Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for...

Area of Science:

• Orthopedics and Sports Medicine
• Physical Therapy
• Pain Management

Background:

• Chronic nonspecific neck pain affects many patients, with mobilization and manipulation therapies frequently used.
• Questions persist regarding the efficacy, optimal dosing, and safety of these interventions compared to alternatives.

Purpose of the Study:

• To systematically review and meta-analyze published trials to determine the efficacy, effectiveness, and safety of mobilization and manipulation therapies for chronic nonspecific neck pain.

Main Methods:

• A systematic literature review and meta-analysis of randomized controlled trials (RCTs) published between January 2000 and September 2017.
• Included RCTs compared manipulation/mobilization to sham, no treatment, other active therapies, or multimodal approaches.
• Risk of bias was assessed using Scottish Intercollegiate Guidelines Network criteria; data were pooled using random-effects meta-analysis where possible.

Main Results:

• 47 RCTs (4,460 patients) with low risk of bias were included. A small effect favoring thrust manipulation plus exercise over exercise alone was found for pain and disability reduction.
• Multimodal approaches (integrating multiple therapies) showed effectiveness in reducing pain and improving function.
• Adverse events were reported in 25/47 studies, with only minor or no events occurring; health-related quality of life was seldom reported.

Conclusions:

• Low-to-moderate quality evidence suggests mobilization and manipulation therapies can reduce pain and improve function in chronic nonspecific neck pain.
• Multimodal therapeutic approaches may offer the greatest potential benefits.
• While manipulation and mobilization appear safe, larger studies are needed to fully characterize safety profiles.