Manual therapy and exercise for neck pain: A systematic review

doi:10.1016/j.math.2010.02.007

Manual Therapy

Volume 15, Issue 4, August 2010, Pages 334-354

https://doi.org/10.1016/j.math.2010.02.007 Get rights and content

Abstract

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI:−1.69,−0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI:−0.76,−0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Section snippets

Background

Neck pain is a frequent impairment associated with disability and substantive health care costs (Côté et al., 1998; Linton et al., 1998; Borghouts et al., 1999; Hogg-Johnson et al., 2008). Manipulation, mobilisation, or exercise applied as single-modal treatment approaches for neck pain have gained some support in Cochrane reviews (Gross et al., 2010 found earlier in this issue of Manual Therapy; Kay et al., 2009). Many practitioners believe that solo-care approaches do not accurately represent

Objectives

Our systematic review update assesses the effectiveness of manual therapy and exercise for neck pain with or without radicular symptoms or cervicogenic headache on pain, function/disability, quality of life, global perceived effect, and patient satisfaction.

Study selection

Abbreviated inclusion criteria follow; see Gross et al., 2010 earlier in this issue for detailed definitions.

Description of studies

We selected 17 trials representing 31 publications from 1820 citation postings (See Fig. 1):

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17 studied neck pain: acute (Mealy et al., 1986, McKinney et al., 1989, Giebel et al., 1997, Bonk et al., 2000); subacute (Karlberg et al., 1996); chronic (Brodin, 1985, Vasseljen et al., 1995, Skargren and Oberg, 1998, Bronfort et al., 2001, Persson and Lilja, 2001, Allison et al., 2002, Jull et al., 2002, Ylinen et al., 2003, Palmgren et al., 2006, Walker et al., 2008); and mixed duration (Provinciali

Discussion

In our previous systematic review:

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up to 1996 (Gross et al., 1996): results remained inconclusive for mobilisation or manipulation as a single intervention and suggested support for combined mobilisation, manipulation and exercise for short-term pain reduction.
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up to 2003 (Gross et al., 2003): results showed no evidence in support of manipulation or mobilisation alone but showed further support to the use of combined mobilisation, manipulation and exercise in achieving clinically important but

Acknowledgements

We thank our volunteers, students, and translators. This is one review of a series conducted by the Cervical Overview Group: Bronfort G, Burnie SJ, Cameron ID, Eddy A, Ezzo J, Goldsmith CH, Graham N, Gross A, Haines T, Haraldsson B, Kay T, Kroeling P, Morien A, Peloso P, Radylovick Z, Santaguida P, Trinh K, Wang E.

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Computer professionals often develop a forward head posture due to prolonged hours of computer use, leading to neck pain. Instrument-assisted soft tissue mobilization (IASTM), an advanced technique for treating myofascial trigger points, has become increasingly popular for addressing these musculoskeletal issues.
The study aimed to compare the effectiveness of IASTM mobilization on SBAL (superficial back arm line) and SM(specific muscles-upper trapezius, levator scapulae, and sternocleidomastoid) in managing chronic neck pain among computer professionals.
The study involved 62 computer professionals, randomly divided into two groups. Group A received IASTM on SBAL and group B received IASTM on SM for neck pain each receiving three sessions weekly for four weeks. Outcome variables like Neck Disability Index (NDI), NPRS(Neck Pain Rating Scale), Craniovertebral angle (CVA), and range of motion (ROM) for flexion, and side flexion (right & left side) were evaluated at baseline, 2 weeks and 4 weeks.
Significant improvement in NPRS were observed in both the SBAL and SM groups after 2 weeks of IASTM, wth the SBAL group demonstrating greater improvement. At 4 weeks, IASTM on SBAL showed significantly higher improvements in NPRS, CVA, NDI, and flexion compared to the SM group. The repeated measures ANOVA indicated a significant main effect of both time and group, along with a significant interaction between time and group for all outcome variables, except for CVA.
The study indicates that IASTM on SBAL may offer a more effective treatment for chronic neck pain in computer professionals compared to targeting specific muscles.
Osteopathic management of non-specific neck pain: Preliminary findings from a cross sectional study of Australian osteopaths
2024, International Journal of Osteopathic Medicine
Neck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP.
Cross sectional design. Via an online survey.
All participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP.
This study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines.
- •
  All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.
- •
  Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.
- •
  Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.
The top 100 highly cited articles on neck pain: A bibliometric analysis
2024, Heliyon
Neck pain has emerged as a significant public health concern. This study is to unveil the present state of neck pain research, thereby furnishing invaluable insights for prospective research endeavours and clinical applications.
The study was initiated by searching the Web of Science Core Collection database, focusing on "neck pain". From the amassed results, the top 100 most cited references were imported into CiteSpace and VOSviewer, enabling a rigorous bibliometric analysis. To ensure precision, synonymous terms conveying similar meanings were harmonized. The bibliometric study encompassed countries, research institutions, authors, journals, and keyword analysis.
The investigation centered on a curated compilation of 100 articles, disseminated across a diverse array of 36 scholarly journals. These seminal articles originated from 24 distinct countries, reflecting contributions from a wide spectrum of 188 research institutions. Impressively, a collaborative effort involving 385 authors emerged. Noteworthy core research countries included the United States and Australia, with the University of Queensland and the University of Toronto asserting notable influence. Prolific authors such as J. David Cassidy and Pierre Cote garnered attention. Present research endeavours pivot around the incidence of neck pain, the identification of risk factors, the efficacy evaluation of treatment modalities, and a pronounced focus on high-quality randomized controlled trials and systematic reviews.
The study shines a light on key research countries, influential institutions, prominent authors, and prevalent trends, effectively contributing to comprehending the knowledge landscape and research dynamics in the field of neck pain.
Assessment of Long-term Effects of Adding Osteopathic Manipulative Treatment to Neck Exercises for Individuals With Non-specific Chronic Neck Pain: A Randomized Trial
2023, Journal of Chiropractic Medicine
The purpose of this study was to evaluate the long-term effects of adding osteopathic manipulative treatment (OMT) to neck exercises compared to exercises alone for individuals with non-specific chronic neck pain (NCNP).
A randomized controlled trial was conducted by assigning 90 individuals with NCNP into the following 2 groups: (1) exercises group (EG, n = 45) or (2) OMT plus exercises group (OMT/EG, n = 45). All participants received 4 weeks of treatment. The clinical outcomes were recorded at baseline and at 3 and 6 months after the treatment. The primary outcomes were pain and function—Numerical Pain Rating Scale (NPRS), Pressure Pain Threshold, and the Neck Disability Index (NDI). The secondary outcomes included range of motion for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire.
In comparison to baseline data, both groups had a reduction of NPRS (P < .05) and NDI (P < .05) after the treatment. However, no statistically significant differences in pain intensity or disability were found when OMT/EG was compared to EG alone at 3 months (P = 0.1 and P = 0.2, respectively) and at 6 months (P = 0.4 and P = 0.9, respectively for pain and disability) and no difference was found between OMT/EG and the EG in the secondary outcomes during the same follow-up period (P > .05).
Outcomes of pain and functionality for patients in both groups were improved at 6 months. Our findings show that the combination of OMT and neck exercises for 4 weeks did not improve functionality and reduction of pain in patients with NCNP.
A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain
2023, Complementary Therapies in Clinical Practice
An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain. However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain. Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain.
A search of the literature was conducted on seven databases (PubMed, Cochrane Center Register of Controlled Trials, Embase, Medline, CNKI, WanFang, and SinoMed) from the establishment of the databases to May 2022. This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies. The retrieved records were independently reviewed by two researchers. Further, the methodological quality was evaluated using the PEDro scale. All statistical analyses were performed using RevMan V.5.3 software. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results.
Seventeen RCTs, including 1190 participants, were included in this meta-analysis. Manipulative therapy showed better results regarding pain intensity and neck disability than the control group. Manipulative therapy was shown to relieve pain intensity (SMD = −0.83; 95% confidence interval [CI] = [-1.04 to −0.62]; p < 0.0001) and neck disability (MD = −3.65; 95% CI = [-5.67 to - 1.62]; p = 0.004). However, the studies had high heterogeneity, which could be explained by the type and control interventions. In addition, there were no significant differences in adverse events between the intervention and the control groups.
Manipulative therapy reduces the degree of chronic neck pain and neck disabilities.
Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis
2022, Journal of Physiotherapy
Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)?
A systematic review and network meta-analysis of randomised clinical trials.
Adults with CNSNP of at least 3 months duration.
All available pharmacological and non-pharmacological interventions.
The primary outcomes were pain intensity and disability. The secondary outcome was adverse events.
Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty.
While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.
PROSPERO CRD42019124501

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Systematic reviewManual therapy and exercise for neck pain: A systematic review

Abstract

Section snippets

Background

Objectives

Study selection

Description of studies

Discussion

Acknowledgements

Manual Therapy

Pain

Archives of Physical Medicine and Rehabilitation

Journal of Manipulative and Physiological Therapeutics

Pain

Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany

Journal of Musculoskeletal Pain

Cervical pain and mobilisation

International Journal of Rehabilitation Research

Cervical pain and mobilisation

Manual Medicine

A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain

Spine

Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain

Spine

Die distorsion der halswirbelsaule: Fruhfunktionalle vs. ruhigstellende behandlung

Zentralbibliotak Chiropractic

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized controlled trial

Annals of Internal Medicine

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial

Clinical Journal of Pain

A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache

Spine

Systematic review
Manual therapy and exercise for neck pain: A systematic review