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: Long's manipulation (LM) is a representative Chinese manipulation approach incorporating both spinal manipulation and traditional Chinese massage (TCM) techniques. This randomized controlled trial (RCT) aimed to compare the immediate and short-term relative effectiveness of LM to TCM on patients with chronic neck pain. Patients were randomly assigned to either LM group or TCM group. LM group was treated with Long's manipulation, while the TCM group received TCM therapy. Patients attended 8 sessions of treatment (one session every three days). Outcome measures included neck disability (Northwick Park Neck Pain Questionnaire; NPQ), pain intensity (Numeric Pain Rating Scale; NPRS), patient perceived satisfaction of care (PPS) (11-point scale), craniovertebral angle (CV angle) and cervical range of motion (ROM). A blinded assessor performed assessment at baseline, immediate after treatment and 3 months post treatment. LM group achieved significantly greater improvement than TCM group in pain intensity (p < 0.001), neck disability (p = 0.049) and satisfaction (p < 0.001) up to 3-month follow-up. There was no significant difference in improvements in CV angle and most of cervical ROM between groups (p = 0.169 ∼ 0.888) with an exception of flexion at 3-month follow-up (p = 0.005). This study shows that LM could produce better effects than TCM in relieving pain and improving disability in the management of patients with chronic mechanical neck pain.
    Manual therapy 01/2013; · 2.32 Impact Factor
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    ABSTRACT: Manual spinal joint mobilisations and manipulations are widely used treatments in patients with neck and low-back pain. Inter-examiner reliability of passive intervertebral motion assessment of the cervical and lumbar spine, perceived as important for indicating these interventions, is poor within a univariable approach. The diagnostic process as a whole in daily practice in manual therapy has a multivariable character, however, in which the use and interpretation of passive intervertebral motion assessment depend on earlier results from the diagnostic process. To date, the inter-examiner reliability among manual therapists of a multivariable diagnostic decision-making process in patients with neck or low-back pain is unknown.
    Chiropractic & manual therapies. 01/2014; 22:22.
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    ABSTRACT: Study Design Randomized clinical study. Objectives To compare the effects of trigger point dry needling (TrP-DN) and trigger point (TrP) manual therapy on pain, function, pressure pain sensitivity, and cervical range of motion in subjects with chronic mechanical neck pain. Background Recent evidence suggests that TrP-DN could be effective in the treatment of neck pain. However, no studies have directly compared the outcomes of TrP-DN and TrP manual therapy in this population. Methods Ninety-four patients (mean ± SD age: 31 ± 3 years old; 66% female) were randomized into a TrP-DN group (n=47), or a TrP manual therapy group (n=47). Neck pain intensity (11-point numeric pain rating scale [NPRS]), cervical range of motion, and pressure pain thresholds (PPT) over the spinous process of C7 were measured at baseline, immediately after treatment and at a 1-week and 2-week follow-up. The Spanish version of the Northwick Park Neck Pain Questionnaire (NPQ) was used to measure disability/function at baseline and the 2-week follow-up. Mixed-model repeated measured ANOVAs were used to determine if a Group * Time interaction existed on the effects of the treatment on each outcome variable with group as the between-subjects variable and time as the within-subjects variables. Results The ANOVA revealed that subjects receiving TrP-DN had similar outcomes to individuals receiving TrP manual therapy in terms of pain, function and cervical range of motion. The 4x2 mixed model ANOVA also revealed a significant Group * Time interaction (P<0.001) for PPT: patients receiving TrP-DN experienced greater increase in PPT (decrease pressure sensitivity) than those receiving TrP manual therapy at all follow-up periods (between-groups differences, post-treatment: 59.0 [95%CI 40.0, 69.2], 1-week follow-up: 69.2 [49.5, 79.1], 2-weeks follow-up; 78.9 [49.5,89.0]). Conclusions The results of this clinical trial suggest that 2 sessions of TrP-DN and TrP manual therapy resulted in similar outcomes in terms of pain, disability and cervical range of motion. Those in the TrP-DN group experienced greater improvements in PPT over the cervical spine. Future trials are needed to examine the effects of TrP-DN and TrP manual therapy at long-term follow-up periods. Level of Evidence Therapy, Level 1b. J Orthop Sports Phys Ther, Epub 30 September 2014. doi:10.2519/jospt.2014.5229.
    Journal of Orthopaedic and Sports Physical Therapy 09/2014; · 2.38 Impact Factor


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Jul 3, 2014