COG. Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther

School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
Manual therapy (Impact Factor: 1.71). 08/2010; 15(4):315-33. DOI: 10.1016/j.math.2010.04.002
Source: PubMed


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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Available from: Anita R Gross, Jul 03, 2014
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    • "Practitioners of Manual Medicine usually use High-Velocity Low-Amplitude (HVLA) thrust to manage different types of musculoskeletal disorders affecting the spine (Walser et al., 2009; Gross et al., 2010; Kuczynski et al., 2012). HVLA techniques produce different effects on the body system: mechanical effects (Triano and Schultz, 1997; Triano, 2001; Millan et al., 2012; Snodgrass et al., 2012) and neurophysiological effects (Pickar, 2002) on the axial muscles (Bicalho et al., 2010; Clark et al., 2011; Koppenhaver et al., 2011; Puentedura et al., 2011) as well as on the peripheral muscles (Herzog et al., 1999; Suter et al., 2000; Hillermann et al., 2006), and on sensitivity (Bialosky et al., 2009; Bishop et al., 2011; Sparks et al., 2013). "
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    ABSTRACT: Very little is known about the kinematics of the upper cervical spine in particular during Manual Therapy techniques. In fact no data about displacement of the atlanto-axial joint during High-Velocity Low-Amplitude (HVLA) thrust are available. Knowing the precise kinematics of these vertebrae might allow a better comprehension of such important technique and possible vital structures involvement. A Zebris CMS20 ultrasound-based motion tracking system was adopted. Twenty fresh human cervical specimens were used in this study. Facet joint displacements of C1 relative to C2 were analysed during three consecutive HVLA thrusts into rotation. Displacement during the thrust and the maximum displacement reached with the manoeuvre were analysed. Descriptive statistics showed a mean Norm displacement during the thrust of 0.5 mm (SD ± 0.5). The maximum displacement, representing the overall facet movement from neutral to end-range position, indicated a Norm value of 6.0 mm (SD ± 3.4). Heterogeneous displacement directions were found during the thrust. Intra and inter-rater reliability reached an insufficient reproducibility level. Considering the amount of displacement induced, no statistical significant differences between the registrations were shown. Displacement during the execution of HVLA thrust is unintentional, unpredictable and not reproducible. On the other hand and in accordance with other studies, the displacement induced with the present technique seems not to be able to endanger vital structure on the Spinal Cord and the Vertebral Artery. This study also adds to a better comprehension of the kinematic of the atlanto-axial segment during the performance of HVLA manipulation. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Manual therapy 03/2015; DOI:10.1016/j.math.2015.03.006 · 1.71 Impact Factor
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    • "Gross and colleagues conducted a systematic review on Manipulation or mobilization for neck pain to determine the, and concluded that both the techniques had the same effects in neck pain.12 Miller and colleagues carried out a systematic review on Manual therapy and exercise for neck pain and concluded that Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain.13 "
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    ABSTRACT: Objective: To determine the efficacy of Sustained Natural Apophyseal Glides (SNAGs) with and without Isometric Exercise Training Program (IETP) in Non-specific Neck Pain (NSNP) Methods: This randomized control trial of one year duration was conducted at out-patient department of Physiotherapy and Rehabilitation, Khyber Teaching Hospital (KTH) Peshawar, Pakistan from July 2012 to June 2013. The sample of 102 patients of NSNP were randomly selected through simple random sampling technique, and placed into two groups. The SNAGs manual physical therapy technique with IETP was applied on 51 patients in group A and SNAGs manual physical therapy techniques was applied alone on 51 patients in group B. The duration of intervention was 6 weeks, at 4 times per week. The Neck Disability Index (NDI) and Visual Analog Scale (VAS) for neck pain were assessment tools used for all patients before and after 6 weeks of physical therapy intervention. All the patients were assessed through NDI and VAS before intervention and at the completion of 6 weeks program. The data of all 102 was analyzed by SPSS-20 and statistical test was applied at 95% level of significance determine the efficacy of both the treatments interventions and compare with each other. Results: The patients in group A, treated with SNAGs and followed by IETP for 6 weeks, demonstrated more improvement in pain and physical activity as assessed by VAS (p=0.013) and NDI (p=0.003), as compared to the patients treated with SNAGS alone, as pain and function assessed by VAS (p=0.047) and NDI (p=0.164). In group A the NDI score improved from 40 to 15 and VAS from 7 to 4, while in group B the NDI score improved from 42 to 30 and VAS from 7 to 4. Conclusion: Patients with non-specific neck pain treated with SNAGs manual physical therapy techniques and followed by IETP was more effective in reduction of pain and enhancement of function, as compared to those patients treated with SNAGs manual physical therapy techniques alone.
    Pakistan Journal of Medical Sciences Online 07/2014; 30(4):872-4. DOI:10.12669/pjms.304.5148 · 0.23 Impact Factor
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    • "analgesic modality for the rehabilitation of muscu- 7 loskeletal dysfunctions including low back pain, neck 8 pain, chronic ankle sprain, cervicogenic headache and 9 dizziness etc. [17] [28] [29] [39]. It has been used by phys-10 iotherapists, osteopaths and chiropractors for more 11 than 2000 years [6] [7] [10] [11] [16] and it is recommended 12 by the majority of international clinical guidelines due 13 to its immediate analgesic effect on musculoskeletal 14 pain [1] [9]. "
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    ABSTRACT: Background: Although the antinociceptive effect of high-velocity, low amplitude thrust manipulation (HVLAM) has been recognized by numerous systematic reviews, the underlying mechanism for manipulation-related pain relief remains poorly understood. An increasing number of studies have explored its analgesic mechanism suggesting that the excitation of the descending inhibitory pain mechanism (DIPM) might play the most important role for musculoskeletal pain relief. Objective: The objective of this review is to investigate the role of the DIPM in musculoskeletal pain following HVLAM as well as to identify the pain-relieving importance of this technique within clinical practice. Methodology: English literature databases were searched to find studies related to the objective of the present review. Results and conclusions: Findings from current literature support that HVLAM has a profound influence on nociceptive stimulus via the possible activation of the DIPM. It seems that the application of this technique activates the periaqueductal gray region area of the midbrain, stimulates the noradrenergic descending system and at the level of the spinal cord, the nociceptive afferent barrage is reduced and mechanical hypoalgesia is induced. However, the literature on HVLAM induced-analgesia is still problematic regarding the methodological design of the existing research. Despite these limitations, the clinical importance of the activation of the DIPM should not be ignored since the resulted analgesic effect of this technique can provide a window of opportunity to restore impaired physical performance and disability.
    Journal of Back and Musculoskeletal Rehabilitation 05/2014; 27(4). DOI:10.3233/BMR-140472 · 0.71 Impact Factor
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