Neck pain: Does manipulation or mobilisation help?

When mobilisation or manipulation by chiropractors or physiotherapists is combined with exercise, it can improve neck pain. But the benefit might be coming from the exercise, not from the neck treatment.

Neck pain is very common. Physiotherapists, chiropractors, masseurs and some doctors use a variety of techniques that are meant to encourage ease of movement in the neck muscles and joints. One type is called mobilisation. This involves a gentle pressure to achieve passive movement in the joints. Manipulation is the combination of movement and stronger pressure.

To see whether these methods can help, researchers studied a range of alternative uses of these treatments. They concentrated on people who had acute neck pain, caused by whiplash, wear and tear, or other problems. The research did not look at people who had neck pain as a result of an illness.

At first glance it looks as though these methods have been well proven. Researchers from the international Cochrane Collaboration found 33 trials. However, there were so many different combinations of treatments used, that it is hard to come to any firm conclusion about any individual technique or combination. The treatments were often combined with exercises, applying heat or cold, medications and/or education.

In the end, there were only nine trials that tested just mobilisation or manipulation. It did not matter whether there was a single treatment or a series of sessions: the people did not feel an improvement after the treatment. However, when mobilisation or manipulation was combined with exercising the neck, people who had had neck pain for longer than a month experienced less pain and less restriction in their daily activities.

It is still not clear, though, whether the improvement really comes from the combination of treatments or if it is in fact the exercise that is responsible. The exercises aimed to strengthen the muscles in the upper body, for example through resistance training, stabilisation exercises or stretching.

The researchers also tried to find out whether mobilisation or manipulation caused any harm. Adverse effects were temporary and relatively harmless. They included headaches, neck pain or dizziness. However these trials cannot provide information on how often serious injuries to the neck might occur as a result of these treatments. Other researchers have come up with estimates of risk as different as one in 3,000 treatments to one in a million.

© IQWiG (Institute for Quality and Efficiency in Health Care)