A study published recently shows evidence that manipulation and/or mobilisation is a safe therapy with a great potential for reducing pain in the neck and improving function. Multimodal therapies which integrates multiple treatment approaches seems to have the greatest potential impact.
Mobilisation and manipulation are already widely used by chiropractors to treat chronic nonspecific neck pain. But questions have been asked about the efficacy, dosing and safety of these therapies as well as their efficiency compared to other treatments. This prompted a group of American and Canadian researchers to look for answers on how efficient manipulation and/or mobilisation is and the effectiveness and adverse events of the treatments.
The researchers carried out a systematic literature review and a meta-analysis of 47 randomised controlled trials comparing manipulation and/or mobilisation to sham, no treatment, each other and other therapies or a combination of multimodal therapies. In total, the 47 RCT’s included data from 4,460 patients who had had treatment for nonspecific neck pain.
10 of the 47 RCT’s focused on multimodal therapies. This type of therapy seems to have the greatest potential effect when it comes to reducing pain and improving function, when suffering from chronic nonspecific neck pain.
The other 37 studies included focused on unimodal approaches to treatment involving manipulation or mobilisation and training compared to sham. 6 of the 37 studies were selected for meta-analysis after 1, 3 and 6 months. They showed a small effect on pain and function when treated with manipulation or mobilisation and exercise compared to only exercise.
The researchers also looked at adverse events in connection with manipulation or mobilisation. Of the 37 unimodal RCTs, 12 reported that no adverse events occurred during the study; 10 reported minor adverse events, typically transient increases in pain in the area of treatment or overall soreness. The remaining 15 studies did not provide any information on adverse events.
Of the 10 multimodal studies, 2 reported minor adverse events such as muscle soreness or increased pain or tiredness; one study reported that no adverse events had occurred during the study. The remaining 7 did not describe any adverse events or mention whether they occurred during the study.
The study was carried out by Jan D. Coulter, Cindy Crawford, Howard Vernon, Eric L. Hurwitz, Raheleh Khorsan, Marika Suttorp Booth og Patricia M. Herman (se affiliations in the research paper)
Ian D. Coulter, PhD, Cindy Crawford, BA, Howard Vernon, DC, PhD, Eric L. Hurwitz, DC, PhD, Raheleh Khorsan, PhD, Marika Suttorp Booth, MS, and Patricia M. Herman, ND, PhD. Manipulation and Mobilization for Treating Chrionic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician 2019.