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Intervention Review

Manipulation and mobilisation for mechanical neck disorders

  1. Anita Gross1,*,
  2. Jan L Hoving2,
  3. Ted Haines3,
  4. Charles H Goldsmith3,
  5. Theresa M Kay4,
  6. Peter Aker5,
  7. Gert Brønfort6,
  8. Cervical Overview Group7

Editorial Group: Cochrane Back Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 29 OCT 2003

DOI: 10.1002/14651858.CD004249.pub2

Database Title

Additional Information

How to Cite

Gross A, Hoving JL, Haines T, Goldsmith CH, Kay TM, Aker P, Brønfort G, Cervical Overview Group. Manipulation and mobilisation for mechanical neck disorders. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004249. DOI: 10.1002/14651858.CD004249.pub2.

Author Information

  1. 1

    McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada

  2. 2

    Academic Medical Center, Universiteit van Amsterdam, Coronel Institute of Occupational Health, Amsterdam,, Netherlands

  3. 3

    McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, Ontario, Canada

  4. 4

    Sunnybrook Health Sciences Centre, North York, ON, Canada

  5. 5

    Chiropractor, Belleville, ON, Canada

  6. 6

    Northwestern Health Sciences University, Wolfe-Harris Center for Clinical Studies, Bloomington, MN, USA

  7. 7

    Hamilton, Canada

*Anita Gross, School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada. grossa@mcmaster.ca.

Publication History

  1. Publication Status: Unchanged
  2. Published Online: 7 OCT 2009

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Abstract

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  2. Abstract
  3. Plain language summary

Background

Neck disorders are common, disabling, and costly. The effectiveness of manipulation and mobilisation remains unclear.

Objectives

To assess whether manipulation and mobilisation, either alone or in combination with other treatments, relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).

Search strategy

Computerised bibliographic databases including CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, were searched without language restrictions from their respective starting dates to March 2002.

Selection criteria

The studies had to be randomised (RCT) or quasi-randomised and investigate the use of manipulation or mobilisation as a treatment for mechanical neck disorders.

Data collection and analysis

Two independent authors conducted citation identification, study selection, data abstraction, and methodological quality assessment. Using a random effects model, relative risk and standardised mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated.

Main results

Of the 33 selected trials, 42% were high quality trials. Single sessions of manipulation or multiple sessions (3 to 11 weeks) of manipulation or mobilisation, or manipulation and mobilisation showed a nonsignificant benefit in pain relief when assessed against placebo, control groups or other treatments for acute/subacute/chronic MNDs with or without headache. There was strong evidence of benefit favouring multimodal care over a waiting list control for pain reduction [pooled SMD -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [SMD -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic MND with or without headache. The common elements in this care strategy were mobilisation and/or manipulation plus exercise. There was moderate evidence of no difference in effect when multimodal care was compared to various other treatments.

Authors' conclusions

Multimodal care has short-term and long-term maintained benefits for subacute/chronic MND with or without headache. The common elements in this care strategy were mobilisation and/or manipulation plus exercise. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings.

The added benefit of exercise needs to be further explored. Factorial design would help determine the active treatment agent(s) within a treatment mix. Phase II trials would help identify the most effective treatment characteristics and dosages. Greater attention to methodological quality is needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Manipulation and mobilisation for mechanical neck disorders

People with neck pain as well as people with neck pain plus related headache that lasted at least one month, who received multimodal care that included exercises plus mobilisation [movement imposed onto joints and muscles] or manipulation [adjustments] reported greater pain reduction, improved ability to perform everyday activities and an increase in their perceived effects of treatment than those who received no treatment.

This review of 33 trials did not favour manipulation or mobilisation done alone or in combination with various other physical medicine agents. It was unclear if manipulation and mobilisation performed in combination were beneficial, but when compared to one another, neither was superior.

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