Effectiveness of Chiropractic Application in Individuals with Cervical Disc Herniation: A Randomized Controlled Trial

Year 2025, Volume: 8 Issue: 2, 208 - 216, 25.04.2025

Nuri Ulutaş , Ömer Şevgin , Beyzanur Dikmen Hoşbaş

https://doi.org/10.33438/ijdshs.1589247

Abstract

Purpose: The objective of this study was to investigate the impact of chiropractic intervention on the severity of neck pain, functional capacity, and disability level in individuals with cervical disc herniation. Method: The study population comprised of 50 individuals with cervical disc herniation who met the inclusion criteria. The participants were randomly assigned to two groups: an intervention group (n=26) and a control group (n=24). All participants received conventional physiotherapy five days a week for four weeks. In the intervention group, in addition to conventional physiotherapy, chiropractic adjustment using a diversified technique for cervical disc herniation was applied twice a week for four weeks. The McGill Melzack Pain Questionnaire (MMPQ), the Neck Disability Index (NDI), and the Bournemouth Neck Questionnaire (BNQ) were employed to evaluate the neck pain, functionality, and disability levels of both groups before and after treatment. Findings: The combination of conventional physiotherapy and additional chiropractic intervention proved to be an effective approach for reducing neck pain and disability levels while enhancing functionality in individuals with cervical disc herniation post-treatment (p<0.001). Nevertheless, no notable discrepancies were discerned between the control and chiropractic intervention groups (p>0.05). Conclusion: The application of chiropractic principles and practices was observed to result in a notable diminution of both neck pain and disability levels among those presenting with cervical disc herniation, together with an enhancement of functional abilities. Therefore, this approach may be considered as a potential alternative to existing treatment options for the management of individuals with cervical disc herniation.

Keywords

Neck pain, Cervical manipulation, Chiropractic, Physiotherapy, Diversified technique

Servikal Disk Hernisi Olan Bireylerde Kiropraktik Uygulamasının Etkinliği: Rastgele Kontrollü Bir Çalışma

Abstract

Bu çalışmanın amacı, servikal disk hernisi olan bireylerde kiropraktik müdahalenin boyun ağrısı şiddeti, fonksiyonel kapasite ve sakatlık düzeyi üzerindeki etkisini araştırmaktır. Çalışma popülasyonu, dahil etme kriterlerini karşılayan servikal disk hernisi olan 50 bireyden oluşuyordu. Katılımcılar rastgele iki gruba ayrıldı: bir müdahale grubu (n = 26) ve bir kontrol grubu (n = 24). Tüm katılımcılar dört hafta boyunca haftada beş gün geleneksel fizyoterapi aldılar. Müdahale grubunda, geleneksel fizyoterapiye ek olarak, servikal disk hernisi için çeşitlendirilmiş bir teknik kullanılarak kiropraktik ayarlama dört hafta boyunca haftada iki kez uygulandı. McGill Melzack Ağrı Anketi (MMPQ), Boyun Sakatlık İndeksi (NDI) ve Bournemouth Boyun Anketi (BNQ), her iki grubun tedavi öncesi ve sonrası boyun ağrısı, işlevsellik ve sakatlık düzeylerini değerlendirmek için kullanıldı. Geleneksel fizyoterapi ve ek kiropraktik müdahalenin kombinasyonu, servikal disk hernisi olan bireylerde tedavi sonrası işlevselliği artırırken boyun ağrısını ve sakatlık seviyelerini azaltmak için etkili bir yaklaşım olduğu kanıtlanmıştır (p<0,05). Bununla birlikte, kontrol ve kiropraktik müdahale grupları arasında dikkate değer bir tutarsızlık fark edilmemiştir (p>0,05). Kiropraktik prensiplerinin ve uygulamalarının uygulanmasının, servikal disk hernisi olan kişilerde hem boyun ağrısında hem de sakatlık seviyelerinde belirgin bir azalmaya ve işlevsel yeteneklerde bir artışa yol açtığı gözlemlenmiştir. Bu nedenle, bu yaklaşım servikal disk hernisi olan bireylerin yönetimi için mevcut tedavi seçeneklerine potansiyel bir alternatif olarak düşünülebilir.

Keywords

Boyun ağrısı, Servikal manipülasyon, Fizyoterapi, Karyopraktik, Diversified tekniği

References

• Aslan, E., Karaduman, A., Yakut, Y., Aras, B., Simsek, I. E., & Yaglý, N. (2008). The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine, 33(11), E362-E365. [PubMed] [CrossRef]
• Bale, A., & Newell, D. (2005). Chiropractic for neck pain: a pilot study examining whether the duration of the pain affects the clinical outcome. Clinical Chiropractic, 8(4), 179-188. [CrossRef]
• Beliveau, P. J., Wong, J. J., Sutton, D. A., Simon, N. B., Bussières, A. E., Mior, S. A., & French, S. D. (2017). The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropractic & manual therapies, 25, 1-17. [PubMed] [CrossRef]
• Binder, A. I. (2007). Cervical spondylosis and neck pain. Bmj, 334(7592), 527-531. [PubMed] [CrossRef]
• Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., Robertson, E. K., Altman, R. D., & Beattie, P. (2017). Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. journal of orthopaedic & sports physical therapy, 47(7), A1-A83. [CrossRef]
• Bolton, J. E., & Humphreys, B. K. (2002). The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. Journal of Manipulative and Physiological Therapeutics, 25(3), 141-148. [PubMed] [CrossRef]
• Bronfort, G., Evans, R., Nelson, B., Aker, P. D., Goldsmith, C. H., & Vernon, H. (2001). A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. In: LWW. [PubMed] [CrossRef]
• Bronfort, G., Haas, M., Evans, R. L., & Bouter, L. M. (2004). Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. The spine journal, 4(3), 335-356. [PubMed] [CrossRef]
• Bryans, R., Decina, P., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R. P., Shaw, L., Watkin, R., & White, E. (2014). Evidence-based guidelines for the chiropractic treatment of adults with neck pain. Journal of Manipulative and Physiological Therapeutics, 37(1), 42-63. [PubMed] [CrossRef]
• Bussières, A. E., Al Zoubi, F., Stuber, K., French, S. D., Boruff, J., Corrigan, J., & Thomas, A. (2016). Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review. BMC complementary and alternative medicine, 16, 1-15. [PubMed] [CrossRef]
• Cohen, S. P. (2015). Epidemiology, diagnosis, and treatment of neck pain. Mayo Clinic Proceedings, [PubMed] [CrossRef]
• Cohen, S. P., & Hooten, W. M. (2017). Advances in the diagnosis and management of neck pain. Bmj, 358. [PubMed] [CrossRef]
• Dinich, P. (2013). Chiropractic and health. Peter Dinich.
• Eubanks, J. D. (2010). Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. American family physician, 81(1), 33-40. [PubMed]
• Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical effectiveness and efficacy of chiropractic spinal manipulation for spine pain. Frontiers in pain research, 2, 765921. [PubMed] [CrossRef]
• Giles, L. G., & Muller, R. (2003). Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. In: LWW. [PubMed] [CrossRef]
• Gross, A., Kay, T. M., Paquin, J. P., Blanchette, S., Lalonde, P., Christie, T., Dupont, G., Graham, N., Burnie, S. J., & Gelley, G. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews(1). 28,1(1), CD004250. [PubMed] [CrossRef]
• Henderson, C. N. (2012). The basis for spinal manipulation: chiropractic perspective of indications and theory. Journal of Electromyography and Kinesiology, 22(5), 632-642. [PubMed] [CrossRef]
• Hidalgo, B., Hall, T., Bossert, J., Dugeny, A., Cagnie, B., & Pitance, L. (2017). The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. Journal of back and musculoskeletal rehabilitation, 30(6), 1149-1169. [PubMed] [CrossRef]
• Katkat, D., & Doğanel, E. D. (2024). Resilience Capacity and Life Skills of Paralympic Athletes. International Journal of Active & Healthy Aging, 2(2), 38–44. [CrossRef]
• Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J., Kolahi, A.-A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23, 1-13. [PubMed] [CrossRef]
• Kim, D. D. (2010). The effects of manipulation and mobilization on NDI and CROM in young adults with mild neck disability. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 16(2), 53-60.
• Kuguoglu, S., Eti-Aslan, F., & Olgun, N. (2003). McGill Melzack Ağrı Soru Formu (MASF) nun Türkçe’ye uyarlanması [Turkish adaptation of the McGill Melzack Pain Questionnaire (MPQ)]. Agrı, 15(1), 47-52.
• Lin, J. H., Shen, T., Chung, R. C. K., & Chiu, T. T. W. (2013). The effectiveness of Long's manipulation on patients with chronic mechanical neck pain: a randomized controlled trial. Manual therapy, 18(4), 308-315. [PubMed] [CrossRef]
• Masaracchio, M., Cleland, J., Hellman, M., & Hagins, M. (2013). Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(3), 118-127. [PubMed] [CrossRef]
• Melzack, R. (1987). The short-form McGill pain questionnaire. Pain, 30(2), 191-197. [PubMed] [CrossRef]
• Melzack, R., & Torgerson, W. S. (1971). On the language of pain. The Journal of the American Society of Anesthesiologists, 34(1), 50-59. [PubMed] [CrossRef]
• Miranda, I. F., Facchini, D., & Manfio, E. F. (2015). Influence of the cervical spine manipulation in the neck disability index in patients with chronic neck pain: A preliminary study. Manual Therapy, Posturology & Rehabilitation Journal, 1-5. [CrossRef]
• Ombregt, L. (2013). A System of Orthopaedic Medicine-E-Book. Elsevier Health Sciences.
• Peng, B., & DePalma, M. J. (2018). Cervical disc degeneration and neck pain. Journal of pain research, 11, 2853–2857. [PubMed] [CrossRef]
• Risbud, M. V., & Shapiro, I. M. (2014). Role of cytokines in intervertebral disc degeneration: pain and disc content. Nature Reviews Rheumatology, 10(1), 44-56. [PubMed] [CrossRef]
• Tabassum, N., & Azim, A. (2024). Common Sports Injuries, Training Load and Treatment Strategies for Optimal Recovery in Female University Athletes. International Journal of Active & Healthy Aging, 2(2), 53–59. [CrossRef]
• Uthman, O. A. (2016). Global, regional, national incidence, prevalence and years lived with disability for 310 acute and chronic diseases and injuries 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053), 1545-1602. [PubMed] [CrossRef]
• Vernon, H., & Mior, S. (1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14(7), 409-415. [PubMed]
• Vernon, H., Puhl, A., & Reinhart, C. (2011). Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes. Chiropractic & manual therapies, 19, 1-12. [PubMed] [CrossRef]
• Vernon, H. T., Triano, J. J., Ross, J. K., Tran, S. K., Soave, D. M., & Dinulos, M. D. (2012). Validation of a novel sham cervical manipulation procedure. The spine journal, 12(11), 1021-1028. [PubMed] [CrossRef]
• Wood, T. G., Colloca, C. J., & Matthews, R. (2001). A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction. Journal of Manipulative and Physiological Therapeutics, 24(4), 260-271. [PubMed] [CrossRef]
• Yilmaz Menek, M., Dansuk, E., & Tayboga, U. I. (2024). Effect of Local Vibration Therapy on Pain, Joint Position Sense, Kinesiophobia, and Disability in Cervical Disc Herniation: A Randomized Controlled Trial. Journal of clinical medicine, 13(15), 4566. [PubMed] [CrossRef]
• Yılmaz, O., Gafuroğlu, Ü., & Yüksel, S. (2019). Translation, reliability, and validity of the Turkish version of the Neck Bournemouth Questionnaire. Turkish Journal of Physical Medicine and Rehabilitation, 65(1), 59. [PubMed] [CrossRef]
• Zuo, G., Gao, T. C., Xue, B. H., Gu, C. C., Yan, Y. T., Zhang, Y. W., Liu, R. J., & Du, S. Q. (2019). Assessment of the efficacy of acupuncture and chiropractic on treating Cervical spondylosis radiculopathy: A systematic review and meta-analysis. Medicine, 98(48), e17974. [PubMed] [CrossRef]