The Effectiveness of Manual Therapy and Exercise Therapy in Treating Non-specific Neck Pain Patients

Background: Non-specific neck pain (NS-NP) is a common disabling condition. Pain, stiffness, tenderness and a restricted range of motion are the most common symptoms observed on the physical examination of an NS-NP patient. Manual therapy (MT) and exercise are treatments commonly used for this population. However, the effectiveness of those treatments in the short and long term is questionable.

Objectives: This systematic review aims to evaluate the effect of MT and/or exercise therapy on the pain and disability caused by NS-NP and to find the best available evidence from the literature.

Study Design: A systematic review of the literature (narrative synthesis).

Search Strategy: An inclusive search of different electronic databases (MEDLINE, CINAHL, PEDro, Science Direct and CENTRAL) was conducted to find the most relevant randomised controlled trials (RCTs) to satisfy the inclusion criteria of the review. The reference lists of relevant studies were also searched to find yet more relevant studies.

Means of Analysis: The methodological quality of the RCTs included was assessed using the PEDro scale. All the included trials were analysed qualitatively (narrative synthesis). The assessment of the methodology of each trial was conducted by a single reviewer.

Main Results: Twenty-five RCTs were eligible for inclusion in this review (13 trials for exercise therapy and 12 for MT). The total number of study participants was 3,422. The mean age of participants was 44. The mean sample size was 137. The methodological quality of the trials was high, except for two trials assessed as being of low quality (a score of 5 on the PEDro scale). This systematic review found strong evidence supporting the following interventions: strengthening exercises in the long term, and both HVLA thoracic manipulation and cervical mobilisation in the short term. Moderate evidence was found to support the following interventions: a combination of upper and middle thoracic manipulation and cervical mobilisation in the short term, a combination of cervical thrust manipulation and exercise in the intermediate term, neck stabilisation exercises in combination with physical therapy modalities in the intermediate term, and a combination of upper cervical and upper thoracic manipulation again in the short term.

Conclusion: Within the limitations of this systematic review, both MT and exercise therapy showed beneficial effects on NP pain and disability in the short term. However, the efficacy of MT on disability in the long term needs further investigation.