Cochrane Summaries

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Manipulation and Mobilisation for Mechanical Neck Disorders

Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL
Published Online: 
12 May 2010

Neck pain is a common musculoskeletal complaint. It can cause varying levels of disability for the affected individual and is costly to society. Neck pain can be accompanied by pain radiating down the arms (radiculopathy) or headaches (cervicogenic headaches). Manipulation (adjustments to the spine) and mobilisation (movement imposed on joints and muscles) can be used alone or in combination with other physical therapies to treat neck pain.

This updated review included 27 trials (1522 participants) that compared manipulation or mobilization against no treatment, sham (pretend) treatments, other treatments (such as medication, acupuncture, heat, electrotherapy, soft tissue massage), or each other. 

There is low quality evidence from three trials (130 participants) that neck manipulation can provide more pain relief for those with acute or chronic neck pain when compared to a control in the short-term following one to four treatment sessions. Low quality evidence from one small (25 participants) dosage trial suggests that nine or 12 sessions of manipulation are superior to three for pain relief at immediate post treatment follow-up and neck-related disability for chronic cervicogenic headache. There is moderate quality evidence from 2 trials (369 participants) that there is little to no difference between manipulation and mobilisation for pain relief, function and patient satisfaction for those with subacute or chronic neck pain at short and intermediate-term follow-up. Very low quality evidence suggests that there is little or no difference between manipulation and other manual therapy techniques, certain medication, and acupuncture for mostly short-term and on one occasion intermediate term follow-up for those with subacute and chronic neck pain (6 trials, 494 participants) and superior to TENS for chronic cervicogenic headache (1 trial, 65 participants).

There is very low to low quality evidence from two trial (133 participants) that thoracic (mid-back) manipulation may provide some immediate reduction in neck pain when provided alone or as an adjunct to electrothermal therapy or individualized physiotherapy for people with acute neck pain or whiplash. When thoracic manipulation was added to cervical manipulation alone, there was very low quality evidence suggesting no added benefit for participants with neck pain of undefined duration.

There is low quality evidence from two trials (71 participants) that a mobilisation is as effective as acupuncture for pain relief and improved function for subacute and chronic neck pain and neural dynamic techniques produce clinically important pain reduction for acute to chronic neck pain. Very low to low quality evidence from three trials (215 participants) suggests certain mobilisation techniques may be superior to others.

Adverse (side) effects were reported in 8 of the 27 studies. Three out of those eight studies reported no side effects. Five studies reported minor and temporary side effects including headache, pain, stiffness, minor discomfort, and dizziness. Rare but serious adverse events, such as stoke or serious neurological deficits, were not reported in any of the trials.

Limitations of this review include the high number of potential biases found in the studies, thus lowering our confidence in the results. The differences in participant and treatment characteristics across the studies infrequently allowed statistical combination of the results.

Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change

This record should be cited as: 
Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL. Manipulation or Mobilisation for Neck Pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004249. DOI: 10.1002/14651858.CD004249.pub3
Assessed as up to date: 
8 July 2009