Conditions Chiropractic May Help With: Carpal Tunnel and Tennis Elbow

 

Do you have tennis elbow or carpal tunnel? Have you been trying other forms of care without success?  Chiropractic manipulation is one of the tools that I use to successfully treat these ailments.
This blog is a continuation of a blog post seeking out the evidence of the above image.  Though I have not found the specific statements in the research regarding the effectiveness of manipulation on tennis elbow and carpal tunnel here is what the evidence says in the literature.
Tennis Elbow
Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study

Background and Purpose. Lateral epicondylitis (“tennis elbow”) is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises.

Subjects and Methods. Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests.

Results. Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2.

Discussion and Conclusion. Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.

Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia 
note: I am unable to read a full copy of this paper therefore I do not know the “specific manipulative treatment”.

The treatment of lateral epicondylalgia, a widely-used model of musculoskeletal pain in the evaluation of many physical therapy treatments, remains somewhat of an enigma. The protagonists of a new treatment technique for lateral epicondylalgia report that it produces substantial and rapid pain relief, despite a lack of experimental evidence. A randomized, double blind, placebo-controlled repeated-measures study evaluated the initial effect of this new treatment in 24 patients with unilateral, chronic lateral epicondylalgia. Pain-free grip strength was assessed as an outcome measure before, during and after the application of the treatment, placebo and control conditions. Pressure-pain thresholds were also measured before and after the application of treatment, placebo and control conditions. The results demonstrated a significant and substantial increase in pain-free grip strength of 58% (of the order of 60 N) during treatment but not during placebo and control. In contrast, the 10% change in pressure-pain threshold after treatment, although significantly greater than placebo and control, was substantially smaller than the change demonstrated for pain-free grip strength. This effect was only present in the affected limb. The selective and specific effect of this treatment technique provides a valuable insight into the physical modulation of musculoskeletal pain and requires further investigation.

Carpal Tunnel Syndrome
An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome.

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. There is little literature available that addresses the management of this condition, which may partly explain why physiotherapy is often overlooked as a treatment approach in its management. This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome. An experimental different subject design compared three groups of subjects in three different conditions (two treatment interventions and one control group). Each group consisted of seven patients. The objectives of the study were: (1) to investigate differences between treated and untreated groups; (2) to investigate differences in the effectiveness of treatment I (median nerve mobilization) compared with treatment II (carpal bone mobilization). Measurements were taken applying several measurement tools, including active range of wrist movement (ROM flexion and extension), upper limb tension test with a median nerve bias (ULTT2a), three different scales to evaluate pain perception and function, and lastly numbers of patients continuing to surgery in each group were compared. In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated, in particular the descriptive analysis of results for ULTT2a and numbers of patients continuing to surgery. When analysed statistically, less could be concluded. Only scores on a Pain Relief Scale (P<0.01) demonstrated highly significant differences between the three groups when analyzed using Kruskal-Wallis Test. In exploring the results of the two intervention groups, no statistically significant difference in effectiveness of treatment was demonstrated between carpal bone mobilization and median nerve mobilization.

Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail.

OBJECTIVE: To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome.

DESIGN: Two-group, randomized, single-blind trial with 9 wk of treatment and a 1-month follow-up interview.

SETTING: Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington, Minnesota.

PATIENTS: Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies.

INTERVENTIONS: Interventions included ibuprofen (800 mg 3 times a day for 1 wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical treatment. Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine (three treatments/week for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk), ultrasound over the carpal tunnel and nocturnal wrist supports.

MAIN OUTCOME MEASURES: Outcome measures were pre- and postassessments of self-reported physical and mental distress, nerve conduction studies and vibrometry.

RESULTS: There was significant improvement in perceived comfort and function, nerve conduction and finger sensation overall, but no significant differences between groups in the efficacy of either treatment.

CONCLUSIONS: Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care.

Chiropractic manipulation in carpal tunnel syndrome.
OBJECTIVE: To determine if chiropractic manipulation could relieve carpal tunnel syndrome (CTS).
CLINICAL FEATURES: A 42-yr-old female suffered from pain, tingling and numbness in the right wrist. Paresthesia along the C6 dermatome, a positive Phalen’s test and Tinel’s sign was present. EMG testing confirmed the clinical diagnosis of CTS.
INTERVENTION AND OUTCOME: Chiropractic manipulations were rendered 3 times per week for 4 wk, to the subject’s cervical spine, right elbow and wrist using a low amplitude, short lever, low force, high velocity thrust. Significant increase in grip strength and normalization of motor and sensory latencies were noted. Orthopedic tests were negative. Symptoms dissipated.
CONCLUSION: In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes. Further investigations using double-blind, cross-over designs with larger samples are warranted.

I hope you found this interesting.

Dr Notley
Chiropractor and Athletic Therapist of Winnipeg

Related Posts

Conditions Chiropractic May Help With: Chronic Neck Pain

Conditions Chiropractic May Help: Chronic neck pain

 

I found this image on Facebook and I thought it was worth sharing with all of you.  What I liked about the image is that it shows many of the conditions I find to be successfully treated in my Chiropractic/Athletic Therapy practise. What I was curious about, when viewing this picture, was if these were actual quotes in the research.  There are no references on the picture but I did find a website that gave some references.  The problems with these references is that either I couldn’t find the article in an internet search or I couldn’t read more than the abstract and if I could read it I did not find the statistical quotes.  If anyone finds them please send them to me.
I decided to search for some evidence of these stated benefits even if I couldn’t find the direct quote. This post will be the first of several blog posts on the above statements.
1. Chronic Neck Pain: “Nearly 80% of chronic neck pain patients improve significantly with chiropractic care”.
Take a look at some of the literature.  You will see that spinal manipulation is of benefit for chronic neck pain especially if a neck exercise program is also performed.
Study Design. A randomized, prospective clinical study was conducted that included 119 patients with chronic neck pain of greater than 3 months’ duration.
Objectives. To compare the relative effectiveness of intensive training of the cervical musculature, a physiotherapy treatment regimen, and chiropractic treatment on this patient group.
Summary of Background Data. There are only a few studies involving chronic neck pain patients representative of those seeking care in primary health care centers. Mobilization techniques and intensive training have been shown to be useful, but cervical manipulation has not been assessed. Clinical results involving these commonly used therapies have not been compared.
Methods. A total of 167 consecutive patients were screened. One hundred nineteen patients were admitted to the study and were randomized according to Taves’ minimization principles. Primary outcome measures included self-reported pain, disability, medication use, patients’ perceived effect, and physician’s global assessment. Patients were assessed at enrollment and at completion of the study. Postal questionnaires were used to carry out 4- and 12-month follow-up assessments. Secondary outcome measures included active range of motion of the cervical spine as well as strength and endurance measurements of the cervical musculature. These measurements were carried out at enrollment and completion of the study.
Results. A total of 88% of the patients completed the study. Of these, 97% completed the 4-month questionnaire and 93% the 12-month questionnaire. Patients from all three groups demonstrated significant improvements regarding self-reported pain and disability on completion of the study. Improvements were maintained throughout the follow-up period. Medication use was also significantly reduced in all groups. There was, however, no significant difference between groups at any assessment period. Physician’s and patients’ assessments were also positive, and again group scores were essentially equal. Patients who underwent intensive training demonstrated significantly greater endurance levels at the completion of treatment.
Conclusions. There was no clinical difference between the three treatments. All three treatment interventions demonstrated meaningful improvement in all primary effect parameters. Improvements were maintained at 4- and 12-month follow-up. However, whether this was a result of the treatments or simply a result of time is unknown. Future studies will be necessary to delineate ideal treatment strategies.
Study Design. A randomized, parallel-group, single-blinded clinical trial was performed. After a 1-week baseline period, patients were randomized to 11 weeks of therapy, with posttreatment follow-up assessment 3, 6, and 12 months later.
Objectives. To compare the relative efficacy of rehabilitative neck exercise and spinal manipulation for the management of patients with chronic neck pain.
Summary of Background Data. Mechanical neck pain is a common condition associated with substantial morbidity and cost. Relatively little is known about the efficacy of spinal manipulation and exercise for chronic neck pain. Also, the combination of both therapies has yet to be explored.
Methods. Altogether, 191 patients with chronic mechanical neck pain were randomized to receive 20 sessions of spinal manipulation combined with rehabilitative neck exercise (spinal manipulation with exercise), MedX rehabilitative neck exercise, or spinal manipulation alone. The main outcome measures were patient-rated neck pain, neck disability, functional health status (as measured by Short Form-36 [SF-36]), global improvement, satisfaction with care, and medication use. Range of motion, muscle strength, and muscle endurance were assessed by examiners blinded to patients’ treatment assignment.
Results. Clinical and demographic characteristics were similar among groups at baseline. A total of 93% of the patients completed the intervention phase. The response rate for the 12-month follow-up period was 84%. Except for patient satisfaction, where spinal manipulative therapy and exercise were superior to spinal manipulation with (P = 0.03), the group differences in patient-rated outcomes after 11 weeks of treatment were not statistically significant (P = 0.13). However, the spinal manipulative therapy and exercise group showed greater gains in all measures of strength, endurance, and range of motion than the spinal manipulation group (P < 0.05). The spinal manipulation with exercise group also demonstrated more improvement in flexion endurance and in flexion and rotation strength than the MedX group (P < 0.03). The MedX exercise group had larger gains in extension strength and flexion–extension range of motion than the spinal manipulation group (P < 0.05). During the follow-up year, a greater improvement in patient-rated outcomes were observed for spinal manipulation with exercise and for MedX exercise than for spinal manipulation alone (P = 0.01). Both exercise groups showed very similar levels of improvement in patient-rated outcomes, although the spinal manipulation and exercise group reported greater satisfaction with care (P < 0.01).
Conclusions. For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone. The effect of low-technology exercise or spinal manipulative therapy alone, as compared with no treatment or placebo, and the optimal dose and relative cost effectiveness of these therapies, need to be evaluated in future studies.
Purpose: To determine whether spinal manipulation as an isolated intervention has any effect on proprioception-dependent performance of subjects with chronic neck pain, compared with effects achieved through stretching exercises.
Design: Matched, nonrandomized, controlled trial.
Setting: Private chiropractic clinic.
Participants: Twenty subjects with chronic (daily, > or = 4 months) neck pain. Volunteers were recruited from a pool of patients visiting the clinic or from those referred by informed clinicians.
Intervention: Half of the subjects received six sessions of high-velocity, low-amplitude manipulation to the cervical and upper thoracic regions during a 3-4 wk period. The other half were instructed in stretching exercises for the cervicothoracic muscles, to be performed in two unsupervised sessions daily over the same time period.
Main Outcome Measurements: Pain levels were assessed at baseline and at each of six follow-up sessions using a 100-mm visual analogue scale. The abilities of the blindfolded subjects to reproduce a neutral head position after moving the head and neck through various planes of motion was the method used to estimate proprioceptive acuity. This was done with the use of a laser pointer affixed to the top of an adjustable cap. Points were marked and measured on a target before and after head movement and repositioning.
Results: Subjects receiving manipulation demonstrated a mean reduction in visual analogue scores of 44%, along with a 41% improvement in mean scores for the head repositioning skill. In comparison, a 9% mean reduction in visual analogue scores and a 12% improvement in head repositioning scores was observed for the stretching group. The difference in the outcomes of the head repositioning skill scores was significant (p < or = .05).
Conclusion: The results suggest a possible effect of manipulation on proprioception in subjects with chronic neck pain. The small sample size, lack of true randomization and lack of blinding of the examiner are factors that weaken these findings. Larger, more controlled studies are needed to determine what specific effects manipulation may have on the function of proprioception.
Objectives. To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period.
Summary of Background Data. There have been few randomized clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes.
Methods. One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses.
Results. Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2;P = 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7;P = 0.001], with spinal manipulation combined with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and spinal manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favor of the two exercise groups.
Conclusion. The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
I hope you found this interesting
Dr Notley

Chiropractic Manipulation: Not just for the back

Evidence is fairly strong when it comes to the effectiveness of joint manipulation for the treatment of acute and chronic neck and back pain. When people think of a Chiropractor they think of someone who is good at treating back and neck problems.  When it comes to injuries to the shoulders, elbows, wrists, hips, knees, ankles and feet an Athletic Therapist or other health care provider may be considered first.

From my experience Chiropractic care, along with soft tissue release (ie. Active Release Techniques) and corrective exercises can be effective for a number of injuries to the extremities. My questions this week are, “What does the evidence say abut the effectiveness of joint manipulation for various extremity problems?””Would seeing a Chiropractor for these conditions be a good idea?”  I found a research paper that reviewed a number of extremity conditions, along with other spinal conditions, and ranked them based on quality of the evidence. Here is a quick summary of their findings.

High Quality Evidence

Evidence is considered high if there are consistent results from well designed and well conducted studies.  There has to be at least two randomized trials.

None of the conditions the researchers had studied exhibited high quality evidence .  If there was high quality then an evidence informed doctor would be able to say that this form of care is effective for the condition.

Moderate Quality Evidence

Evidence was considered moderate if there is sufficient data leading to that conclusion but their confidence is less due to the number, size or quality of each study, inconsistency of findings between the studies or lack of coherence in the chain of evidence.

The researchers found that manipulation/mobilization was positively effective for pain between the shoulder blades or scapular dysfunction and hip osteoarthritis.  High grade mobilization is positively effective for adhesive capsulitis/frozen shoulder.  The use of manipulation/mobilization along with exercise is positively effective for knee osteoarthritis, patellofemoral pain syndrome, tennis elbow and plantar fasciitis.

Based on these findings an evidence informed doctor would say these are effective treatments for the conditions listed.

Low Quality Evidence

Evidence quality is low due to several factors.  There may be a limited number or power of studies.  There may be important flaws in the design or methods of the study.  There may be unexplained inconsistency between higher quality trials or their may be gaps in the chain of evidence.

Rotator cuff pain, carpal tunnel syndrome, ankle sprains, morton’s neuroma hallux limitus all have favourable outcome using manipulation or mobilization, in the research, but the quality of the evidence is low.

Based on this information use of manipulation/mobilization would be an effective alternative in the absence of an effective alternative.

I hope you found this interesting and that if you are suffering from any of these conditions

Dr Chris Notley
Winnipeg Athletic Therapist/Chiropractor since 2000

P.S. A great response to the paper I read was from a very well respected Chiropractor, Dr Scott Haldemann.  He describes how he uses evidence informed care with his patients. This is a great way to treat my patients. You can read that response here.

Barefoot Running: Should you or shouldn’t you?

barefoot_runningWhat do you wear on your feet when you run? Shoes of course! But do you really need shoes? The vast majority of people would say, “Yes, of course!” In Winnipeg half the year is winter running on snow and ice would not be very fun. But there are those who are ditching their shoes all together and training barefoot or in minimalist shoes (. The main reason for training barefoot, by barefoot runners, is often because it helped the person with their plantafasciitis, achille’s tendonitis, knee pain, ITB pain, hip pain, or lower back pain.

Proponents for barefoot running indicate that our feet are meant to respond to the surfaces that they encounter and this form of running results in less force on the body. Conventional shoes allow for cushioning and protection from the ground and weakens the muscles in the feet.  Running barefoot strengthens the foot.

The skeptic in me started to question.  Is there really a difference when running with or without shoes?  Do injuries occur less often while training barefoot?

Is there a difference in running style?

So I did a search on pubmed using the terms “barefoot running” and “barefoot running injuries” . This is what I discovered about barefoot running verses running with shoes:

  • Those who run without shoes tend to land on their forefoot versus their heel (with shoes).
  • Barefoot runners have shorter stride lengths
  • Barefoot running has an increase in stride frequency.
  • Vertical ground reaction forces are lower in barefoot runners
There seems to be a natural change in running style when going from shoes to barefoot.  It stands to reason, striking your heel down onto a hard surface would be much more stressful than landing on the forefoot and absorbing the force with the feet and calf muscles.
Do injuries occur less often?
 

When it comes to injuries there doesn’t appear to be any research that shows an actual reduction in injury rate.  There was one interesting article that found a reduction in pain in those with chronic anterior  compartment syndrome. The two individuals in this study showed improvements with training barefoot and performing rehab exercises intended to prepare them for barefoot running.  All other reports were more anecdotal evidence.  I also saw a case report of a person who developed a metatarsal stress fracture as a result of running barefoot (abstract only).

In my Chiropractic practise I have had patients report to me of there injuries improving while running barefoot. I have also seen patients who develop Achille’s tendonopathy/tendonitis as a result of running barefoot.

Conclusion

There appears to be some logic to the argument of running barefoot.  The resolution of symptoms in runners’ injuries may be a result of changes in running mechanics thus placing less stress on the offended tissues.  The shoes that these runners were wearing, though intended to help, may actually be causing the problem.  Weakening of the foot musculature may be the result of many of the foot, ankle, knee, hip or back ailments that runners experience.  Therefore, at this point in time, I recommend some barefoot training inserted into a running program.  This will give the muscles of the feet an opportunity to train and strengthen.

To prepare yourself for barefoot running, start with walking around your house barefoot. Try walking as if you are sneaking across a floor that squeaks; “tip toe across the floor”.  Progress to light jogging on grass for short distances. Increase your volume and speed as you see fit. You can also work on skipping and making sure to land on the forefoot; both one leg and two leg skipping.  You may also want to consider strengthening up the feet musculature with towel crunch exercises and stretching your calf muscles more frequently.

If you have any questions feel free and ask.
Dr Notley

Choosing a Pillow? Which is best?

I am often asked by my neck pain and headache sufferers, “What is the best type of pillow to use when sleeping?” I’ve always been of the opinion that the pillow depends on the person and the problem they are experiencing but is this what the research says?

So what is the best pillow? Is it the chiropractic pillow? Is it a regular pillow? Does the material matter?  Rather than sticking with my own opinion, I decided to see what the research had to say regarding the subject. Take a look at the end of this blog to read the research papers I found. I used a pubmed search using the search term “neck/cervical pain and pillows“.

Highlights of the research papers I read:

  • The rubber pillow performed better than subjects’ own pillow in most instances. Subjects’ own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.
  • From a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow.
  • The results suggest that the ARCP  (Align-Right (roll-shaped) cervical pillow) has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. 
  • The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. 
  • The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating. 
  • The opinion was that an ideal pillow should be soft and with good support for the neck lordosis (curve). A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis (curve in the neck) can reduce neck pain and headache and give a better sleep quality.
Impression
 
It is evident that not many articles are available to review.  From what I see, there is no specific pillow that is best for everyone.  The conclusion of the last article provides the best advice, “a specially selected and individually tested pillow” is best.  Therefore, try different pillows, those that support the neck, until the best results are experienced.  
 
Dr Notley
 
Articles
 

Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers.
Gordon SJ, Grimmer-Somers K, Trott P.
Man Ther. 2009 Dec;14(6):671-8. Epub 2009 May 7.

Abstract
A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N=106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects’ own pillow in most instances. Subjects’ own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.

A comparison of three types of neck support in fibromyalgia patients.
Ambrogio N, Cuttiford J, Lineker S, Li L.
Arthritis Care Res. 1998 Oct;11(5):405-10.

Abstract
OBJECTIVE:
To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support.
METHODS:
Thirty-five patients with FMS chose the order of application and used each type of neck support for a 2-week period, followed by a 2-week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram.
RESULTS:
Analysis using Friedman’s 2-way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow.
CONCLUSIONS:
The results of this study are inconclusive due to the small sample size. However, from a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted.

Before/after study to determine the effectiveness of the align-right cylindrical cervical pillow in reducing chronic neck pain severity.
Hagino C, Boscariol J, Dover L, Letendre R, Wicks M.
J Manipulative Physiol Ther. 1998 Feb;21(2):89-93.

Abstract
OBJECTIVE:
To determine the effectiveness (at the 0.1 level of statistical significance) of the Align-Right (roll-shaped) cervical pillow (ARCP) on neck pain severity and headache/neck pain medication use in chronic neck pain subjects.
DESIGN:
The design was a “before/after” (i.e., a “pre/post” trial).
SUBJECTS:
Twenty-eight subjects, 25-45 yr of age with cervical spine pain of biomechanical origin of > 2 on an 11-point ordinal pain scale.
OUTCOME MEASURES:
The primary outcome measure was severity of morning and evening neck pain. The secondary outcome measure was daily quantity of analgesics ingested. The data were analyzed descriptively and inferentially for clinically and statistically significant pre/post intervention differences.
METHODS:
Eligible subjects who successfully finished a 2-wk baseline data-gathering period by mailing in two properly completed diaries each received a pillow and four more diaries (to be filled in over the subsequent 4 wk). Three repeated-measures analyses of variance were performed using the Bonferroni-corrected level of statistical significance of 0.03. Ninety-five percent confidence intervals (for paired-samples mean differences) were also calculated for those pre/post differences that seemed descriptively clinically important.
RESULTS:
The clinically and statistically significant reductions in neck/shoulder pain severity in this sample of chronic neck pain subjects suggest that the ARCP is an effective therapy for target populations with the same profile as this sample. Patient characteristics predicting suitability were not studied in this project.
CONCLUSION:
The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. Further randomized clinical trial research comparing the ARCP with other commonly used cervical pillows is recommended.

Cervical pain: A comparison of three pillows
Robert A. Lavin, MD, Marco Pappagallo, MD, Keith V. Kuhlemeier, PhD
Archives of Physical Medicine and Rehabilitation Volume 78, Issue 2 , Pages 193-198, February 1997

Abstract
Objective: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects’ usual pillow, a roll pillow, and a water-based pillow.

Study Design: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods.

Patients: Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments.

Main Outcome Measures: Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows.

Results: The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow.

Conclusions: Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

Neck support pillows: a comparative study.
Persson L, Moritz U.
 J Manipulative Physiol Ther. 1998 May;21(4):237-40.

BACKGROUND:
Special neck support pillows claiming to improve rest and reduce neck pain are currently being advertised.
OBJECTIVE:
To test whether neck pillows have any positive effect on neck pain and quality of sleep compared with usual pillows and, if so, to find the optimal characteristics of such a pillow.
METHODS:
Thirty-seven hospital employees and 18 neck patients were asked to test six neck pillows with different shapes and consistency randomly over the course of 3 wk, to grade them according to comfort and to describe the characteristics of an ideal pillow.
RESULTS:
Thirty-six of 55 persons found the pillows positively affected sleep and 27 of 42 found that they positively affected neck pain. The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating.
CONCLUSION:
A neck pillow with good shape and consistency and with firm support for cervical lordosis can be recommended as a part of treatment for neck pain.

Neck pain and pillows – A blinded study of the effect of pillows on non-specific neck pain, headache and sleep
Liselott Persson
2006, Vol. 8, No. 3 , Pages 122-127 (doi:10.1080/14038190600780239)

Neck support pillows are widely used in patients with neck pain to reduce pain and get better quality of sleep. To test whether specific neck pillows have any effect on neck pain, headache and quality of sleep in people with chronic non-specific neck pain and to find the optimal characteristics of such a pillow, 52 patients with chronic neck pain tested four different pillows (three specially designed neck pillows and one normal pillow) with different shapes and consistency randomly over 4–10 weeks. The patients graded them according to comfort and described the characteristics of an ideal pillow. The effects of the pillows on neck pain, sleep quality and headache were stated on a questionnaire. Forty of the 52 patients found a positive effect on the neck pain, 24 of 31 (77%) reported a positive effect on night’s sleep and 19 of 31 (61%) a positive effect on headache. There were no differences in graded comfort between two of the specially designed neck pillows and the “normal pillow” in the test. The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis can reduce neck pain and headache and give a better sleep quality.