Manual therapy and exercise for neck pain: A systematic review

School of Rehabilitation Science, McMaster University, Hamilton, Canada.
Manual therapy (Impact Factor: 1.71). 06/2010; 15(4). DOI: 10.1016/j.math.2010.02.007
Source: PubMed


Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI:-1.69,-0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI:-0.76,-0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

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    • "However, recent studies suggest that, in patients with chronic neck pain, consideration of not only the neck region but also the whole body physical fitness, and also anxiety and depression parameters might be more beneficial for the management strategies (Yalcinkaya et al., 2014). In this context, chronic MNP has been addressed with a variety of interventions including heat, traction, laser, manual therapy, and exercise (Sherman et al., 2009; Miller et al., 2010; Graham et al., 2013). Exercise was considered as one of the evidence-based modality to decrease pain, prevent further injury, increase muscle strength, endurance and flexibility, improve proprioception, and contribute and sustain normal life activities (Saal, 1992; Hides et al., 2001; Chiu et al., 2005; Kay et al., 2012). "
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    ABSTRACT: This study was planned to assess and compare the effectiveness of cervical and scapulothoracic stabilization exercise treatment with and without connective tissue massage (CTM) on pain, anxiety, and the quality of life in patients with chronic mechanical neck pain (MNP). Sixty patients with chronic MNP (18-65 years) were recruited and randomly allocated into stabilization exercise with (Group 1, n = 30) and without the CTM (Group 2, n = 30). The program was carried out for 12 sessions, 3 days/week in 4 weeks. Pain intensity with Visual Analog Scale, pressure pain threshold with digital algometer (JTech Medical Industries, ZEVEX Company), level of anxiety with Spielberger State Trait Anxiety Inventory, and quality of life with Short Form-36 were evaluated before and after the treatment. After the program, pain intensity and the level of anxiety decrease, physical health increase in Group 1 and 2 were found (p < 0.05). Pressure pain threshold and mental health increase were detected in only Group 1 (p < 0.05). The intergroup comparison showed that significant difference in pain intensity at night, pressure pain threshold, state anxiety and mental health were seen in favor of Group 1 (p < 0.05). The study suggested that stabilization exercises with and without the CTM might be a useful treatment for patients with chronic MNP. However, stabilization exercises with CTM might be superior in improving pain intensity at night, pressure pain threshold, state anxiety and mental health compared to stabilization exercise alone. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jul 2015 · Manual therapy
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    • "Recent studies have supported a multimodal approach in the treatment of neck pain, with exercise as an important component, within a bio-psychosocial framework (Miller et al., 2010; Kay et al., 2012). To date, exercise programmes have mainly focused on improving neuromuscular control, specific and general muscle activity (Miller et al., 2010). However, the cervical spine is unique with an abundance of mechanoreceptors, muscle spindles and cervical afferents associated with the vestibular, visual and central nervous systems and an important function of the cervical spine is quick and precise head movement in reaction to surrounding stimuli (Selbie et al., 1993; McLain, 1994; Corneil et al., 2002; Liu et al., 2003). "

    Full-text · Article · May 2015 · Physiotherapy
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    • "Primary care referral to physiotherapy is a widely adopted treatment option for patients with chronic neck pain, and the best evidence suggests that therapies involving exercise and manual therapy are more effective than other conservative approaches to neck pain (Kay et al., 2005; Miller et al., 2010). Exercise-based physiotherapy is a widespread clinical approach, but exercise protocols may be very different in each clinical setting. "
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    ABSTRACT: This study was conducted to identify possible prognostic factors to predict drop-out and favorable outcome in patients following a multimodal treatment program at an outpatient rehabilitation clinic. A retrospective cohort study was conducted on 437 patients with chronic neck pain involved in an exercise-based rehabilitation program of an outpatient rehabilitation center between January 2008 and November 2011. Prognostic factors were analyzed through a univariate and a multivariate logistic regression analysis. Multivariate logistic regression revealed that a higher age (OR=0.960), presence of headache (OR=0.436) or low back pain (OR=0.525), and having low levels of depression (OR=1.044) increase the odds to complete the multimodal treatment program. A high NDI-score (OR=0.945), a high NRS-score for pain in the upper extremities (OR=0.862), a low NRS score for pain in the neck (OR=1.372), and a trauma in the patient's history (OR=0.411) decrease the odds of having a favorable outcome after the given treatment program. It is important to assess these prognostic factors as they may help therapists to identify patients with a good prognosis or patients at risk. For those at risk, this would allow the treatment approach to be redirected to address their specific needs. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Feb 2015 · Manual Therapy
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