The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medications, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions.
Applying Evidence to a Patient With Neck Pain
Can spinal manipulation/ mobilization help this patient?
Neck pain is a common condition, with estimates of the prevalence in the previous 12 months between 30% and 50% and activity limitations from neck pain between 1.7% and 11.5%. The impact of neck pain on society is large due to high medical costs, time off from work, and associated disability.
Manual therapy techniques, including manipulation and mobilization, are utilized by physical therapists as one option to reduce neck pain.
Previous systematic reviews have demonstrated a benefit from manipulation and mobilization in combination with exercise but were inconclusive in regard to the specific effects from manipulation and mobilization. In addition, debates continue in regard to the need for manipulation of the cervical spine, especially due to the potential for serious risks, such as vertebral artery dissection and stroke. A 2002 clinical practice guideline reported the true risk from manipulation is not known and that the greatest reported estimate of risk in the literature for irreversible injury is 1 in 20,000. Uncertainty is associated with the reported estimates due to small sample sizes and the quality of the studies reviewed. Di Fabio concluded that the risk may be minimized, but not entirely eliminated, with the use of mobilization instead of manipulation. To date, however, there is no empirical evidence that the risk is influenced by the type of technique.
The author presents a case study and tries to establish correlation between evidence with practice with an appropriate take home message.