When your neck becomes arthritic and painful, the bones and inflamed soft tissue can compress the nerves that travel through the neck and down the arms. This is called osteoarthritis and degenerative joint disease (DJD). More specific to the bones in the spine, this is called degenerative disc disease (DDD). When you have degenerative disc disease and it presses on a nerve, it is called a radiculopathy, and it will cause pain that travels down the arm, tingling in the fingertips or arm, and numbness in the fingertips or arm. If a radiculopathy gets bad enough, it can cause the muscles to shut down, and this can be a surgical case, rather than a chiropractic case.
But before it becomes a surgical problem, can chiropractic care fix it?
A paper published in the journal Clinical Rehabilitation took a good look at the current published evidence to find out. They noted that cervical radiculopathy is often treated by conservative methods. These conservative methods include non-steroidal-anti-inflammatory drugs (NSAIDS), oral steroids, computerized cervical traction (decompression), manual therapy, cervical collar.
NSAIDs are a very common for the common person to use. It’s available over the counter, and you can buy as many as you want for very cheap. The problem with NSAIDS is that they tear up your stomach–they can cause ulcers. NSAIDS are actually a very common cause of illness or death in around the world. NSAID use has been associated with ulcers, serious cardiovascular events, hypertension, acute renal failure, and worsening of previous heart failure. Use them sparingly.
Cervical collars use to to be used more commonly for neck pain, but in the past couple of decades, you don’t see them being used anymore. This is because the supportive collar can make you dependant on it to move through your life. It can make the muscles in your neck shrink. And worse, this kind of brace can reinforce your pain avoiding behavior, rather than confronting the painful area with better function. It’s pretty well-known in chiropractic and physiotherapy that we should use cervical collars sparingly.
Because more and more people are using spinal manipulation around the world, these reviewers are in China, they wanted to take a critical look at how it works. They recognize that when you have your neck adjusted, it provides pain relief accompanied by an audible pop. They surmise that within the joint, there is a gapping in the facet joints and a reflex relaxation of the supporting muscles of the spine. This allows better circulation in the soft tissue in the joints and supportive ligaments in the spine, and it accelerates your body’s ability to heal itself.
These researches looked at over 2500 articles to find out what research was available for neck pain, radiculopathy, and manipulation. They sorted through them and only found 3 studies that met their exact criteria. They found that the three studies were of “moderate” quality. What this is is an understated way of saying that the studies were really good. They’re not gold standard, but they were very well designed. All three studies were randomized controlled trials. Some people in the studies got the treatment, and some got no treatment, and the patient’s outcomes were compared.
What they found was that in all three studies, the patients with pinched nerves improved compared to the patients that had no treatment or computer traction. Spinal manipulation works better than traction. Not only does cervical manipulation work better than other forms of treatment, but it has an immediate effect with treatment. Getting adjusted gives you an immediate, palpable improvement in the way you feel. You feel like pressure is released immediately.
In summary, this review is similar to the guidelines published by the North American Spine Society. The NASS guidelines are evidence-based reviews that give spine doctors a roadmap for treatment when they have patients with certain conditions. For patients with low-back radiculopathy, they recommend spinal manipulation by chiropractors as the first course of care. Spinal manipulation has positive evidence in support of it, while certain medications have no evidence, or evidence against their use. There is no evidence in support of exercise or stretching techniques for treating a pinched nerve. Only chiropractic adjustments show improvement for lumbar spine radiculopathy. This study shows the same for the neck.
Todd Lloyd, DC
chiropractor in San Francisco.
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