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Systematic review of manual therapies for nonspecific neck pain

PainSci » bibliography » Vincent et al 2013
Tags: treatment, bad news, neck, manual therapy, spinal adjustment, exercise, head/neck, spine, self-treatment

Three articles on PainSci cite Vincent 2013: 1. The Complete Guide to Neck Pain & Cricks2. Healer Syndrome3. “Windows of Opportunity” in Rehab

PainSci commentary on Vincent 2013: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Although the authors of this review conclude from 18 “high quality” trials that manual therapies “contribute usefully,” none of them was actually any better than any other therapy, either alone or in combination — never a good sign — and the evidence is “limited” for practically everything (most treatments, all long-term effects, and chronic neck pain). The one bright point here was the short-term effect of upper thoracic mobilization, where the positive evidence was judged “moderate.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To evaluate the effectiveness of manual therapies in the treatment of nonspecific neck pain.

MATERIALS AND METHODS: Medline and the Cochrane Library were searched for randomized controlled trials of manual therapy or mobilization, used alone or with exercises to treat pain and functional impairment related to nonspecific neck pain. Cochrane Back Review Group criteria were used to assess the quality of the trials and the level of evidence (unclear, limited, moderate, or high) for short-, medium-, and long-term effects.

RESULTS: Of 27 identified trials, 18 were of high quality. In acute neck pain, effective treatments were thoracic manipulation combined with electrothermal therapy in the short term and cervical manipulation in the long term. In chronic neck pain and neck pain of variable duration, both pain and function improved consistently at all follow-up time points. None of the manual therapies used alone or in combination was superior over the others. In the long term, exercises alone or combined with manual therapies were superior over manual therapies used alone.

CONCLUSION: Manual therapies contribute usefully to the management of nonspecific neck pain. The level of evidence is moderate for short-term effects of upper thoracic manipulation in acute neck pain, limited for long-term effects of neck manipulation, and limited for all techniques and follow-up durations in chronic neck pain.

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