The effectiveness of manual therapy for neck pain: a systematic review of the literature

The effectiveness of manual therapy for neck pain: a systematic review of the literature

A systematic review of randomised, controlled trials was undertaken to determine the effectiveness of manual therapy for mechanical neck disorders in reducing pain and disability in adult populations. Neck pain is a common ailment that can result in pain, disability and considerable cost. Manual therapy is a treatment modality commonly sought by patients to manage neck pain.

A literature search of MEDLINE, CENTRAL, CINHAL, SPORTdiscus, PEDro and MANTIS was conducted. Articles were included if manual therapy was performed on one group within the trial, on participants with mechanical neck pain, including neck disorders with associated headache. Studies were excluded if the cause of neck pain was serious pathology, systemic disease, or trauma, or if neck pain was associated with radicular findings, or the headache was the primary disorder.

Five trials involving 995 participants were included; four of the trials were of high methodological quality according to the validated Jadad criteria. Due to the heterogeneity of the data from the included trials, the studies could not be pooled for meta-analysis and a qualitative analysis was performed instead. Strong evidence demonstrated that manual therapy was not significantly superior to other interventions (exercise, physical therapy, medication, short wave diathermy) for relief of neck pain. Patients who received manual therapy reported being significantly more satisfied with their care than patients who received any other single therapy. A trend across three of the studies showed that manual therapy combined with exercise returned moderately larger improvements, although not statistically significant, improvements in pain, disability and patient-perceived recovery than manual therapy alone. Results in favour of combined therapies suggest multinodal care, including manual therapy and exercise, may be a potentially useful intervention in the treatment of mechanical neck disorders.