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The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain: A Randomized Clinical Trial

Walker, Michael J., PT, DSc, OCS, CSCS, FAAOMPT*; Boyles, Robert E., PT, DSc, OCS, FAAOMPT; Young, Brian A., PT, DSc, OCS, FAAOMPT; Strunce, Joseph B., PT, DSc, OCS, FAAOMPT§; Garber, Matthew B., PT, DSc, OCS, FAAOMPT; Whitman, Julie M., PT, DSc, OCS, FAAOMPT; Deyle, Gail, PT, DSc, DPT, OCS, FAAOMPT**; Wainner, Robert S., PT, PhD, OCS, ECS, FAAOMPT††

doi: 10.1097/BRS.0b013e318183391e
Randomized Trial

Study Design. Randomized clinical trial.

Objective. To assess the effectiveness of manual physical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper extremity (UE) symptoms, as compared to a minimal intervention (MIN) approach.

Summary of Background Data. Mounting evidence supports the use of manual therapy and exercise for mechanical neck pain, but no studies have directly assessed its effectiveness for UE symptoms.

Methods. A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization.

Results. The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference −5.1, 95% confidence intervals (CI) −8.1 to −2.1; P = 0.001) and short-term cervical VAS scores (mean 6-week difference −14.2, 95% CI −22.7 to −5.6; P = 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference −16.3, 95% CI −23.1 to −9.5; P = 0.000). At 1-year, patient perceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group (P = 0.004).

Conclusion. An impairment-based MTE program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound.

This randomized trial compared the use of manual physical therapy and exercise versus minimal intervention for 94 patients with mechanical neck pain. Manual physical therapy and exercise interventions resulted in significantly greater short- and long-term improvements in neck disability, neck pain, patient-perceived improvement, and treatment success rates.

From the *Doctoral Program in Physical Therapy, US Army-Baylor University, Fort Sam Houston, TX; †School of Physical Therapy, University of Puget Sound, Tacoma, WA; ‡Department of Physical Therapy, Sheppard Air Force Base, TX; §Department of Rehabilitation, Northern Navajo Medical Center, TX; ¶Department of Physical Therapy, Blanchfield Army Community Hospital, Fort Campbell, KY; ∥RHSHP-Department of Physical Therapy, Regis University, Denver, CO; **Post-professional Doctoral Program in Orthopaedic Manual Physical Therapy, US Army-Baylor University, Fort Sam Houston, TX; and ††Department of Physical Therapy, Texas State University, San Marcos, TX.

Acknowledgment date: September 11, 2007. First revision date: November 14, 2007. Second revision date: February 13, 2008. Third revision date: April 16, 2008. Acceptance date: May 15, 2008.

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

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

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the Department of the Army, Department of the Air Force, or the United States Public Health Service. ID: NCT00416117.

Address correspondence and reprint requests to Michael J. Walker, PT, DSc, OCS, CSCS, FAAOMPT, 418 Dickman Road, San Antonio, TX 78234; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.