Expert: Gerald Anzalone, D.C. - 9/16/2010

Question
I am a 46 yr old atheletic female with neck pain. I have recently seen a chiropractor who is treating my misaligned cervical spine. I would like some evidenced based feedback on the effectiveness of using the activator versus manually adjusting.  Does it depend on the severity of the problem?  

Answer
Thanks for your question.

Instrument techniques, such as the Activator, work well for some people and not for others, just as some patients seem to fare better with manual thrust-type manipulation, while others are better candidates for non-thrust mobilization or soft tissue techniques.

In a recent study published in the Journal of Manipulative and Physiological Therapeutics (Schneider MJ, Brach J, Irrgang JJ, Abbott KK, Wisniewski SR, Delitto A. "Mechanical vs. manual manipulation for low back pain: an observational cohort study". J Manipulative Physiol Ther. 2010 Mar-Apr; 33(3):193-200), researchers found that for acute low back pain, there were no significant differences between patients who received a manual spinal manipulation and those who received an Activator instrument manipulation when measured with the Oswestry Disability Index.

The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure ("The Oswestry Disability Index",Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952).

However, patients in the manual manipulation group reported lower scores in the Numeric Pain Rating Scale (showing that the manual manipulation group reported less pain after 4 weeks of treatment versus the instrument manipulation group).

In 2006, British researchers published a study in the journal Chiropractic and Osteopathy (Gemmel H, Miller P. "Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial." Chiropractic and Osteopathy 2006; 14:7doi:10.1186/1746-1340-14-7) in which one group received manual thrust manipulation of their neck, one group received non-thrust mobilization of their neck, and one group received an Activator instrument manipulation of their neck.

The authors concluded that although they studies a small number of patients, all three methods of treating mechanical neck pain had long-term benefit, without serious side-effects associated with any of the treatments.

Ultimately, the important factor for you will be whether you show improvement in your symptoms; if you fail to achieve improvement within a 4 to 6 week period, your practitioner should re-evaluate the treatment approach and make any changes that are appropriate.

I hope that this helps to answer your question.