I see a chiropractor and a physical therapist alternately almost every week for my neck pain. My brother insists that all he ever needs is just a little “adjustment” and he’s good to go for another week. My experience has been that the exercises I’m doing help “hold” the adjustment. Is there any proof either way?

Two of the most popular treatment methods for chronic neck pain are spinal manipulation and exercise.
Research has shown us that exercise therapy works well for neck pain. Spinal manipulation is also helpful for neck pain. Would combining the two make a difference? And if so, how much more benefit is there of adding spinal manipulation to an exercise program?

To find out, a group of chiropractors, physicians, and physical therapists treated adults who had chronic neck pain with either supervised exercise therapy (ET), home exercise and advice (HEA), or exercise therapy and spinal manipulation therapy (ET + SMT).

The supervised exercise therapy groups received high-dose strengthening exercises. High-dose means many repetitions with increased resistance (load). The exercises for this group were geared toward the neck and upper body. The home exercise group performed low-dose exercises that were gentle and emphasized motion rather than strength. The home exercise and advice group also received patient education about neck anatomy, posture, and ways to reduce strain on the neck.

Results were compared after a 12-week treatment period. Follow-up was one full year. Neck pain, neck motion, and neck strength were the main measures of outcomes. Everyone in all three groups showed improvements but the exercise groups had the most gains in all areas measured.

Patient satisfaction was highest in the supervised exercise therapy group. And overall results were better for the exercise groups with or without spinal manipulation. This last finding suggests that adding spinal manipulation to supervised exercise therapy for chronic neck pain has little value.

The authors summarized their findings by saying that intense, supervised exercise may be the best way to treat chronic neck pain. Spinal manipulation does not appear to add enough benefit to be helpful in this approach. Since there was a significant response among the patients receiving home therapy and advice (HEA), perhaps it makes the most sense to being with HEA and then try supervised high-dose exercise therapy if the HEA isn’t successful. Spinal manipulation may not be needed at all.

As always, any treatment program should be provided based on each individual’s needs. Exercise therapy with or without supervision requires discipline and a long-term commitment on the part of the patient. But for those who are seeking pain relief and improved function, the results are consistent with exercise.