Neck pain constitutes a considerable healthcare cost to society in the form of clinical visits and lost workdays. Various forms of manual therapy management approaches ranging from soft tissue massage, active and passive mobilization and manipulation have been purported to be effective in the management of this potentially disabling condition usually as a part of a multimodal management strategy.
In a recent Cochrane systematic review, Gross et al (2010) have reviewed the literature concerning the efficacy of manipulation or mobilization as a single treatment for management of neck pain. This review excluded combined treatment approaches.
This updated systematic review assessed the effect of manipulation or mobilisation alone on pain, function, disability, patient satisfaction, global perceived effect (GPE), and quality of life in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache.
The selection criteria included any randomized or quasi randomized trial on patients experiencing neck pain with or without radicular symptoms and cervicogenic headache. The participants with specific neurological or traumatic conditions were excluded. The intervention used had to be either manipulation (defined as a localised force of high velocity and low amplitude directed at specific spinal segments) or mobilization (use low-grade/ velocity, small or large amplitude passive movement techniques or neuromuscular techniques within the patient’s range of motion and within the patient’s control). After the exclusion of studies as per the selection criteria, 27 studies were included for review.
Description of the effects of interventions included
Effect of manipulation alone (16 trials) -
Effects of mobilization alone (8 trials) -
Thus from the above results it is clear that there is no high level evidence for use of manipulation or mobilization alone for the management of neck pain. The authors have attributed the lack of clear evidence to the poor methodological quality and wide spectrum of comparisons, treatment characteristics and dosages.
Reference:
Gross AR, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, et al. Manipulation or mobilisation for neck pain. Cochrane Database of Systematic Reviews 2010;(1):CD004249.
This updated systematic review assessed the effect of manipulation or mobilisation alone on pain, function, disability, patient satisfaction, global perceived effect (GPE), and quality of life in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache.
The selection criteria included any randomized or quasi randomized trial on patients experiencing neck pain with or without radicular symptoms and cervicogenic headache. The participants with specific neurological or traumatic conditions were excluded. The intervention used had to be either manipulation (defined as a localised force of high velocity and low amplitude directed at specific spinal segments) or mobilization (use low-grade/ velocity, small or large amplitude passive movement techniques or neuromuscular techniques within the patient’s range of motion and within the patient’s control). After the exclusion of studies as per the selection criteria, 27 studies were included for review.
Description of the effects of interventions included
Effect of manipulation alone (16 trials) -
- There is moderate quality evidence(two trials,369 participants) that manipulation produces similar changes in pain, function and patient satisfaction when compared to mobilisation for subacute or chronic neck pain at short- and intermediate-term follow-up.
- There is low quality evidence(three trials,130participants) that manipulation alone versus a control may provide immediate- and short-term pain relief following one to four treatment sessions in subjects with acute or chronic neck pain.
- There is very low quality evidence at short- term follow-up that manipulation is equivalent to certain medication(2 trials,69 participants), acupuncture (2 trials,81participants), certain soft-tissue treatments(1trial,53 participants) or certain combined treatments for subacute and chronic neck pain and to some extent improved function and manipulation maybe superior to TENS(1 trial, 64 participants) for individuals with chronic cervicogenic headache.
Effects of mobilization alone (8 trials) -
- There is a moderate to low quality evidence showing no difference between mobilisation compared to manipulation and other treatments for pain, function and patient satisfaction for subacute/ chronic neck pain.
- There was low quality evidence (1trial,51participants) that a combination of Maitland mobilisation techniques was as effective as acupuncture for pain relief and improved function immediately post-treatment for subacute/ chronic neck pain.
- Low quality evidence exists from one small trial suggesting neural dynamic techniques led to statistically insignificant, but clinically important pain reduction immediately post-treatment in participants with neck pain of mixed duration.
Thus from the above results it is clear that there is no high level evidence for use of manipulation or mobilization alone for the management of neck pain. The authors have attributed the lack of clear evidence to the poor methodological quality and wide spectrum of comparisons, treatment characteristics and dosages.
Reference:
Gross AR, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, et al. Manipulation or mobilisation for neck pain. Cochrane Database of Systematic Reviews 2010;(1):CD004249.
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