Neck pain is one of the top 10 reasons for an individual to visit their physician. Cervical spine dysfunction can produce radiating arm pain often resulting from a pinched nerve. The lead article in the most recent issue of Spine reports on the results of a randomized clinical trial, which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in neck pain and arm symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck and arm pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003).

Manual physical therapy includes the use of hands-on techniques including joint mobilization, spinal manipulation, and soft-tissue techniques designed to restore motion and reduce pain. These manual techniques are applied to the neck or cervical spine and the thoracic spine considering the role and interdependence of the cervical and thoracic spine. The decision of when and where to apply these skilled manual therapy techniques is based upon physical examination findings that are specific to each individual patient. Hurwitz et al (2008) concluded in a systematic review on neck pain, also in the journal of Spine, Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.

The combination of manual therapy and exercise results in more meaningful reduction in pain in both the neck and arm in less time as well as improved patient satisfaction when compared to spinal manipulation or neck exercises alone. Three recent studies have demonstrated improved satisfaction scores and that it is more cost effective to seek therapies consisting of manual therapy and exercise as compared to general practitioner care and other forms of physical therapy. The current best evidence supports the use of manual therapy and exercise for patients with cervicogenic headaches, or headaches that originate from mechanical neck dysfunction.

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain. He continued, Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain. If you have neck or back pain or the aches and pains of musculoskeletal problems, contact a physical therapist today.