The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review

Abstract

OBJECTIVE: To review and update the evidence for different forms of manual therapy (MT) and exercise for patients with different stages of non-specific neck pain (NP). Data sources: MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE.METHOD: A qualitative systematic review covering a period from January 2000 to December 2015 was conducted according to updated-guidelines. Specific inclusion criteria only on RCTs were used; including differentiation according to stages of NP (acute – subacute [ASNP] or chronic [CNP]), as well as sub-classification based on type of MT interventions: MT1 (HVLA manipulation); MT2 (mobilization and/or soft-tissue-techniques); MT3 (MT1 + MT2); and MT4 (Mobilization-with-Movement). In each sub-category, MT could be combined or not with exercise and/or usual medical care.RESULTS: Initially 121 studies were identified for potential inclusion. Based on qualitative and quantitative evaluation criteria, 23 RCTs were identified for review. Evidence for ASNP: MODERATE-evidence: In favour of (i) MT1 to the cervical spine (Cx) combined with exercises when compared to MT1 to the thoracic spine (Tx) combined with exercises; (ii) MT3 to the Cx and Tx combined with exercise compared to MT2 to the Cx with exercise or compared to usual medical care for pain and satisfaction with care from short to long-term. Evidence for CNP: STRONG-evidence: Of no difference of efficacy between MT2 at the symptomatic Cx level(s) in comparison to MT2 on asymptomatic Cx level(s) for pain and function. MODERATE to STRONG-evidence: In favour of MT1 and MT3 on Cx and Tx with exercise in comparison to exercise or MT alone for pain, function, satisfaction with care and general-health from short to moderate-terms. MODERATE-evidence: In favour (i) of MT1 as compared to MT2 and MT4, all applied to the Cx, for neck mobility, and pain in the very short term; (ii) of MT2 using sof-tissue-techniques to the Cx and Tx or MT3 to the Cx and Tx in comparison to no-treatment in the short-term for pain and disability.CONCLUSION: This systematic review updates the evidence for MT combined or not with exercise and/or usual medical care for different stages of NP and provides recommendations for future studies. Two majors points could be highlighted, the first one is that combining different forms of MT with exercise is better than MT or exercise alone, and the second one is that mobilization need not be applied at the symptomatic level(s) for improvements of NP patients. These both points may have clinical implications for reducing the risk involved with some MT techniques applied to the cervical spine.

Physiotherapy management of a patient with neck pain having block vertebra: A case report

“…To our knowledge, this is the rst study that describes physiotherapeutic intervention for neck pain associated with block vertebra. Literature supports the ndings of our case report and suggests that exercise alone or combined with manual therapy does result in signi cant pain reduction [7], [8]. The authors used a speci c patient-reported issue as an outcome measure, the sitting duration showed improvement.…”

Cognitive behavioural interventions, and function and pain outcomes among patients with chronic neck pain managed with the McKenzie approach

“…There is currently a lack of strong evidence to support most conservative interventions for the management of CNSNP (Hidalgo et al, ), including those involving CBA. In response to this assertion, investigators have recommended that future studies be designed such that the baseline or comparison intervention is similar across subjects (Hidalgo et al, ).…”

“…One possible explanation for our findings of no clinically meaningful difference in function or pain outcomes when comparing intervention with GA/GEX versus no GA/GEX is that the patient education elements of the McKenzie approach may be similar to those of GA/GEX, thereby negating much of the effect of GA/GEX in our study population. One study examining patients with neck pain (Kjellman & Oberg, 2002) found a significant reduction in distress related depressive symptoms There is currently a lack of strong evidence to support most conservative interventions for the management of CNSNP (Hidalgo et al, 2017), including those involving CBA. In response to this assertion, investigators have recommended that future studies be designed such that the baseline or comparison intervention is similar across subjects (Hidalgo et al, 2017).…”

“…One study examining patients with neck pain (Kjellman & Oberg, 2002) found a significant reduction in distress related depressive symptoms There is currently a lack of strong evidence to support most conservative interventions for the management of CNSNP (Hidalgo et al, 2017), including those involving CBA. In response to this assertion, investigators have recommended that future studies be designed such that the baseline or comparison intervention is similar across subjects (Hidalgo et al, 2017). Our study had the advantage of evaluating the effect of adding CBA interventions to a cohort of subjects who were also receiving one very specific intervention strategy, the McKenzie approach, thereby mitigating this concern that the non-CBA interventions differed between those subjects receiving and not receiving GA/GEX.…”

Efficacy of Tuina in patients with chronic low back pain: study protocol for a randomized controlled trial

“…Additionally, some systematic reviews showed a moderate level of evidence for the clinical efficacy of manual therapy, massage, and spinal manipulations in patients with low back pain [25][26][27]. Tuina, one of the key noninvasive therapies of traditional Chinese medicine, is a Chinese manual manipulation.…”