MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

A pain in the neck is just that: A PAIN IN THE NECK! Unfortunately, this symptom is both common and often difficult to treat. Chiropractors pride themselves of treating neck pain effectively. Yet, the evidence is at best thin, the costs are high and, as often-discussed, the risks might be considerable. Thus, any inexpensive, effective and safe alternative would be welcome.

This RCT  tested two hypotheses:

1) that denneroll cervical traction (a very simple device for the rehabilitation of sagittal cervical alignment) will improve the sagittal alignment of the cervical spine.

2) that restoration of normal cervical sagittal alignment will improve both short and long-term outcomes in cervical myofascial pain syndrome patients.

The study included 120 (76 males) patients with chronic myofascial cervical pain syndrome (CMCPS) and defined cervical sagittal posture abnormalities. They were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up.

After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS and NDI. However, at 10 weeks, there were significant differences between groups favouring the intervention group for PPT and all measures of CROM. Additionally, at 10 weeks the sagittal alignment variables showed significant differences favouring the intervention group for CV and SH indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favouring the intervention group at 1-year follow up.

The authors concluded that the addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings.

Yes, I know, this study is far from rigorous or conclusive. And the evidence for traction is largely negative. But the device has one huge advantage over chiropractic: it cannot cause much harm. The harm to the wallet is less than that of endless sessions chiropractors or other manual therapists (conceivably, a self-made cushion will have similar effects without any expense); and the chances that patients suffer a stroke are close to zero.

12 Responses to Neck pain? Forget about chiropractic; a simple device might be much better

  • A simple way to achieve something similar is to sleep on an orthopaedic pillow (heavy memory foam with a gutter in the middle for the head). They are available from most places that sell pillows and are comfortable, cheap, safe and don’t require a prescription. I have used one for years and the headaches and neck pain that I used to get have all but gone. I know this is anecdotal and deserves to be put in the same category as the man who told me that the best way to prevent gout is to sleep with a potato in the bed, but I have found the improvement to be quite marked and durable.

  • Eine Freundin von mir hat mich einmal zu einem Chiropraktiker mitgenommen. Mir hat nicht gefehlt, keine schmerzen nichts. Hat dieser Scharlatan gemeint, dass er meine Wirbel einrenken müsse und ich nächste Woche noch einmal kommen solle zu einem ausführlicheren Gespräch, weil angeblich meine Seele mit meinem Körper im Ungleichgewicht wäre. Ich habe diesen Menschen gewarnt, wenn er Hand an mich legt bekommt er eine Anzeige wegen Körperverletzung und wenn er für diesen Scheiß auch noch Geld von mir will, zeige ich ihn an wegen Betruges.
    Danach war dieser Kerl ganz klein mit Hut, ich habe zwar jetzt eine Freundin weniger, dafür bin ich aber zufrieden und gesund.

    [A rather inadequate translation by Google:

    A friend of mine once took me to a chiropractor. I was not missing, no pain. Did this charlatan mean that he had to fix my vertebrae and I should come again next week for a more detailed conversation, because supposedly my soul would be in imbalance with my body. I warned these people, if he puts his hand to me, he gets an ad for assault and if he wants for this shit even money from me, I show him for fraud.

    After that, this guy was very small with hat, I have now a friend less, but I am satisfied and healthy.

    Admin]

  • I brought up a few concerns on this paper on another forum about a month ago. In this case my comments centered around some of their references. This seems to be a common problem in some of the papers from these authors.

    —-

    A few of my thoughts… Do these papers really support this?

    “In the cervical region, various studies point to the fact that altered sagittal plane alignment of the cervical spine such as straightened, s-curves, reversed curves, and anterior head translation can result in abnormal stresses and strains leading to premature and acceleration of degenerative changes in the muscles, ligaments, bony structures and neural elements [11–13].”

    Whose standard of care?

    “Accordingly, the present randomized controlled trial was undertaken to investigate the functional and pain response outcomes of denneroll cervical extension traction compared to standard care in patient cases with chronic MPS, with a verified hypo-lordosis and anterior translation of the cervical spine.”

    These studies don’t appear to investigate this approach.

    “ Initial cervical radiological assessment was important to identify the cervical curve apex to determine where a subject should properly place the apex of the denneroll in their cervical spine [16, 18].”

    Someone mentioned above that there may be other reasons not to use a denerroll. Should the exclusion criteria be expanded? Would that affect outcomes?

    “Participants were excluded if any signs or symptoms of medical “red flags” were present: tumor, fracture, rheumatoid arthritis, osteo- porosis, and prolonged steroid use. Additionally, subjects were excluded with previous spine surgery and any exam findings consistent with neurological diseases and vascular disorders.”

    Is this standard of care and for whom? Are these approaches used mainly by some physical therapists?

    “Both the control group and the intervention groups received the treatment interventions including: Integrated neuromuscular inhibition technique (INIT), Ischemic Compression, Strain Counterstrain (SCS), and muscle energy technique (MET).”

    Has this been determined to be a placebo? Where are the references? How was the size of the towel determined and was it standardized to all subjects? Does the size of the subject matter? Etc. (you just can’t call something a placebo).

    “The control group was treated also with a placebo treatment using a small cervical towel applied in the supine position located in the mid cervical spine as an intervention to mimic the denneroll traction time; but without applying significant extension bending of the cervical spine.”

    Why 30 treatments? Why not 24 or 50?

    “Following 30 sessions…”

    Reference 18 is…Juul T, Søgaard K, Davis AM, Roos EM. Psychometric properties of the neck outcome score, neck disability index, and short form–36 were evaluated in patients with neck pain. J Clin Epidemiol. 2016;79:31–40

    Reference 21 is…MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39:400–17

    These papers don’t appear to even address the topic.

    “The participants in the intervention group additionally received the denneroll cervical extension traction (Den- neroll Industries, Sydney Australia; http://www.denner- oll.com) following previously published protocols [18, 21].”

    Uh, Ok, the purpose of these calls was what? Compliance? Why wasn’t this information reported?

    “During the follow up period, participants were followed up by telephone inter- views every 3 months.”

    Regarding photogrammetry…

    “Standing cervical and shoulder posture was measured with photogrammetry, which provide valid and reliable indicators of the spine [16].”

    However,

    “With photogrammetry, various spinal posture assessment protocols can be adopted. However, the literature lacks evidence to support the use of photogrammetry in accompanying postural treatment, whether for clinical or research purposes.” World J Orthop. 2016 Feb 18; 7(2): 136–148.

    The reference was on a small sample of healthy subjects.

    “Cervical spine global range-of-motion was measured using the valid and reliable cervical range-of-motion (CROM) device [26].”

    Reference 26…”The psychometric properties of the CROM were shown to be very good for measures taken from healthy subjects,..”

  • The patented Denneroll device was invented by an Australian chiropractor and its application is determined by the biomechanical analysis of the patient’s radiographic digital image. Only certain cervical sagittal configurations would qualify for this method of spinal traction with other chiropractic traction procedures being more appropriate for cervical sagittal curve rehabilitation. Your understanding is limited because Chiropractic cannot be forgotten in the management of neck pain because the diagnosis of sagittal curve rehabilitation requires the skill and education of a professional trained in the correction of spinal displacements. As this study detailed on page 12 of 13, Deed Harrison, Chiropractor “made substantial contributions to the conception and design of the study, the analysis and interpretation of the data…”

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