How do we know patients have strong expectations for spinal manipulation?
Bishop et al gathered that data years ago in a paper titled “Patient Expectations of Benefit from Interventions for Neck Pain and Resulting Influence on Outcomes.” In this study, 140 patients currently experiencing neck pain were asked the following question about specific interventions prior to receiving treatment. “How much do you agree with the following statement? I believe [the intervention] will significantly help to improve this episode of my neck pain.” Answer options included: Definitely agree, agree, neutral, disagree, definitely disagree. A wide range of intervention options were included such as manual therapy, surgery, medication, exercise, etc.. Coming in at the #1 and #2 spots were both manual therapy interventions: Soft tissue massage and spinal manipulation. Specifically, 87% of patients believed soft tissue massage would significantly improve their neck pain and 75% of patients believed spinal manipulation would get the job done. These two interventions outpaced strengthening, aerobic training, stretching, traction, rest, medication, and many more. This is great news IF you are a provider who is comfortable and competent with the delivery of both soft tissue massage and spinal manipulation.
What are patients seeking out when dealing with neck or back pain?
It is also important to examine the angle of consumer behavior when experiencing pain. Observing action people take is likely just as valuable as asking them about their preferences while receiving physical therapy treatment. A paper titled “Observational Retrospective Study of the Association of Initial Healthcare Provider for New-Onset Low Back Pain with Early and Long-Term Opioid Use” published in 2019 gives terrific insight on this whether or not spinal manipulation techniques were preferred by patients. The paper examined data on a large cohort of individuals with back pain to identify which provider they sought care from first and key outcomes associated with that decision. Of the 216,504 patients in the study, over 20% of them (50,041) sought chiropractic treatment – while only 1.6% (3499) chose physical therapy. While access barriers and cost are likely relevant variables, this asymmetry strongly suggests that patients struggling with back pain believe spinal manipulation is what they need to recover.
We all want to get our patients better and we want our physical therapy businesses to thrive. Those results happen when we effectively blend our patient’s expectations with clinical reasoning and experience to deliver the most effective plan of care. We know a high percentage of patients with back and neck pain are seeking manipulation as part of their treatment package, let’s make sure we can effectively provide it.
Improve Your Spinal Manipulation Skills as a Physical Therapist
If you want to learn and refine your spinal manipulation technique and clinical reasoning make sure to check out our Total Spine Thrust CEU course. This two day course for physical therapists teaches effective manipulation techniques for the entire spine as well as safety and indications vital to leveraging this skill effectively in practice. Find this course at https://ptonice.com/our-courses/total-spine-thrust-manipulation/.
Bishop, Mark D., Paul E. Mintken, Joel E. Bialosky, and Joshua a. Cleland. 2013. “Patient Expectations of Benefit from Interventions for Neck Pain and Resulting Influence on Outcomes.” The Journal of Orthopaedic and Sports Physical Therapy 43 (7): 457–65.
Kazis, Lewis E., Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, Kathleen Carey, et al. 2019. “Observational Retrospective Study of the Association of Initial Healthcare Provider for New-Onset Low Back Pain with Early and Long-Term Opioid Use.” BMJ Open 9 (9): e028633.