Abstract
Study Design Systematic review.
Study Rationale Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures
are becoming an accepted treatment for neck pain. However, data on the effectiveness
of these treatments have not been summarized.
Objective To compare manipulation or mobilization of the cervical spine to physical therapy
or exercise for symptom improvement in patients with neck pain.
Methods A systematic review of the literature was performed using PubMed, the National Guideline
Clearinghouse Database, and bibliographies of key articles, which compared spinal
manipulation or mobilization therapy with physical therapy or exercise in patients
with neck pain. Articles were included based on predetermined criteria and were appraised
using a predefined quality rating scheme.
Results From 197 citations, 7 articles met all inclusion and exclusion criteria. There were
no differences in pain improvement when comparing spinal manipulation to exercise,
and there were inconsistent reports of pain improvement in subjects who underwent
mobilization therapy versus physical therapy. No disability improvement was reported
between treatment groups in studies of acute or chronic neck pain patients. No functional
improvement was found with manipulation therapy compared with exercise treatment or
mobilization therapy compared with physical therapy groups in patients with acute
pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared
to exercise treatment, results for short-term functional improvement were inconsistent.
Conclusion The data available suggest that there are minimal short- and long-term treatment
differences in pain, disability, patient-rated treatment improvement, treatment satisfaction,
health status, or functional improvement when comparing manipulation or mobilization
therapy to physical therapy or exercise in patients with neck pain. This systematic
review is limited by the variability of treatment interventions and lack of standardized
outcomes to assess treatment benefit.
Keywords
neck pain - spinal manipulation - physical therapy - exercise - mobilization therapy
