Manual therapy for mechanical neck disorders: a systematic review

doi:10.1054/math.2002.0465

Manual Therapy

Volume 7, Issue 3, August 2002, Pages 131-149

https://doi.org/10.1054/math.2002.0465 Get rights and content

Abstract

SUMMARY. Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. Two independent reviewers extracted data while three assessed trial quality. Standard mean difference and relative risks were translated to number needed to treat (NNT) and the percent treatment advantage. The 20 selected trials' quality was 2.4 (SD: 1.04) on the 5-point scale described by Jadad. Trials were clinically heterogenous. Manipulation alone, mobilizations alone, manipulation/mobilization and treatments including massage consistently showed similar effects to placebo, wait period or control. Multimodal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain and patient satisfaction. The NNT for a clinically important reduction in pain varied from 2 to 11 and treatment advantage from 6% to 41% at the cost of benign transient side-effects. While results remain inconclusive, some clinical themes have emerged. For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.

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The purpose of this case report is to describe the management of a patient with trigeminal symptoms of cervical origin after a motor-vehicle crash (MVC).
After a head-on MVC, a 65-year-old woman presented with complaints of dizziness, headaches, facial tingling, visual disturbance, tinnitus, loss of cervical motion, and pain in the cervical spine.
The intervention applied was manipulation of the left C1-C2 and right C2-C3, with targeted exercise to strengthen the cervical musculature. After 4 weeks of treatment, the patient reported improvement in functional tasks and reduction in overall pain, headaches, facial tingling, tinnitus, and dizziness. At a 9-month follow-up, the patient had no report of facial tingling, tinnitus, loss of motion, or eye pain.
This patient with trigeminal symptoms of cervical origin after an MVC responded well to manual therapy to the cervical spine as part of a combination of services.
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As therapists, we often recommend exercise to reduce patients' low-back pain, as well as increase their active range of motion and muscle strength. However, physical therapists face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient's ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise program aggravates the individual's low-back pain. This article discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process. The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory mobilization; end-of-range passive stretch; and mindfulness.
Does a manual therapy approach improve the symptoms of functional constipation? A systematic review of the literature
2020, International Journal of Osteopathic Medicine
Citation Excerpt :
Such treatments are also more patient-centric and may be beneficial as techniques can be chosen based on the characteristics of the target tissues [34] in addition to the perception of patient's needs. Additionally, findings from other manual therapy reviews [38,39] suggest that a multi-modal style treatment may actually be associated with favourable clinical outcomes. The majority of included studies provided the intervention at a frequency of 2–5 times per week for the length of the intervention period, which, considering the associated financial cost and time commitment is perhaps an unachievable course of treatment for many people, an issue that has been acknowledged in previous reviews on massage [20,34].
Functional constipation is highly prevalent and places a significant burden on healthcare systems around the world. Manual therapy is a commonly used intervention, however to date there has not been a systematic review that critically appraises a wide range of manual therapy disciplines.
To systematically review the literature and analyse the methodological quality of all included studies, and to provide an overall level of evidence analysis.
A database search was completed to identify eligible studies that were published from database creation to July 2018. The relevant characteristics of each study were extracted, and each study was assessed for methodological quality with a modified version of the Downs and Black appraisal tool.
Seven studies fulfilled the inclusion criteria and were assessed for methodological quality. One study was found to have ‘strong’ methodological quality, five were of ‘moderate’ quality, and one was of ‘low’ quality. All studies reported consistent findings regarding their individual primary outcome measures. Overall level of evidence for the use of manual therapy as an intervention for constipation was found to be ‘moderate’.
There is moderate quality evidence for the use of manual therapy as an intervention for constipation. The review identified several themes that can guide future research on this topic, including intervention type and frequency, reporting quality, mechanism of effect, and variability of outcome measures.
Treatment of Neck Pain With Myofascial Therapies: A Single Blind Randomized Controlled Trial
2020, Journal of Manipulative and Physiological Therapeutics
This study aimed to investigate the effects of myofascial release therapy vs a standard physical therapy program in patients with neck pain (NP).
This was a randomized controlled trial in which 54 participants with mechanical NP were randomly assigned into an experimental group (EG) or a comparison group (CG). The EG group (n = 27) received 5 therapy sessions of myofascial release therapy while the CG group (n = 27) received 10 sessions of massage, ultrasound therapy, and transcutaneous electric nerve stimulation over a 2-week period. Outcome measures were the numerical pain rating scale (NPRS), pressure pain thresholds (PPTs) and range of motion at the end of treatment and at 1-month follow-up.
At 1-month follow-up, between-group differences in change scores were found in the NPRS (mean = –1.56, 95% confidence interval [CI] [–2.30 to –0.81]; P < .001), in the right thoracic PPT (mean = 0.35, 95% CI [0.03-0.66]; P = .031), and in both left (mean = 0.34, 95% CI [0.08-0.61]; P = .012) and right (mean = 0.29, 95% CI [0.04-0.54]; P = .026) suboccipital PPTs. The success rate was 63.0% in the CG and 92.6% in the EG. The number needed to treat was 3.38 (95% CI = 1.99-11.23).
Myofascial release therapy could be better than a standard physical therapy program for improving pain and suboccipital PPTs in patients with NP. However, the difference between both treatments is less than the minimum detectable change of the NPRS.
Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration
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Neck pain is a public health problem associated with disability, reduced health-related quality of life, and substantial health-care system costs [1–3]. Numerous treatments, including manual therapies, passive physical modalities, and acupuncture, are commonly used to treat neck pain [4,5]. However, few interventions have been demonstrated to be effective and most are associated with short-term benefits [5].
In 2008, the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD).
This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD.
This is a systematic review and best evidence synthesis.
The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention.
The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events.
We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance.
We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I–II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I–II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I–II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I–II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I–II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I–II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.
Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.
Effects of cranio-cervical flexion and manual spinal mobilisation in patients with chronic neck pain: Case series
2020, Fisioterapia
La cervicalgia crónica (CC) es una afección frecuente, siendo una de las principales causas de discapacidad. Dentro de los tratamientos fisioterapéuticos más utilizados se encuentran el ejercicio y la movilización manual vertebral (MMV). No obstante, la aplicación de MMV se basa en fundamentos artrocinemáticos y no en el propósito directo de favorecer la ejecución de un ejercicio específico.
Describir el efecto de un programa de fisioterapia a corto y medio plazo basado en MMV destinada a favorecer el ejercicio de flexión cráneo-cervical (EFCC).
Se evaluaron la intensidad de dolor, el umbral de dolor a la presión, el rango de movimiento, el control neuromuscular y la discapacidad cervical en 12 mujeres con CC al inicio, al término y a 3 meses de finalizada la intervención.
Se ejecutó un programa de 10 sesiones de tratamiento basadas en EFCC y MMV.
Todas las participantes experimentaron una mejoría clínicamente relevante de su condición a corto plazo, la que se mantuvo 3 meses postintervención.
El EFCC sumado a una técnica de MMV que busca potenciar la ejecución del ejercicio presentó resultados positivos en mujeres con CC a corto y medio plazo.
Chronic neck pain is a frequent condition, considered one of the main causes of disability. Among the most used physiotherapeutic treatments are exercise and vertebral manual mobilisation (VMM). However, the application of VMM is based on arthrokinematic fundamentals and not on directly favouring the execution of a specific exercise.
to describe the effect of a short- and medium-term physiotherapy programme based on VMM aimed at promoting the exercise of cranio-cervical flexion (CCFE).
Pain intensity, pressure pain threshold, range of motion, neuromuscular control and cervical disability were evaluated in 12 women with chronic neck pain at the beginning, end and 3 months after the intervention.
A programme of 10 treatment sessions based on CCFE and VMM was executed.
all participants experienced a clinically relevant improvement of their condition in the short term, which remained 3 months post-intervention.
The CCFE added to a VMM, which seeks to enhance the execution of the exercise, presented positive results in women with chronic neck pain in the short and medium term.

View all citing articles on Scopus

^☆: A. R. Gross, BScPT, MSc, GradDipManipTher, Hamilton Health Sciences, Hamilton, Canada and McMaster University, Hamilton, Canada, T. Kay, BHScPT, MSc, Sunnybrook and Women's College Health Sciences, Toronto, Canada, C. Kennedy, BScPT, University of Toronto, Toronto, Canada, M. Hondras, DC, MSc, LAMP, Toronto, Canada, C. Goldsmith, PhD, McMaster University, Hamilton, Canada, T. Haines, MD, MSc, DOHS, FRCP(C), LAMP, Toronto, Canada, P. Peloso, MD, MSc, FRCP(C), University of Saskatchewan, Saskatoon, Canada, J. Hoving, PhD, Institure for Research in Extramural Medicine, vrije Universiteit Amsterdam, Netherlands

^☆☆: Support from University of Saskatchewan, Clinical Teaching and Research Award; Hamilton Health Sciences, Chedoke-McMaster Foundation.

^f3: Correspondence to: ARG, Hamilton Health Sciences, Chedoke Campus, Out-patient Physiotherapy, Wilcox Building, 1st floor, 565 Sanatorium Rd., Hamilton, Ont., Canada L8N 3Z5, Tel: +905-521-7945; Fax: +905-521-2606 attention: Out-patient Physiotherapy; E-mail: [email protected]

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Regular ArticleManual therapy for mechanical neck disorders: a systematic review☆,☆☆

Abstract

Pain

Controlled Clinical Trials

Archives in Physical Medicine and Rehabilitation

Pain

Pain

Physical therapy in occipital headaches

Manual Medizin

Rational Manual Therapies

Zur objectivierung der manualtherapeutischen beeinflussbarkeit des spondylogenen kopfschmerzes

Nervenarzt

Cervical pain and mobilization

International Journal of Rehabilitation Research

Cervical pain and mobilization

Manual Medicine

A randomized controlled clinical trial of rehabilitative exercise and spinal manipulation for chronic neck pain. Effects on neck pain and disability, functional health status, biomechanical neck dysfunction, and somato-visceral symptoms

A randomized controlled clinical trial of rehabilitative exercise and chiropractic spinal manipulation for chronic neck pain

Proceedings of the Scientific Symposium, 1997 World Chiropractic Congress

A randomized controlled clinical trial of spinal manipulation and exercise for chronic neck pain: A report on neck performance outcomes after 11 weeks and long-term effects on patient-rated outcomes

Proceedings of the 1998 International Conference of Spinal Manipulation Foundation for Chiropractic Education and Research

A randomized controlled clinical trial of rehabilitative exercise and chiropractic spinal manipulation for chronic neck pain

Spine

The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: A randomized controlled trial

Journal of Manipulative Physiology Therapy

The Saskatchewan health and back pain survey

The prevalence of neck pain and related disability in Saskatchewan adults. Spine

Chronic neck pain: A comparison of acupuncture treatment and physiotherapy

British Journal of Rheumatology

Controlled Clinical Trials

Introduction to Statistical Analysis

Conservative treatment of neck pain: Distinguishing useful from useless therapy

Journal of Back and Musculoskeletal Rehabilitation

Statistics with confidence

Confidence intervals and statistical guidelines. BMJ

Die distorsion der halswirbelsaule: Fruhfunktionalle vs. ruhigstellende behandlung

Zentralbibliotak Chiropractic

Estimating the horizon of a literature search

Criteria for clinically important changes in outcomes. Development, scoring and evaluation of rheumatoid arthritis patients and trial profiles

Journal of Rheumatology

Clinical practice guideline on the use of manipulation of mobilization in the treatment of adults with mechanical neck disorders

Manual Therapy

A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain

Spine

Manipulation and mobilization of the cervical spine: A systematic review of the literature

Spine

The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: A controlled cost-effectiveness study

Scandinavian Journal of Rehabilitation Medicine

Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: A prospective single-blind randomized clinical trial

Spine

Regular Article
Manual therapy for mechanical neck disorders: a systematic review☆,☆☆