Manual therapies for neck pain
Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews
From: Europa Medicophysica. 2007 Mar;43(1):91-118
Manual therapy for neck pain enjoys a long history, with increasing popularity in recent times. The evidence base for manual therapies for neck pain consists of a reasonably large body of clinical trials, an even greater number of systematic reviews and, more recently, a number of practice guidelines. We have conducted several systematic reviews pertaining to the evidence base for both acute and chronic neck pain as well as for the outcome of control groups of chronic neck pain subjects in clinical trials of conservative therapies. In this review, we first provide background material on the definition and characterization of manual therapies as well as on the epidemiology of neck pain. We then review our recent systematic reviews on manual therapies for acute and chronic neck pain without whiplash. Finally, we provide brief, original reviews of, first, the literature on the treatment of whiplash injury by manual therapies followed by the current practice guidelines pertaining to manual therapies for neck pain. While there are several publications, especially those registered with the Cochrane Collaboration, that are currently the authoritative evaluations of the use of manual therapies for neck pain, the present review is designed to present a broad overview of the topic with a distinctive approach emphasizing the analysis of change scores in the clinical trials. It is hoped that this will benefit researchers and clinicians alike in their management of neck pain patients.
We have provided a generic description of manual therapies and we have reviewed our recent systematic reviews on manual therapies for acute and chronic neck pain without whiplash. We then provided brief, original reviews of, first, the literature on the treatment of whiplash injury by manual therapies and, then, the current practice guidelines pertaining to manual therapies for neck pain.
While there are several publications, especially those registered with the Cochrane Collaboration, that are currently the authoritative evaluations of the use of manual therapies for neck pain, it was our hope, in the present review, to present a broad overview of the topic with a distinctive approach emphasizing the analysis of change scores in the clinical trials.
The evidence reviewed here provides support for the contention that the manual therapies which induce joint mobility—manipulation and mobilization—are effective in the treatment of neck pain, especially chronic neck pain and neck pain due to whiplash injury, in those subjects who have been randomized to receive these therapies. This is demonstrated by relatively large intragroup effect sizes as well as other indicators of change. These indicators of clinical change or improvement appear to, in general, agree with the levels of clinically important change endorsed in the literature and to exceed those of the natural history of subjects with neck pain enrolled in clinical trials. The evidence reviewed here does not yet support the contention that massage therapy is similarly effective in those subjects randomized to receive it.
While integroup changes were not the focus of this review, the evidence reviewed here does not, in general, contradict the current consensus thatmanual therapies, particularly manipulation or mobilization have been shown to be superior to each other or to other treatments to which they have been compared. A small number of trials have demonstrated a superior effect of manipulation or mobilization versus the comparison treatment in chronic neck pain as well as in whiplash, but, of course, the majority of studies have manual therapies in a multimodal therapeutic approach is still valid and sensible.
Despite the variability in reported outcomes, a number of current clinical guidelines have positively endorsed manual therapies in the treatment of neck pain, although a minority of the published guidelines have not. At present, there is no overall consensus on the status of manual therapies for neck pain. Future research is still warranted to clarify these outstanding issues and to provide guidance to practitioners of these therapies for the optimal management of their neck pain patients.
