Manual therapy and exercise for neck pain: A systematic review

Area of Science:

• Orthopedics and Sports Medicine
• Physical Therapy and Rehabilitation
• Pain Management

Background:

• Neck pain is a prevalent condition often managed with manual therapy and exercise.
• The combination of manual therapy (manipulation or mobilization) and exercise is a common treatment approach.
• Evidence regarding the efficacy of this combined approach for various neck pain presentations needs regular updating.

Purpose of the Study:

• To systematically review and update evidence on the effectiveness of manual therapy plus exercise for neck pain.
• To assess improvements in pain, function, quality of life, and patient satisfaction.
• To evaluate outcomes for adults with neck pain, including those with cervicogenic headache or radiculopathy.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searches conducted up to July 2009, with independent study selection, data abstraction, and quality assessment.
• Calculation of pooled relative risk (pRR) and standardized mean differences (pSMD).

Main Results:

• Low-quality evidence suggests clinically important long-term improvements in pain, function, and global perceived effect when manual therapy and exercise are compared to no treatment.
• High-quality evidence indicates greater short-term pain relief with manual therapy plus exercise compared to exercise alone for various neck pain types.
• Moderate evidence supports the combination for chronic neck pain and acute whiplash, with sparse evidence for radiculopathy.

Conclusions:

• Manual therapy combined with exercise provides short-term pain relief superior to exercise alone for neck pain.
• The combination shows long-term benefits compared to no treatment, but long-term differences over exercise alone are not consistently found.
• Further research is recommended, particularly for neck pain with radiculopathy.