Not so Good News for Cervical Manipulation

Reference:Evans R, et al Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976). 2012 May 15;37(11):903-14.

This 2012 RCT involved 270 patients with chronic neck pain who visited an outpatient clinic. The patients were randomly allocated to:

Group 1: Basic home exercises and advice

Group 2: Comprehensive supervised exercises

Group 3: Comprehensive supervised exercises & cervical manipulation

Basic Results: After 3 months, Group 2 & 3 did significantly better than Group 1 with respect to pain, global perceived effect and satisfaction.

There were no differences between Group 2 & 3, so cervical manipulations did not add to the benefits of supervised exercises.

Conclusion: Supervised neck and upper extremity strengthening exercises can be of benefit for individuals with chronic neck pain but the addition of spinal manipulations appears to provide no extra benefit in the short and long term.

Personal Comment: I personally perform cervical mobilizations and focus on self-management strategies. I do avoid cervical manipulations as most of my patients have had symptoms for several years and I doubt that a “click” is going resolve their pain. However for acute neck pain, I do find that thoracic manipulations sometimes provide immediate pain relief …and there are a few RCTs to support this.

Posted on: July 05, 2012

Categories: Cervical Spine

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