Neck Solutions Blog

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

From: Arch Phys Med Rehabil. 2010 Sep;91(9):1313-1318

To determine whether neck manipulation is more effective for neck pain than mobilization, a randomized controlled trial with blind assessment of outcome was undertaken by the authors. The setting was Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks, from which the number of days taken to recover from the episode of neck pain.

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization. The authors concluded that neck manipulation is not appreciably more effective than mobilization. The authors further noted that the use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

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The craniocervical flexion test: intra-tester reliability in asymptomatic subjects

From: Physiother Res Int. 2010 Feb 9. [Epub ahead of print]

The deep neck flexor muscles stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test provides an indirect method of assessing the endurance capacity of the deep neck flexor muscles. The purpose of the present study was to evaluate the intratester reliability of the cranio-cervical flexion test in asymptomatic subjects.

The clinical protocol of the cranio-cervical flexion test was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22-36) were recruited.

The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman’s limits of agreement analysis confirmed the high reliability of the test.

The cranio-cervical flexion test results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test.

The effect of an analgesic mobilization technique when applied at symptomatic or asymptomatic levels of the cervical spine in subjects with neck pain: a randomized controlled trial

From: J Man Manip Ther. 2009;17(2):101-8

The purpose of this single-blinded, randomized controlled trial was to compare the effects of a manual treatment technique on neck pain and movement sensation when applied in different segments of the cervical spine. Consecutive patients with neck pain (n=126) were recruited and randomly allocated to two groups (A or B). Group A received a single 4-minute pain alleviating traction at the most symptomatic zygopophyseal joint of the cervical segment, where movement was correlated with pain. Group B received the same treatment 3 segments away from the concordant segment. Pain intensity and sensation of movement were assessed with a numeric rating scale. Statistical analysis included a t-test for paired and unpaired samples. Pre- and post-test findings demonstrated significant improvements in both types of mobilization although there was no significant difference between the two groups. Similar results have been reported in the literature for cervical manipulation. The findings of this study question the necessity of precise symptom localization tests for a pain treatment. However, limitations of the study prevent generalization of these results.

Chiropractic care for patients with acute neck pain: results of a pragmatic practice-based feasibility study

From: J Chiropr Med. 2009 Dec;8(4):143-55.

The purpose of this study was to determine the feasibility of a chiropractic practice-based research network to investigate the treatment of acute neck pain and to report resulting findings. Participating chiropractors recruited sequentially presenting acute neck pain patients on their initial visit to the office. Patients were treated by the chiropractors using their usual methods. Data were prospectively collected by having patients complete the Neck Disability Index, Characteristic Pain Intensity score, and a patient satisfaction questionnaire. Questionnaires were completed during routine office visits at baseline and then at weeks 1, 2, 4, 8, and 26, either in the office or by mail.

Ten chiropractors supplied data on 99 patients. The number of cases contributed by each of the participating chiropractors ranged from 1 to 54, with a mean (SD) of 9.2 (10.5). Mean (SD) Neck Disability Index scores were 36 (17.9) at baseline and 9.8 (12.2) at the final evaluation; the Characteristic Pain Intensity scores were initially 55.3 (20.4) and were 24.5 (21.5) at the final evaluation. Transient minimal adverse effects were reported by chiropractors for only 7 (7.8%) patients. No serious adverse reactions were reported.

The practice-based research methodology used in this study appears to be a feasible way to investigate chiropractic care for acute neck pain, and its methodologies could be used to plan future research.