Article

Manipulation or mobilisation for neck pain: a Cochrane Review.

School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
Manual therapy (Impact Factor: 2.32). 08/2010; 15(4):315-33. DOI: 10.1016/j.math.2010.04.002
Source: PubMed

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.

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    ABSTRACT: Study Design Controlled, repeated-measures, single-blind randomized study. Objectives To determine the effect of cervical or thoracic manipulation on neurotensin, oxytocin, orexin A and cortisol levels. Background Previous studies have researched the effect of spinal manipulation on pain modulation and/or range of movement. Knowledge is scarce regarding the biochemical process that supports the anti-nociceptive effect of spinal manipulation (SM). Methods Thirty asymptomatic subjects were randomly divided into three groups: cervical manipulation (n=10), thoracic manipulation (n=10), and non-manipulation (control) (n=10) groups. Blood samples were extracted before each intervention, immediatly after, and two hours after the intervention. Neurotensin, oxytocin and orexin A were determined in plasma using ELISA. Cortisol was measured by microparticulate enzyme immunoassay in serum samples. Results Immediately after the intervention, significantly higher values of neurotensin (p<0.05) and oxytocin (p < 0.001) levels were observed in both cervical and thoracic manipulation, whereas cortisol concentration was increased only in the cervical manipulation group (p < 0.05). No changes were detected for orexin A levels. Two hours after the intervention, no significant differences were observed in between-group analysis. Conclusions The mechanical stimulus provided by spinal manipulation triggers an increase in neurotensin, oxytocin and cortisol blood levels. Data suggest that the initial capability of the tissues to tolerate mechanical deformation affects the capacity of these tissues to produce an induction of neuropeptide expression. Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther, Epub 22 January 2014. doi:10.2519/jospt.2014.4996.
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    ABSTRACT: Previous studies have analyzed the effects of spinal manipulation on pain sensitivity by using several sensory modalities, but to our knowledge, no studies have focused on serum biomarkers involved in the nociceptive pathway after spinal manipulation. Our objectives were to determine the immediate effect of cervical and dorsal manipulation over the production of nitric oxide and substance P, and establishing their relationship with changes in pressure pain thresholds in asymptomatic subjects. In this single-blind randomized controlled trial, 30 asymptomatic subjects (16 men) were randomly distributed into 3 groups (n=10 per group): control, cervical and dorsal manipulation groups. Blood samples were extracted to obtain serum. ELISA assay for substance P and chemiluminiscence analysis for nitric oxide determination were performed. Pressure pain thresholds were measured with a pressure algometer at the C5-C6 joint, the lateral epicondyle and the tibialis anterior muscle. Outcome measures were obtained before intervention, just after intervention and 2 hours after intervention. Our results indicated an increase in substance P plasma level in the cervical manipulation group (70.55 %) when compared with other groups (P<0.05). This group also showed an elevation in the pressure pain threshold at C5-C6 (26.75 %) and lateral epicondyle level (21.63 %) immediately after the intervention (P<0.05). No changes in nitric oxide production were observed. In conclusion, mechanical stimulus provided by cervical manipulation increases substance P levels and pressure pain threshold but does not change nitric oxide concentrations. Part of the hypoalgesic effect of spinal manipulation may be due to the action of substance P.
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    ABSTRACT: Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens.Aim: To describe the utilization of interventions in patients with neck pain by clinicians. A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and 'other' interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics). This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective.
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