Manipulation and mobilisation for neck pain

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. – PubMed – NCBI – Cochrane Database Syst Rev. – 2015 Sep

Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010.


To assess the effects of manipulation or mobilisation alone compared with those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up.  

When appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes.


Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs).


Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse.

Publication bias cannot be ruled out. Research designed to protect against various biases is needed.

Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up.

Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up.

Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.  

The risks of complementary or alternative medical treatments for pain are never mentioned, only their possible benefit, while only the risks of opioids are being studied and none of their benefits.

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