The efficacy of manual therapy and exercise for treating non-specific neck pain: An update of systematic reviews (original) (raw)
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Manual therapy and exercise for neck pain: A systematic review
Manual Therapy, 2010
Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: À1.69,À0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50 (95% CI:À0.76,À0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.
Research Paper: The Effect of Combination Therapy; Manual Therapy and Exercise, in Patients With Non-Specific Chronic Neck Pain: A Randomized Clinical Trial Purpose: Neck pain is one of the most common health problems that its prevalence ranges from 34% to 50%. Chronic Neck Pain (CNP) is also a frequent complaint in the general population. The pathogenesis of nonspecific CNP is not clear. This study aimed to assess the effects of soft tissue release, muscle energy techniques and exercise on neck Range of Motion (ROM), Neck Disability Index (NDI), and pain in patients with nonspecific CNP. Methods: This is a randomized, single-blind, clinical study conducted on two groups of patients in Iran, during 2016-2017. Group A received intervention treatment and group B, as control, received no treatment for 21 days. Each group consisted of 12 participants who were selected considering inclusion and exclusion criteria. Each patient in group A received manual treatment protocols (soft tissue release and muscle energy techniques) plus exercise therapy, in six sessions, one session per day, two days a week over a period of 21 days. Clinical assessments were performed at the first and last session (before and after the treatment). Before starting the study, the reliabilities of measurement methods were evaluated and the results were acceptable. Clinical assessments included neck ROM, NDI and pain based on Visual Analogue Scale (VAS). Repeated measures ANOVA test was performed for data analysis using SPSS (version 20). Results: Totally, 16 women and 8 men were participated in this study. To test the hypothesis and analysis of the study variables at regular intervals from the beginning to the end of treatment, repeated measures ANOVA was used. In the intervention group, the indexes showed significant improvements (P<0.001). This means that our intervention treatment was effective. Conclusion: The study results support the effectiveness of the combination therapy (soft tissue release, muscle energy techniques plus exercise therapy) with some improvements in the neck ROM, NDI and pain (Based on VAS scores) for the management of patients with non-specific CNP. CrossMark Citation: Ghodrati M, Mosallanezhad Z, Shati M, Rastgar Koutenaei ?, Nourbakhsh MR, Noroozi M. The Effect of Combina
Disability and Rehabilitation, 2013
Purpose: The aim of this systematic review was to determine the efficacy of thoracic spine manipulation (TSM) in reducing pain and disability in patients diagnosed with non-specific neck pain. Methods: An extensive literature search of PubMed, The Cochrane Library, CINAHL and EMBASE was conducted in February 2012. Randomized controlled trials (RCTs) or controlled clinical trials evaluating the effect of TSM in patients aged 18 to 65 years with non-specific neck pain were eligible. Methodological quality of the studies was assessed according to the Physiotherapy Evidence Database scale (PEDro). Qualitative analyses were conducted by means of the best evidence synthesis of van Peppen et al. Results: The methodological quality of the 10 included RCTs (677 patients) varied between four and eight points. Eight studies reported significant reduction in pain and/or disability by TSM. Overall, according to the best evidence synthesis, there is insufficient evidence that TSM is more effective than control interventions in reducing pain and disability in patients with non-specific neck pain. Conclusions: TSM has a therapeutic benefit to some patients with neck pain, when compared to the effect of interventions such as electrotherapy/thermal programme, infrared radiation therapy, spinal mobilization and exercises. However, in comparison to cervical spine manipulation, no evidence is found that TSM is more effective in reducing pain and disability.
Journal of the Pakistan Medical Association, 2020
Objective: To compare the effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain. Methods: The randomized controlled trial was conducted at 3 different hospitals in Peshawar, Pakistan, from October 2016 to January 2017, and comprised patients suffering from non-specific neck pain aged 25-60 years. The control group received cervical manual therapy alone while the experimental group received cervical along with thoracic manual therapy for 2 weeks. Data was analysed using SPSS 20. Results: Of the 37 subjects, 20(54%) were cases and 17(46%) were controls.The overall mean age was 35.9±9.6 years. There was no significant difference between the groups at baseline in terms of the levels of pain (p=0.125) and disability (p=0.392). The experimental group showed greater reduction in pain (p=0.02) and disability (p=0.03) compared to the control group. Conclusion: Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone.
Evidence-Based Spine-Care Journal, 2013
Study Design Systematic review. Study Rationale Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion The data available suggest that there are minimal short-and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit.
Journal of Manipulative and Physiological Therapeutics, 2007
This study provides a systematic analysis of group change scores in randomized clinical trials of chronic neck pain not due to whiplash and not including headache or arm pain treated with manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2005. Only clinical trials scoring above 11.5 (Amsterdam-Maastricht Scale) were included in the analysis. From 1980 citations, 19 publications were selected. Of the 16 trials analyzed (3 were rejected for poor quality), 9 involved spinal manipulation (12 groups), 5 trials (5 groups) were for spinal mobilization or nonmanipulative manual therapy (1 trial overlapped), and 2 trials (2 groups) involved massage therapy. No trials included trigger point therapy or manual traction of the neck. For manipulation studies, the mean effect size (ES) at 6 weeks for 7 trials (10 groups) was 1.63 (95% confidence interval [CI], 1.13-2.13); 1.56 (95% CI, 0.73-2.39) at 12 weeks for 4 trials (5 groups); 1.22 (95% CI, 0.38-2.06) from 52 to 104 weeks for 2 trials (2 groups). For mobilization studies, 1 trial reported an ES of 2.5 at 6 weeks, 2 trials reported full recovery in 63.8% to 71.7% of subjects at 7 to 52 weeks, and 1 trial reported greater than 2/10 point pain score reduction in 78.3% of subjects at 4 weeks. For massage studies, 1 reported an ES of 0.03 at 6 weeks, whereas the other reported mean change scores of 7.89/100 and 14.4/100 at 1 and 12 weeks of, respectively. There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks posttreatment. The current evidence does not support a similar level of benefit from massage.