NID- Neck Index Disabillity is a ratings system where a score id given on the current mobility of the neck. Measurements are taken on the degree of flextion and extension of the neck.VAS- Visual Analog Scale of pain gives a rating system of 0-100 or 0-10, depending on the study, as a self-assessment of pain. Zero is no pain where 100 is the worst possible pain.Figure 2Is Spinal Manipulation Therapy (SMT) a Superior TreatmentMethod Compared to Other Conventional Methods? An Argument Designed to Persuade an Educated General AudienceAlix Crone & Kelli BoyleIPHY 3700December 8, 20041The issue of chiropractic medicine and its efficacy as a treatment continues to circulate inthe medical community. Unfortunately, there are many ambiguous issues regarding chiropractic medicine, including how beneficial it is, what frequency of treatment is necessary, is it an effective treatment, and how it compares to standard forms of medicine. Therefore, we have narrowed the topic to be specific and manageable in order to investigate. We will explore the efficacy of spinal manipulation therapy (SMT), a common mechanism used by chiropractors along with other medical professions, for low back and neck pain compared to other forms of therapy. There has been research conducted that measures improvements in pain and functionality. From this paper you will gain knowledge that allows you to make an informed decision on whether SMT would be the best treatment to alleviate low back and neck pain. Our question at hand is whether or not SMT is more effective than other standard procedures such as acupuncture, physical or exercise therapy, pharmaceutical drugs, an educational booklet, and professional advice as a form of treatment for chronic and acute back and neck pain. The effectiveness of SMT, as treatment for lower back and neck pain, is highly debated inthe scientific community. In order to make an informative argument, the included research, took place during the late 90’s to present day, and was taken from different countries across the globe. All test subjects were patients that had been suffering from back or neck pain, and ranged in age from 17 to 70. Results between studies have varied, as some have found clear positive results of the effectiveness of SMT over other conventional treatment methods, whereas others have either found no difference or favored other treatments over SMT. Though SMT is most commonly usedby chiropractors, it is also used by physical therapists and osteopaths, therefore we did not limit our use of research articles exclusively to chiropractic manipulation, but any method of manual therapy via spinal manipulation. 2Back and neck pain is an overwhelmingly persistent problem in the United States, effecting people of all ages but has usually shown to be the most prevalent among people of middle age. It is reported by Haas, Groupp and Kramer (2004) that anywhere from 65-80% of adults will experience an episode of back and/or neck pain during their lifetime, many of whom experience the pain for one year or more. Pharmaceutical drugs such as ibuprofen, Vicodin and other pain relievers only provide temporary relief (if at all), and may be quite harmful to one’s health not only because of their possible side effects, but also because of the potential addiction and immunization, or resistance to their effects after long-term use, that one can gain with continued usage. Being one of the most popular forms of “alternative medicine,” chiropractic care is becoming widespread among people of all ages, races and socioeconomic statuses, therefore it is important to address both sides of the argument regarding its efficacy in order to reach a decision about its strength as a viable medical treatment. The current state of research reveals conflicting arguments about the true effectiveness of SMT for lower back and neck pain when compared to other forms of treatment, hence why SMT is presently still an unresolved issue. Figure 1 shows data from a powerful meta-analysis prepared by Assendelft et al. (2003) which includes 22 different studies (some done multiple times by the same researchers). The graph compares SMT to other treatment methods (sham (1), general practitioner care, physical therapy/exercise, traction or other therapy (2), and back school(3)). [Numbers refer to glossary of terms at end of paper] Negative marks to the left of the origin favor the other treatment over SMT, whereas positive marks to the right of the origin favor SMT. Seven of the studies had results that clearly preferred the other experimental treatment over SMT,while eleven of the studies’ results preferred SMT. Four of the studies were very borderline, indicating a very slight and therefore negligible difference between the two treatment methods, 3showing that neither treatment was superior to the other. Figure 2 shows results from a study by Cherkin et al.(1998) comparing the efficacy of physical therapy, chiropractic manipulation (SMT), or the provision of an educational booklet (4) on the treatment of lower back pain. Other than the first week of follow up, SMT by chiropractic care showed slightly lower “bothersomeness” of symptoms than both physical therapy and the educational booklet. The study concluded that chiropractic manipulation had marginally better outcomes than the other two treatments. Figure 3 shows part of a table showing the results of the study by Frost et al. (2004) comparing SMT and regular advice to remain active from a physiotherapist. While subjects in the SMT group had a slightly higher perceived benefit (on a sale of 0-10), differences were not significant enough from the advice-only group to conclude that SMT was a more effective treatment.There are two sides of the argument regarding the efficacy of SMT versus other treatments. In the research report by Hoving et al. (2002), editors made extended efforts to note that “primary care physicians should consider manual therapy when treating patients with neck pain.” However, the counterargument claims that there is no advantage of SMT over other methods of therapy. For example, Andersson et al. (1999) investigated SMT versus standard care (via prescribed anti-inflammatory medication) and concluded that “osteopathic manual care and standard medical care have similar clinical results in patients with subacute low back pain.” Despite the variance in the data, we argue that SMT is indeed a more superior treatment method