Review: Manipulation vs mobilization to treat neck pain

In this Cochrane review, the effects of manipulation and mobilization alone or combined with other treatment approaches on neck pain were evaluated.

First, the details.

• 27 studies involving 1522 participants were reviewed
• The objective was to assess manipulation vs mobilization for improved pain, function/disability, patient satisfaction, quality of life, and global perceived effect in adults with acute/subacute/chronic neck pain with or without cervicogenic (neck) headache or radicular (sciatica type) findings.
• Quality of evidence was defined as follows:
  • High quality: Further research is very unlikely to change our confidence in the estimate of effect.
  • Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
  • Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
• Manipulation: Short, quick movement that moves the joint beyond where patient’s muscles could move the joint by themselves.
• Mobilization: Movements administered by the clinician within physiologic joint space  to increase range of motion.

And, the results.

Cervical manipulation for subacute/chronic neck pain

• Manipulation and mobilization produce similar effects on pain, function, and patient satisfaction over an intermediate period (moderate quality).
• Manipulation alone vs control may provide short-term relief after 1 to 4 sessions, and 9 or 12 sessions is better than 3 for pain and disability in cervicogenic headache (low quality).
• Optimal technique and dose must be determined.

Thoracic manipulation for acute/chronic neck pain

• Thoracic manipulation is an additional treatment to reduce pain and increased function in acute pain (low quality).
• A single session is better for immediate pain reduction vs placebo for chronic neck pain (low quality).

Mobilization for subacute/chronic neck pain

• Combining Maitland mobilization techniques is similar to acupuncture for immediate pain relief and increased function (low quality).
• There’s no difference between mobilization and acupuncture as additional treatments for immediate pain relief and improved function (low quality).
• Neuraldynamic mobilizations (reduction in pressure) may produce a clinically important reduction of pain immediately after treatment (low quality).
• Certain mobilization techniques are superior to others (low quality).

The bottom line?

The authors concluded, “Cervical manipulation and mobilization produced similar changes. Either may provide immediate- or short-term change.”

“Thoracic manipulation may [also] improve pain and function.”

However, there are no long-term data on effectiveness, and optimal techniques and dose are unresolved.

Researchers from the Canadian Memorial Chiropractic College in Toronto reviewed the response to a single session of manual therapy for chronic neck pain not due to whiplash and without headache or arm pain. They were more positive, concluding, “There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation.”

4/18/10 17:59 JR