Elsevier

Manual Therapy

Volume 15, Issue 4, August 2010, Pages 315-333
Manual Therapy

Systematic review
Manipulation or mobilisation for neck pain: A Cochrane Review

https://doi.org/10.1016/j.math.2010.04.002Get rights and content

Abstract

Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. This review assesses if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults experiencing neck pain with or without cervicogenic headache or radicular findings. A computerised search was performed in July 2009. Randomised trials investigating manipulation or mobilisation for neck pain were included. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardised mean differences (pSMD) were calculated. 33% of 27 trials had a low risk of bias. Moderate quality evidence showed cervical manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate-term follow-up. Low quality evidence suggested cervical manipulation may provide greater short-term pain relief than a control (pSMD −0.90 (95%CI: −1.78 to −0.02)). Low quality evidence also supported thoracic manipulation for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and immediate pain reduction in chronic neck pain (NNT 5; 29% treatment advantage). Optimal technique and dose need to be determined.

Section snippets

Background

Neck disorders are common, disabling to various degrees, and costly (Côté et al., 1998, Linton et al., 1998, Borghouts et al., 1999, Hogg-Johnson et al., 2008). A significant proportion of direct healthcare costs associated with neck disorders is attributable to visits to healthcare providers, sick leave, and the related loss of productive capacity (Borghouts et al., 1998, Linton et al., 1998, Skargren and Oberg, 1998, Côté et al., 2008). Manipulation and mobilisation are commonly used

Objectives

This update of our systematic review assessed the effect of manipulation or mobilisation alone on pain, function, disability, patient satisfaction, global perceived effect (GPE), and quality of life (QoL) in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache.

Types of studies

Any published or unpublished randomised controlled trial (RCT) or quasi-RCT (QRCT), either in full text or abstract form, was included.

Types of participants

The participants were adults (18 years or older) with the following:

  • Neck pain without radicular findings, including neck pain without specific cause, whiplash-associated disorder (WAD) categories I and II (Spitzer et al., 1987, Spitzer et al., 1995, Guzman et al., 2008), myofascial pain syndrome, and neck pain associated with degenerative changes (Schumacher

Description of studies

Fig. 2 and Gross et al. (2010) describe the flow of the studies from our previous updates (1011 citation postings) and this update (809 citation postings). Of 68 identified RCTs representing 114 publications, we selected 27 RCTs (1522/1805 participants analysed/randomised) representing 32 publications for manipulation or mobilisation performed as a single-modal application. All included trials were small, with fewer than 70 subjects per intervention arm. Agreement between pairs of independent

Discussion

This update investigates the effect of mobilisation or manipulation alone in the treatment of neck pain and is a co-publication of a Cochrane Review. The overall methodological quality of trials has not improved in spite of CONSORT guidelines (Schultz et al., 2010). The evidence suggests some immediate- or short-term pain relief with a course of cervical manipulation or mobilisation alone, but these benefits are not maintained over the long-term. Evidence seems to support the use of thoracic

Implications for practice

Manipulation for acute to chronic neck pain:

  • cervical manipulation produces similar pain relief, functional improvements, and patient satisfaction to mobilisation

  • cervical manipulation may provide short-term, but not long-term pain relief

  • thoracic manipulation used alone or in combination with electrothermal or individualised physiotherapy treatments may improve pain and function

Mobilisation for neck pain of mixed duration:

  • cervical mobilisation is similar to manipulation or acupuncture for pain

Acknowledgements

We are indebted to the many authors of primary studies for their support in retrieving original research. We thank our volunteers, translators, students, the Cochrane Back Review Group editors, and Lisa Carlesso and Colleen McPhee for early access to their research.

Declarations of interest: Two of our review authors are authors of included studies. Although Gert Brønfort and Jan Hoving were review authors, they were not involved in decisions about the inclusion, risk of bias assessment or data

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  • Cited by (0)

    This paper is based on a Cochrane Review published in The Cochrane Library 2010, Issue 1 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.

    1

    COG – Cervical Overview Group: Bronfort G, Burnie SJ, Cameron ID, D’Sylva J, Dumoulin-White R, Eddy A, Ezzo J, Goldsmith CH, Graham N, Gross A, Haines T, Haraldsson B, Hildebrand C, Hoving J, Kay T, Kroeling P, Lilge L, Miller J, Morien A, Peloso P, Perry L, Radylovick Z, Santaguida P, Trinh K, Voth S, Wang E.

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