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Emerg Med J 20:62 doi:10.1136/emj.20.1.62
  • Best evidence topic reports

Alternative treatments for neck sprain

  1. Kerstin Hogg, Clinical Research Fellow,
  2. Rosemary Morton, Consultant,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

      Abstract

      A short cut review was carried out to establish whether osteopathy or chiropractic treatments improve outcome in patients with neck sprain. Altogether 206 papers were found using the reported search, of which nine presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated

      Report by Kerstin Hogg, Clinical Research Fellow
 Checked by Rosemary Morton, Consultant

      Clinical scenario

      A 25 year old woman attends the emergency department having been in a rear end shunt. She complains of pain in her neck. On examination she has right sternomastoid tenderness and restricted movement. You diagnose a neck sprain and advise physiotherapy, exercise and anti-inflammatory drugs. She asks you whether she should go and see an osteopath or a chiropractor. You wonder whether there is any evidence for these alternative treatments.

      Three part question

      In [adults with neck sprain] does [osteopathy or chiropractic] improve [outcome]?

      Search strategy

      Medline using the OVID interface 1966–10/02, Cochrane Library 2002 Issue 3 and hand search of paper references. [(exp Neck injuries OR exp Neck pain OR neck.mp OR whiplash.mp) AND (exp Osteopathic medicine OR osteopath$.mp OR chirop$.mp)] LIMIT to human AND English.

      Search outcome

      Altogether 206 papers were found, of which 13 were relevant. One literature review is not included in table 2 as all the papers are either represented in another review or described separately. Three papers were excluded on the basis of having 10 or fewer patients. The remaining nine papers are shown in table 2 .

      Many of the studies also include patients with lower back pain—only the neck pain patients are described in table 2.

      Comments

      Virtually all of these studies are flawed and the numbers tiny. In particular there are no powerful studies comparing best conventional treatment with best alternative treatments. There were no papers relating directly to osteopathy.

      ▸ CLINICAL BOTTOM LINE

      Chiropractic therapy is associated with improvement in neck symptoms but there is no evidence to show whether this improvement is greater or worse than that obtained with conventional treatment.

      Report by Kerstin Hogg, Clinical Research Fellow
 Checked by Rosemary Morton, Consultant

      References


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