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A Cochrane Review of Manipulation and Mobilization for Mechanical Neck Disorders

Gross, Anita R., MSc*†; Hoving, Jan L., PhD; Haines, Ted A., MSc*; Goldsmith, Charles H., PhD*; Kay, T, MSc§; Aker, Peter, MSc; Bronfort, Gert, PhDpara; the Cervical Overview Group

doi: 10.1097/01.BRS.0000131218.35875.ED
Cochrane Review

Study Design and Objectives. Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.

Summary of Background Data. Neck disorders are common, disabling, and costly.

Methods. Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model.

Results. Of the 33 selected trials, 42% were high quality trials. Single or multiple (3–11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences −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 [standardized mean differences −2.73 (95% CI: −3.30 to −2.16)] for subacute/chronic mechanical neck disorders with or without headache.

Conclusions. Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

This review of 33 trials favored mobilization and/or manipulation when used with exercise for persistent mechanical neck disorder with or without headache. Done alone, manipulation and/or mobilization was not effective; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings.

From *McMaster University, Hamilton, Ontario, Canada, †St Joseph’s Healthcare, Hamilton, Ontario, Canada, ‡Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia, §Sunnybrook and Women’s College Health Sciences, Toronto, Ontario, Canada, ∥Private Practice, Belleville, California, and the ¶Northwestern Health Sciences University, Bloomington, Indiana.

Supported by grants from NIH subcontract though Palmer Center for Chiropractic Research #AT 00170-05; and Hamilton Hospital Assessment Centre Research Fund.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal and Foundation funds were received to support this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Ms. Anita R. Gross, McMaster University, Faculty of Health Sciences, School of Rehabilitation Sciences, Institute of Applied Health Sciences, 1400 Main St West, 4th Floor, Hamilton, Ontario, Canada L8S 1C7; E-mail: grossa@mcmaster.ca

© 2004 Lippincott Williams & Wilkins, Inc.