Conditions: Cervical (Neck Pain) Pain
Curator: Mitchell Haas DC MA
Contributors: Gert Bronfort DC PhD, Michael Schneider DC PhD
Papers
1-10 10
| Reviews | |
Effectiveness of manual therapies: the UK evidence report. |
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| Bronfort, Gert; Haas, Mitch; Evans, Roni; Leininger, Brent & Triano, Jay | |
| Chiropractic \& osteopathy | |
| 2010 | |
| The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. | |
| Get the paper here | |
| Reviews | |
Manual therapy with or without physical medicine modalities for neck pain: a systematic review. |
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| D’Sylva, Jonathan; Miller, Jordan; Gross, Anita; Burnie, Stephen J; Goldsmith, Charles H; Graham, Nadine; Haines, Ted; Br\o nfort, Gert & Hoving, Jan L | |
| Manual therapy | |
| 2010 | |
| 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. | |
| Get the paper here | |
| Reviews | |
Manipulation or mobilisation for neck pain. |
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| Gross, Anita; Miller, Jordan; D’Sylva, Jonathan; Burnie, Stephen J; Goldsmith, Charles H; Graham, Nadine; Haines, Ted; Br\o nfort, Gert & Hoving, Jan L | |
| The Cochrane database of systematic reviews | |
| 2010 | |
| BACKGROUND: Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. OBJECTIVES: To assess if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life, and global perceived effect in adults with acute/subacute/chronic neck pain with or without cervicogenic headache or radicular findings. SEARCH STRATEGY: CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, Manual Alternative and Natural Therapy, CINAHL, and Index to Chiropractic Literature were updated to July 2009. SELECTION CRITERIA: Randomised controlled trials on manipulation or mobilisation. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, abstracted data, and assessed risk of bias. Pooled relative risk and standardised mean differences (SMD) were calculated. MAIN RESULTS: We included 27 trials (1522 participants).Cervical Manipulation for subacute/chronic neck pain : Moderate quality evidence suggested manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate-term follow-up. Low quality evidence showed manipulation alone compared to a control may provide short- term relief following one to four sessions (SMD pooled -0.90 (95\%CI: -1.78 to -0.02)) and that nine or 12 sessions were superior to three for pain and disability in cervicogenic headache. Optimal technique and dose need to be determined.Thoracic Manipulation for acute/chronic neck pain : Low quality evidence supported thoracic manipulation as an additional therapy for pain reduction (NNT 7; 46.6\% treatment advantage) and increased function (NNT 5; 40.6\% treatment advantage) in acute pain and favoured a single session of thoracic manipulation for immediate pain reduction compared to placebo for chronic neck pain (NNT 5, 29\% treatment advantage).Mobilisation for subacute/chronic neck pain: In addition to the evidence noted above, low quality evidence for subacute and chronic neck pain indicated that 1) a combination of Maitland mobilisation techniques was similar to acupuncture for immediate pain relief and increased function; 2) there was no difference between mobilisation and acupuncture as additional treatments for immediate pain relief and improved function; and 3) neural dynamic mobilisations may produce clinically important reduction of pain immediately post-treatment. Certain mobilisation techniques were superior. AUTHORS’ CONCLUSIONS: Cervical manipulation and mobilisation produced similar changes. Either may provide immediate- or short-term change; no long-term data are available. Thoracic manipulation may improve pain and function. Optimal techniques and dose are unresolved. 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. | |
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| Reviews | |
Manual therapy and exercise for neck pain: A systematic review. |
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| Miller, Jordan; Gross, Anita; D’Sylva, Jonathan; Burnie, Stephen J; Goldsmith, Charles H; Graham, Nadine; Haines, Ted; Br\o nfort, Gert & Hoving, Jan L | |
| Manual therapy | |
| 2010 | |
| 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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| Efficacy and Comparative Efficacy/Effectiveness | |
Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. |
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| Bronfort, Gert; Evans, Roni; Anderson, Alfred V; Svendsen, Kenneth H; Bracha, Yiscah & Grimm, Richard H | |
| Annals of internal medicine | |
| 2012 | |
| BACKGROUND: Mechanical neck pain is a common condition that affects an estimated 70\% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain. OBJECTIVE: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. DESIGN: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770) SETTING: 1 university research center and 1 pain management clinic in Minnesota. PARTICIPANTS: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks. INTERVENTION: 12 weeks of SMT, medication, or HEA. MEASUREMENTS: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks. RESULTS: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.LIMITATIONS: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature. CONCLUSION: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine, National Institutes of Health. | |
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| Efficacy and Comparative Efficacy/Effectiveness | |
Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. |
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| Dunning, James R; Cleland, Joshua a; Waldrop, Mark a; Arnot, Cathy F; Young, Ian a; Turner, Michael & Sigurdsson, Gisli | |
| The Journal of orthopaedic and sports physical therapy | |
| 2012 | |
| Randomized clinical trial. | |
| Get the paper here | |
| Efficacy and Comparative Efficacy/Effectiveness | |
Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. |
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| Evans, Roni; Bronfort, Gert; Schulz, Craig; Maiers, Michele; Bracha, Yiscah; Svendsen, Kenneth; Grimm, Richard; Garvey, Timothy & Transfeldt, Ensor | |
| Spine | |
| 2012 | |
| STUDY DESIGN: Randomized controlled trial using mixed methods. OBJECTIVE: To evaluate the relative effectiveness of high-dose supervised exercise with and without spinal manipulation and low-dose home exercise for chronic neck pain. SUMMARY OF BACKGROUND DATA: Neck pain is a common global health care complaint with considerable social and economic impact. Systematic reviews have found exercise therapy (ET) to be effective for neck pain, either alone or in combination with spinal manipulation. However, it is unclear to what extent spinal manipulation adds to supervised exercise or how supervised high-dose exercise compares with low-dose home exercise. METHODS: Two hundred and seventy patients with chronic neck pain were studied at an outpatient clinic. Patients were randomly assigned one of the following interventions: (1) high-dose supervised strengthening exercise with spinal manipulation (exercise therapy combined with spinal manipulation therapy [ET + SMT]), (2) high-dose supervised strengthening exercise (ET) alone, or (3) low-dose home exercise and advice (HEA). The primary outcome was patient-rated pain at baseline and at 4, 12, 26, and 52 weeks. Secondary measures were disability, health status, global perceived effect, medication use, and satisfaction. RESULTS: At 12 weeks, there was a significant difference in patient-rated pain between ET + SMT and HEA (1.3 points, P < 0.001) and ET and HEA (1.1 points, P = 0.001). Although there were smaller group differences in patient-rated pain at 52 weeks (ET + SMT vs. HEA, 0.2 points, P > 0.05; ET vs. HEA, 0.3 points, P > 0.05), linear mixed model analyses incorporating all time points yielded a significant advantage for the 2 supervised exercise groups (ET + SMT vs. HEA, P = 0.03; ET vs. HEA, P = 0.02). Similar results were observed for global perceived effect and satisfaction. CONCLUSION: Supervised strengthening exercise with and without spinal manipulation performed similarly, yielding better outcomes than home exercise particularly in the short term. Various stakeholders’ perspectives should be considered carefully when making recommendations regarding these therapies, taking into account side effects, preferences, and costs. | |
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| Efficacy and Comparative Efficacy/Effectiveness | |
Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. |
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| Haas, Mitchell; Spegman, Adele; Peterson, David; Aickin, Mikel & Vavrek, Darcy | |
| The spine journal : official journal of the North American Spine Society | |
| 2010 | |
| Systematic reviews of randomized controlled trials suggest that spinal manipulative therapy (SMT) is efficacious for care of cervicogenic headache (CGH). The effect of SMT dose on outcomes has not been studied. | |
| Get the paper here | |
| Efficacy and Comparative Efficacy/Effectiveness | |
The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain – a randomized controlled trial. |
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| Lau, Herman Mun Cheung; Wing Chiu, Thomas Tai & Lam, Tai-Hing | |
| Manual therapy | |
| 2011 | |
| The aim of our study was to assess the effectiveness of thoracic manipulation (TM) on patients with chronic neck pain. 120 patients aged between 18 and 55 were randomly allocated into two groups: an experimental group which received TM and a control group without the manipulative procedure. Both groups received infrared radiation therapy (IRR) and a standard set of educational material. TM and IRR were given twice weekly for 8 sessions. Outcome measures included craniovertebral angle (CV angle), neck pain (Numeric Pain Rating Scale; NPRS), neck disability (Northwick Park Neck Disability Questionnaire; NPQ), health-related quality of life status (SF36 Questionnaire) and neck mobility. These outcome measures were assessed immediately after 8 sessions of treatment, 3-months and at a 6-month follow-up. Patients that received TM showed significantly greater improvement in pain intensity (p = 0.043), CV angle (p = 0.049), NPQ (p = 0.018), neck flexion (p = 0.005), and the Physical Component Score (PCS) of the SF36 Questionnaire (p = 0.002) than the control group immediately post-intervention. All these improvements were maintained at the 6-month follow-ups. This study shows that TM was effective in reducing neck pain, improving dysfunction and neck posture and neck range of motion (ROM) for patients with chronic mechanical neck pain up to a half-year post-treatment. | |
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| Efficacy and Comparative Efficacy/Effectiveness | |
A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. |
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| Leaver, Andrew M; Maher, Christopher G; Herbert, Robert D; Latimer, Jane; McAuley, James H; Jull, Gwendolen & Refshauge, Kathryn M | |
| Archives of physical medicine and rehabilitation | |
| 2010 | |
| UNLABELLED: A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. OBJECTIVE: To determine whether neck manipulation is more effective for neck pain than mobilization. DESIGN: Randomized controlled trial with blind assessment of outcome. SETTING: Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia. PARTICIPANTS: Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner. INTERVENTIONS: Participants 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. MAIN OUTCOME MEASURE: The number of days taken to recover from the episode of neck pain. RESULTS: 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 (hazard ratio=.98; 95\% confidence interval, .66-1.46). CONCLUSIONS: Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness. | |
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