck pain is pain in the anatomic region of the neck for which it is impossible to identify a specific pathologic cause of pain. It can include neck pain and from time to time, pain in the upper limbs, which may or may not interfere with the activities of daily living.

Chiropractors treat mechanical neck pain using a package of care that may include manual therapies, exercise, therapeutic advice and postural advice.

There is evidence to support this approach to patient care:

Haldeman S, Carroll L, Cassidy D. Schubert J, Nygren A: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine 2008. 33: S5-S7.

WHIPLASH ASSOCIATED DISORDERS

Whiplash is the term commonly given to traumatically induced neck pain, most commonly arising secondary to road traffic collision trauma. The term accelerationdeceleration injury is also used to describe this clinical syndrome.

It may involve a range of symptoms, most commonly neck and shoulder pain, upper back pain, upper arm pain and headaches. Multiple tissues can be involved, including joints, ligaments, tendons and nerves.

Chiropractors treat acceleration-deceleration injuries using a package of care that may include manual therapies, exercise and rehabilitation and acupuncture.

There is evidence to support this approach to patient care:

Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Swissa S, Zeiss E. Scientific monograph of the Quebec Task Force on Whiplash Associated Disorders: redefining whiplash and its management. Spine 1995;20(8S): 1S-73S.

Hurwitz EL, Caragee EJ, van der Weld G, et al Treatment of neck pain: non-invasive interventions: results of the Bone and Joint Decade 2000-2010. Task force on neck pain and its associated disorders. J. Manipulative Physiol 2009 Feb; 32(2 suppl): S141-175