Manual therapy with exercise for neck pain

Area of Science:

• Evidence-based medicine
• Musculoskeletal rehabilitation
• Clinical trials

Background:

• Manual therapy and exercise are effective for neck pain individually.
• The combined effect of manual therapy and exercise for neck pain is not well-established.

Purpose of the Study:

• To evaluate the benefits and harms of combining manual therapy with exercise.
• To compare this combined approach against placebo or no treatment for adults with neck pain.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Included nine RCTs with 694 participants comparing manual therapy with exercise to placebo or no treatment.
• Assessed outcomes including pain intensity, function, quality of life, treatment success, and adverse events.

Main Results:

• Compared to placebo, manual therapy with exercise showed moderate functional improvement but minimal pain reduction (low-certainty evidence).
• Compared to no treatment, it led to significant pain reduction and functional improvement (low-certainty evidence).
• Non-serious adverse events were minimally increased; data on serious adverse events and treatment success were limited.

Conclusions:

• Manual therapy with exercise may improve function but not significantly reduce pain compared to placebo.
• This combination therapy offers substantial benefits for pain and function when compared to no treatment.
• Further high-quality trials are needed, particularly for acute and subacute neck pain, with improved reporting standards.