Vergleich der Wirksamkeit von Mobilisation und Manipulation bei mechanischen Nackenschmerzen

Zusammenfassung

Nackenschmerzen sind weltweit eine der häufigsten muskuloskelettalen Beschwerden und können zu chronischen Problemen führen. Manuelle Therapie ist hierbei eine häufig verordnete und durchgeführte Therapie zur Verbesserung von Schmerz und Funktion, unklar ist jedoch, ob Mobilisation oder Manipulation dabei größere Effekte zeigt.

Ziel dieser Übersichtsarbeit mit Metaanalyse ist es, die Wirksamkeit von Manipulation im Vergleich zu Mobilisation bei mechanischen Nackenschmerzen zu beurteilen.

Eine systematische Literaturrecherche erfolgte in den Datenbanken PubMed, CINAHL, Cochrane und Web of Science. Untersuchte Endpunkte waren Schmerzintensität (VAS und NPRS), Aktivitätseinschränkungen (NDI), subjektiver Behandlungseffekt (GROC) und aktive Beweglichkeit der Halswirbelsäule (ACROM).

Die Suche ergab 410 Treffer, von denen 5 Artikel in das Review und die Metaanalyse eingeschlossen werden konnten. Die Ergebnisse zeigen, dass sowohl Manipulation als auch Mobilisation Vorteile bei der Behandlung direkt nach der Intervention bieten. Im direkten Vergleich der beiden Techniken zeigte die Manipulation in mehreren Bewegungsrichtungen tendenziell größere Verbesserungen der Beweglichkeit.

Im Bereich der Flexion wurden Verbesserungen zwischen 2,1° (95% CI -0,39; 4,59) und 5,5° (95% CI 3,64; 7,36) beobachtet, während die Verbesserungen der Extension zwischen 1,68° (95% CI -1,19; 4,55) und 9,9° (95% CI 6,45; 13,35) variierten. Für die Rotation nach rechts wurden Verbesserungen zwischen 7,29° (95% CI 5,36; 9,22) und 9,6° (95% CI 7,85; 11,35) gemessen. Eine signifikante Überlegenheit der Manipulation gegenüber der Mobilisation konnte jedoch bei anderen Endpunkten nicht festgestellt werden.

Aufgrund der hohen Heterogenität der eingeschlossenen Studien, die auf erhebliche Unterschiede in den Stichproben und der Durchführung der Intervention zurückzuführen sind, sowie der begrenzten Anzahl vergleichbarer Studien wurde die Evidenzqualität als gering eingestuft. Weitere Forschung ist notwendig, um die optimalen Bedingungen für den Einsatz beider Techniken zu klären. Zukünftige Studien sollten sich auf die mittel- und langfristigen Effekte konzentrieren und ihre Anwendbarkeit in der klinischen Praxis evaluieren.

Abstract

Neck pain is one of the most common musculoskeletal complaints worldwide and can lead to chronic impairment. Manual therapy is a frequently prescribed and widely used treatment aimed at improving pain and function. However, it remains unclear whether mobilization or manipulation yields greater effects.

This systematic review and meta-analysis aim to evaluate the effectiveness of manipulation compared to mobilization for mechanical neck pain.

A systematic literature search was conducted in the databases PubMed, CINAHL, Cochrane, and Web of Science. Examined outcomes included pain intensity (VAS and NPRS), neck function and disability (NDI), subjective treatment effect (GROC), and active cervical range of motion (ACROM).

The search identified 410 records, of which five studies met the inclusion criteria for the review and meta-analysis. The results indicate that both manipulation and mobilization provide benefits immediately after the intervention. In direct comparison, manipulation tended to yield greater improvements in cervical range of motion across several directions.

Improvements in flexion ranged from 2.1° (95% CI -0.39; 4.59) to 5.5° (95% CI 3.64; 7.36), while extension improved between 1.68° (95% CI -1.19; 4.55) and 9.9° (95% CI 6.45; 13.35). For rotation to the right, improvements ranged from 7.29° (95% CI 5.36; 9.22) to 9.6° (95% CI 7.85; 11.35). However, no significant superiority of manipulation over mobilization was observed for other outcome measures.

Due to the high heterogeneity among included studies, attributed to considerable differences in sample sizes and intervention execution, as well as the limited number of comparable studies, the quality of evidence was rated as low. Further research is needed to determine the optimal conditions for the application of both techniques. Future studies should focus on medium- and long-term effects and assess their clinical applicability.

Schlüsselwörter

Nackenschmerzen - Manuelle Therapie - Manipulation - Mobilisation - Systematisches Review - Metaanalyse

Keywords

neck pain - manual therapy - manipulation - mobilization - systematic review - meta-analysis

Publication History

Received: 08 December 2023

Accepted: 13 January 2024

Article published online:
18 July 2025

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