Neck pain and the limited neck function associated with it are very common medical complaints. Unfortunately, little is known about its causes and how to treat it. Current therapies for neck pain include pain relievers, postural or ergonomic changes, stretching and strengthening exercises, physical therapy, acupuncture, and chiropractice care. Both physical therapy and chiropractic care can include manual therapy, in which the practitioner performs “hands-on” muscular and joint mobilization and stabilization techniques. Manual therapy does not, however, include spinal manipulation.

Research recently published in the Annals of Internal Medicine suggests that manual therapy may be a more effective treatment for neck pain than either physical therapy or conventional medical care.

About the study

Australian and Dutch researchers studied 183 patients with neck pain in four outpatient clinics in the Netherlands between February 1997 and October 1998. Participants were between the ages of 18 and 70 and had been experiencing neck pain for at least two weeks, but had not been to physical or manual therapy in the previous six months. Patients were excluded from the study if they had previously undergone neck surgery or if their neck pain appeared to be caused by a medical condition, such as a fracture, herniated disc, tumor, or rheumatic or neurologic disease.

Although all participants were allowed to take pain relievers, they were randomly assigned to receive one of the following therapies for six weeks:

Manual therapy for 45 minutes once per week – Therapists performed muscle mobilization techniques, joint mobilization techniques and coordination and stabilization techniques on the patients.

Physical therapy (without manual therapy) for 30 minutes twice per week – Therapists taught patients to do stretching, strengthening, range-of-motion, postural, relaxation, and functional exercises. Manual stretching by the therapist and heat application were allowed, as well. The physical therapists that provided this care were not practitioners of manual therapy.

Medical care from general practitioners – Physicians provided advice on self-care (heat application and home exercises) and ergonomics and a booklet on ergonomics and exercises.

At the start of the study and at weeks three and seven, two physical therapists who were unaware of each patient’s treatment interviewed and examined the patients. During the interviews, patients rated their recovery on a 6-point scale ranging from “much worse” to “completely recovered.” In addition, the physical therapists rated the severity of physical dysfunction on an 11-point scale (Neck Disability Index) and patients rated their pain in the previous week on an 11-point scale.

Researchers compared patients’ perceived recovery, physical dysfunction, and pain severity among the three treatment groups.

The findings

At week seven, 68% of patients who received manual therapy reported they were “completely recovered” or “much improved” compared with 50% of their counterparts who received physical therapy and 36% who received medical care. There was little difference among the three groups on the separate disability and pain scales, though. However, the perceived recovery scale does include pain and disability measures.

In addition, patients who received manual or physical therapy took fewer pain relievers than those who received conventional medical care. However, patients who received manual or physical therapy did report more minor adverse reactions, such as temporary increase in neck pain after therapy sessions, headache, dizziness, and tingling in the arms.

Although these results are interesting, there are limitations to this study. Self-reported perception of recovery is subjective, and differences in the way different people rate pain and disability may vary. In addition, patients knew which treatment they were receiving, which introduces the possibility of the placebo effect. That is, maybe patients who received manual or physical therapy believed that their symptoms had improved, when in fact they had not. Finally, because the manual therapy consisted of an array of techniques, it’s not clear if all or only some of the techniques are effective.

How does this affect you?

Should you try manual therapy for relief of chronic neck pain? Why not? You most likely have little to lose, since according to this study, manual therapy was more effective than physical therapy or the self-care measures a primary care physician would prescribe. However, more research is needed to confirm that manual therapy is, in fact, the best treatment for neck pain. And don’t forget that physical therapy was also relatively effective in this study.

Where can you find a manual therapist? The following health care professionals practice manual therapy: chiropractors, physical therapists, doctors of osteopathy, and massage therapists. Make sure your practitioner has been specially trained in manual therapy techniques, though. And remember, manual therapy as performed in this study did not include spinal manipulation. Manual therapy involves low-velocity, passive movements within a joint’s range of motion. Spinal manipulations are high-velocity, thrusting movements. So if you go to a chiropractor, be sure to tell him or her that you want manual therapy rather than spinal manipulation. And don’t be afraid to include your health care provider in choosing a manual therapist.