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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    • "Specific grade, direction of the manipulation, region of the neck targeted for the manipulation, and choice of thrust or non-thrust technique were selected by the treating clinician based on individual subject-specific motion limitations and/or concordant pain identified during the cervical spine examination. In a review by Gross et al. (2010), thrust and non-thrust manipulation in patients with neck pain was found to yield similar results for pain, function and patient satisfaction. Subjects received the manual therapy intervention only during the first visit. "
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    ABSTRACT: Introduction: Scapulothoracic muscle weakness has been associated with neck pain (NP). Little evidence exists regarding lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) strength in this population. LT strength changes have been observed following thoracic manipulation in healthy subjects. The purpose of the present study was to examine scapulothoracic strength changes following cervical manipulation in subjects with NP. Methods: Twenty-two subjects with NP and 17 asymptomatic control (AC) subjects underwent strength testing of the LT, MT and SA using a hand-held dynamometer. Subjects with NP were treated with passive intervertebral neck manipulation and neck range of motion exercises. The AC group received no intervention. Strength testing was repeated after manipulation, then 48 and 96 hours later. Change scores were calculated for strength over time. Paired t-tests were done for strength change between painful and non-painful sides in the NP group. Independent t-tests were done for strength change between the NP group and AC group. Results: There was no significant difference between groups for age, gender, hand dominance or body mass index. Mean (standard deviation) symptom duration for subjects in the NP group was 43.27 (62.71) months. There was no significant difference in strength change over time between painful and non-painful sides in the NP group for any muscle; however, there was a significant difference in strength change over time between those in the NP group and AC group for the LT (p < 0.01), SA (p < 0.01) and MT (p < 0.01). Discussion: Scapulothoracic muscle strength improvements were observed in both extremities following passive intervertebral neck manipulation and neck range of motion exercises. Improvements lasted up to 96 hours following manipulation, even though no strengthening exercises were prescribed. Conclusions: Manipulation and range of motion should be considered as a component of intervention programmes for patients with NP and scapulothoracic muscle weakness. Future studies should compare manipulation alone to exercise alone to determine impact on strength. Copyright © 2016 John Wiley & Sons, Ltd.
    Full-text · Article · Jan 2016 · Musculoskeletal Care
    • "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.
    No preview · Article · Mar 2015 · Manual therapy
    • "3.3. Data collection and analysis At least two reviewers independently conducted citation identification , study selection, data abstraction, and risk of bias assessment according to Cochrane methodology detailed in Gross et al., (2010) earlier in this issue. Agreement was assessed for study selection using the quadratic weighted Kappa statistic (K w ); Cicchetti weights (Cicchetti, 1976). "

    No preview · Chapter · Jul 2014
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