What is the evidence for spinal manipulation and mobilization (chiropractic treatment) for neck pain?
AMSTAR Rating
Summary
Patient Population:
- 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons)
- Adults experiencing neck pain (neck pain without specific cause, whiplash-associated disorder, myofascial pain syndrome, neck pain with associated degenerative changes) with or without radicular findings and cervicogenic headache
Intervention:
- Cervical manipulation, thoracic manipulation, and/or mobilisation
Comparison:
- Inactive control:
- placebo (sham/mock treatment, e.g sham TENS or mock mobilisation)
- adjunct therapy (e.g mobilisation plus treatment versus the same treatment, such as ultrasound)
- wait list or no treatment
- Active treatment:
- Manipulation/mobilisation versus another intervention (e.g medication, acupuncture, physical therapy)
- One technique of manipulation/mobilisation versus another
- One dose of manipulation/mobilisation versus another
Outcome:
- Primary Outcomes:
- Pain
- Cervical manipulation versus oral medicine (variations/combinations of NSAID, analgesic, opiod analgesic and muscle relaxant)
- Intermediate follow-up: no significant difference
- Long term follow-up: favours manipulation; SMD -0.21 (-0.50 to -0.08); one trial, N=182
- Thoracic manipulation versus inactive control
- Short term follow-up: favours manipulation; SMD -1.46 (-2.20 to -0.71); four trials, N=242
- Intermediate follow-up: favours manipulation; SMD -0.64 (-1.04 to -0.25); one trial, N=111
- Cervical manipulation versus mobilisation
- Intermediate follow-up: no significant difference
- Cervical manipulation versus exercise
- Intermediate and long term follow-up: no significant difference
- High (12-18 sessions) versus low (3-8 sessions) dose manipulation
- No significant difference
- Cervical manipulation versus oral medicine (variations/combinations of NSAID, analgesic, opiod analgesic and muscle relaxant)
- Function
- Cervical manipulation versus oral medicine
- Intermediate follow-up: favour manipulation; SMD -0.30 (-0.59 to 0.00); one trial, N=182
- Long term follow-up: no significant difference
- Thoracic manipulation versus inactive control
- Short term follow-up: favours manipulation for acute/subacute pain; SMD -1.73 (-2.68 to -0.78); three trials, N=258
- Short term follow-up: favours manipulation for chronic pain; SMD -0.5 (-0.89 to -0.10); one trial, N=111
- Intermediate follow-up: favour manipulation; SMD -0.38 (-0.77 to 0.01); one trial, N=111
- Cervical manipulation versus mobilisation
- Short and intermediate term follow-up: no significant difference
- Cervical manipulation versus exercise
- Intermediate and long term follow-up: no significant difference
- High (12-18 sessions) versus low (3-8 sessions) dose manipulation
- No significant difference
- Cervical manipulation versus oral medicine
- Pain
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Cervical Manipulation (PAIN)
v. Simple Oral Pain Meds
v. Mobilization
v. Exercise
High v. Low Dose
Cervical Manipulation (FUNCTION)
v. Simple Oral Meds
v. Mobilization
High v. Low Dose
Thoracic Manipulation (PAIN)
v. inactive control
Thoracic Manipulation (FUNCTION)
v. inactive control
Relevant Clinical Info
Author conclusions:
“No high-quality evidence was found, so uncertainty about the effectiveness of mobilisation or manipulation for neck pain remains. Future research is likely to have an important impact on the effect estimate.”
Participant Information
the sample size was 2920
their were 51 studies used.
