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: 1.71). 10/2010; 15(5):415-33. DOI: 10.1016/j.math.2010.04.003
Source: PubMed


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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Available from: Anita R Gross, Dec 12, 2015
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    • "The combination of mobilization or manipulation with exercise therapy produces a greater increase in CROM and a greater reduction of pain, which in turn cause an improvement of function in patients with chronic cervical disorders, both after treatment and at short-term follow up (D'Sylva et al., 2010; Miller et al., 2010). "
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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.
    Full-text · Article · May 2014 · International Journal of Advanced Research
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    • "A Cochrane review has reported the benefit of using mobilization techniques and that no differential benefit for spinal manipulation as opposed to mobilization has been shown for the outcomes of pain, function and patient satisfaction [36]. Using the techniques alone compared to combining them with exercise is mainly of short term benefit on pain only [37]. Regarding the effectiveness of massage therapy/soft tissue techniques, findings of systematic reviews are concordant [41-43]. "
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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.
    Full-text · Article · Mar 2014 · Chiropractic and Manual Therapies
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    • "A variety of conservative treatments are available for chronic mechanical NP. One commonly used treatment, spinal manipulation, is recommended by several evidencebased guidelines for patients without severe or progressive neurological deficits [19] [20] [21] [22] [23] [24] [25] [26]. There is a wide range of terms often grouped under the heading of spinal manipulation that currently show limited differences with respect to clinical effectiveness but are mechanically distinct. "
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    ABSTRACT: BACKGROUND CONTEXT: No clinical trial of spinal manipulation for chronic neck pain (NP), for either single or multiple intervention session(s), has used an effective manual sham-manipulation control group. PURPOSE: Validate a practical sham cervical high-velocity low-amplitude spinal manipulation. STUDY DESIGN/SETTING: Randomized experimental validation study in an institutional clinical research laboratory. PATIENT SAMPLE: Eligible subjects were males and females, 18 to 60 years of age with mechanical NP (as defined by the International Association for the Study of Pain Classification) of at least 3 months' duration. Subjects with arm pain, any pathologic cause of NP, or any contraindication to spinal manipulation were excluded. OUTCOME MEASURES: The primary outcome was the patient's self-report or registration of group allocation after treatment. Secondary outcomes were numerical rating scale-101 for NP, range of motion (ROM; by goniometer), and tenderness (by pressure algometry). METHODS: Eligible subjects were randomly allocated to one of two groups: real cervical manipulation (RM) or sham cervical manipulation (SM). All subjects were given two procedures in sequence, either RM+SM or SM+SM. Immediately after the two procedures, subjects were asked to register any pain experienced during the procedures and to identify their treatment group allocation. Force-time profiles were recorded during all procedures. Secondary clinical outcome measures were obtained at baseline, 5 and 15 minutes after the intervention, including ROM, self-report of pain, and local spinous process tenderness. Data for each variable were summarized and tested for normality in distribution. Summary statistics were obtained for each variable and statistically tested. RESULTS: Sixty-seven subjects were randomized. Data from 64 subjects (32 per group) were available for analysis. There were no significant differences between the groups at baseline. One adverse event occurred in the "real" group, which was a mild posttreatment pain reaction lasting less than 24 hours. In the RM group, 50% of subjects incorrectly registered their treatment allocation; in the sham group, 53% did so. For the SM group, none of the procedures resulted in cavitation, whereas in the RM group, 87% of procedures resulted in cavitation. There were no significant changes between groups on pain, tenderness, or ROM. Force-time profiles of the RM and SM procedures demonstrated fidelity with significant differences between components as intended. CONCLUSIONS: The novel sham procedure has been shown to be effective in masking subjects to group allocation and to be clinically inert with respect to common outcomes in the immediate posttreatment stage. Further research on serial applications and for multiple operators is warranted.
    Full-text · Article · Nov 2012 · The spine journal: official journal of the North American Spine Society
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