Manual therapy with or without physical medicine modalities for neck pain: a systematic review.

School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
Manual therapy (Impact Factor: 1.76). 10/2010; 15(5):415-33. DOI: 10.1016/j.math.2010.04.003
Source: PubMed

ABSTRACT Manual therapy interventions are often used with or without physical medicine modalities to treat neck pain. This review assessed the effect of 1) manipulation and mobilisation, 2) manipulation, mobilisation and soft tissue work, and 3) manual therapy with physical medicine modalities on pain, function, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults with neck pain. A computerised search for randomised trials was performed up to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (RR) and standardised mean differences (SMD) were calculated when possible. We included 19 trials, 37% of which had a low risk of bias. Moderate quality evidence (1 trial, 221 participants) suggested mobilisation, manipulation and soft tissue techniques decrease pain and improved satisfaction when compared to short wave diathermy, and that this treatment combination paired with advice and exercise produces greater improvements in GPE and satisfaction than advice and exercise alone for acute neck pain. Low quality evidence suggests a clinically important benefit favouring mobilisation and manipulation in pain relief [1 meta-analysis, 112 participants: SMD -0.34(95% CI: -0.71, 0.03), improved function and GPE (1 trial, 94 participants) for participants with chronic cervicogenic headache when compared to a control at intermediate and long term follow-up; but no difference when used with various physical medicine modalities.

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    ABSTRACT: The aim of the present study was to compare the effects between sustained natural apophyseal glides (SNAGs) mobilization and manipulation in the treatment of patients with cervical spine disorders. Forty-nine male patients participated and completed the study. They were randomly assigned into three groups: SNAGs group, manipulation group, and exercise group. Patients in all groups received exercise therapy. The SNAGs group received the specialized SNAGs mobilization. The manipulation group was treated with high-velocity, low-amplitude manipulation. The cervical range of motion (CROM) was measured using CROM device, with the pain assessed using the visual analogue scale (VAS) and the grade of functional recovery measured using the neck disability index (NDI). The patients received two sessions per week for 6 weeks. Evaluations were carried out before treatment, immediately after treatment, and at one month follow up. Repeated measures analysis, Friedman’s test, and Wilcoxon signed ranked test respectively revealed a significant increase in ROM, pain reduction, and improved function after treatment and at one-month follow-up. The results showed significant difference in the ROM, VAS, and NDI between the exercise group and both the SNAGs group and the manipulation group. No significant difference was found between the SNAGs group and the manipulation group in terms of ROM, VAS, and NDI after treatment and after one month follow up. The SNAGs mobilization and manipulation were found to be effective treatments more than the exercises alone in the treatment of cervical spine disorders.
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    ABSTRACT: Neck pain (NP) and low back pain (LBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) has been used to treat various symptoms and diseases in China and has been demonstrated to be effective. The objective of the present study was to review and analyze the existing data about pain and disability in TCM treatments for NP and LBP. Studies were identified by a comprehensive search of databases, such as MEDLINE, EMBASE, and Cochrane Library, up to September 1, 2013. A meta-analysis was performed to evaluate the efficacy and safety of TCM in managing NP and LBP. Seventy five randomized controlled trials (n = 11077) were included. Almost all of the studies investigated individuals experiencing chronic NP (CNP) or chronic LBP (CLBP). We found moderate evidence that acupuncture was more effective than sham-acupuncture in reducing pain immediately post-treatment for CNP (visual analogue scale (VAS) 10 cm, mean difference (MD) = -0.58 (-0.94, -0.22), 95% confidence interval, p = 0.01), CLBP (standardized mean difference = -0.47 (-0.77, -0.17), p = 0.003), and acute LBP (VAS 10 cm, MD = -0.99 (-1.24, -0.73), p< 0.001). Cupping could be more effective than waitlist in VAS (100 mm) (MD = -19.10 (-27.61, -10.58), p < 0. 001) for CNP or medications (e.g. NSAID) for CLBP (MD = -5.4 (-8.9, -0.19), p = 0.003). No serious or life-threatening adverse effects were found. Acupuncture, acupressure, and cupping could be efficacious in treating the pain and disability associated with CNP or CLBP in the immediate term. Gua sha, tai chi, qigong, and Chinese manipulation showed fair effects, but we were unable to draw any definite conclusions, and further research is still needed. The efficacy of tuina and moxibustion is unknown because no direct evidence was obtained. These TCM modalities are relatively safe.
    PLoS ONE 02/2015; 10(2):e0117146. DOI:10.1371/journal.pone.0117146 · 3.53 Impact Factor
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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; 44(11):1-34. DOI:10.2519/jospt.2014.5229 · 2.38 Impact Factor