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Meta-Analysis
. 2015 Sep 23;2015(9):CD004249.
doi: 10.1002/14651858.CD004249.pub4.

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

Anita Gross  1 , Pierre Langevin, Stephen J Burnie, Marie-Sophie Bédard-Brochu, Brian Empey, Estelle Dugas, Michael Faber-Dobrescu, Cristy Andres, Nadine Graham, Charles H Goldsmith, Gert Brønfort, Jan L Hoving, Francis LeBlanc
Affiliations
Meta-Analysis

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

Anita Gross et al. Cochrane Database Syst Rev. .

Abstract

Background: 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.

Objectives: To assess the effects of manipulation or mobilisation alone compared wiith 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.

Search methods: Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. We updated this search in June 2015, but these results have not yet been incorporated.

Selection criteria: Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain.

Data collection and analysis: 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).

Main results: We included 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons). Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality).

Authors' conclusions: 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.

PubMed Disclaimer

Conflict of interest statement

Two of our review authors are authors of included studies. Although Jan Hoving and Gert Bronfort were review authors, they were not involved in decisions about study inclusion, risk of bias assessment or extraction of data from their studies.

Figures

1
1
PRISMA diagram for manipulation and mobilisation.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: manipulation vs control, outcome: FUNNEL PLOT for PAIN: thoracic manipulation vs same treatment in both arms.
4
4
Forest plot of comparison: manipulation vs another treatment, outcome: PAIN: cervical manipulation vs medicine.
5
5
Forest plot of comparison: manipulation vs another treatment, outcome: PAIN: cervical manipulation vs mobilisation at intermediate‐term follow‐up.
1.1
1.1. Analysis
Comparison 1 Manipulation versus placebo, Outcome 1 PAIN: cervical manipulation vs placebo.
1.2
1.2. Analysis
Comparison 1 Manipulation versus placebo, Outcome 2 PAIN: thoracic manipulation vs placebo.
2.1
2.1. Analysis
Comparison 2 Manipulation versus control, Outcome 1 PAIN: cervical manipulation vs control.
2.2
2.2. Analysis
Comparison 2 Manipulation versus control, Outcome 2 PAIN: cervical manipulation plus treatment vs same treatment in both arms.
2.3
2.3. Analysis
Comparison 2 Manipulation versus control, Outcome 3 PAIN: cervical manipulation vs same treatment in both arms.
2.4
2.4. Analysis
Comparison 2 Manipulation versus control, Outcome 4 PAIN: thoracic manipulation vs control.
2.5
2.5. Analysis
Comparison 2 Manipulation versus control, Outcome 5 PAIN: thoracic manipulation vs same treatment in both arms.
2.6
2.6. Analysis
Comparison 2 Manipulation versus control, Outcome 6 PAIN: cervical and thoracic manipulation vs control.
2.7
2.7. Analysis
Comparison 2 Manipulation versus control, Outcome 7 FUNCTION: thoracic manipulation vs same treatment in both arms.
2.8
2.8. Analysis
Comparison 2 Manipulation versus control, Outcome 8 FUNCTION: cervical manipulation vs same treatment in both arms.
2.9
2.9. Analysis
Comparison 2 Manipulation versus control, Outcome 9 FUNCTION: cervical and thoracic manipulation vs control.
2.10
2.10. Analysis
Comparison 2 Manipulation versus control, Outcome 10 QUALITY OF LIFE: thoracic manipulation vs control.
2.11
2.11. Analysis
Comparison 2 Manipulation versus control, Outcome 11 FUNNEL PLOT for pain: thoracic manipulation vs same treatment in both arms.
2.12
2.12. Analysis
Comparison 2 Manipulation versus control, Outcome 12 FUNNEL PLOT for function: thoracic manipulation vs same treatment in both arms.
3.1
3.1. Analysis
Comparison 3 Mobilisation versus control, Outcome 1 PAIN: cervical mobilisation vs control.
4.1
4.1. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 1 PAIN: cervical manipulation vs mobilisation at immediate post treatment.
4.2
4.2. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 2 PAIN: cervical manipulation vs mobilisation at intermediate‐term follow‐up.
4.3
4.3. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 3 PAIN: cervical manipulation vs massage.
4.4
4.4. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 4 PAIN: cervical manipulation vs medicine.
4.5
4.5. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 5 PAIN: cervical manipulation vs exercise.
4.6
4.6. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 6 PAIN: cervical manipulation vs electrotherapy.
4.7
4.7. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 7 PAIN: cervical manipulation vs acupuncture.
4.8
4.8. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 8 PAIN: cervical manipulation vs orthotic devices (K‐tape).
4.9
4.9. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 9 PAIN: cervical manipulation vs varied multi‐modal approaches.
4.10
4.10. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 10 PAIN: cervical manipulation ‐ 1 technique vs another technique.
4.11
4.11. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 11 PAIN: cervical manipulation ‐ varied dosage comparison.
4.12
4.12. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 12 PAIN: thoracic manipulation vs exercise.
4.13
4.13. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 13 FUNCTION: cervical manipulation vs mobilisation.
4.14
4.14. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 14 FUNCTION: cervical manipulation vs massage.
4.15
4.15. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 15 FUNCTION: cervical manipulation vs medicine.
4.16
4.16. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 16 FUNCTION: cervical manipulation vs exercise.
4.17
4.17. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 17 FUNCTION: cervical manipulation vs orthotic devices (K‐taping).
4.18
4.18. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 18 FUNCTION: cervical manipulation vs acupuncture.
4.19
4.19. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 19 FUNCTION: cervical manipulation vs varied multi‐modal approaches.
4.20
4.20. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 20 FUNCTION: cervical manipulation ‐ 1 technique vs another technique.
4.21
4.21. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 21 FUNCTION: cervical manipulation ‐ varied dosage comparison.
4.22
4.22. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 22 PATIENT SATISFACTION: cervical manipulation vs mobilisation.
4.23
4.23. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 23 PATIENT SATISFACTION: cervical manipulation vs varied multi‐modal approaches.
4.24
4.24. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 24 GLOBAL PERCEIVED EFFECT: cervical manipulation vs mobilisation.
4.25
4.25. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 25 QUALITY OF LIFE: cervical manipulation vs mobilisation.
4.26
4.26. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 26 QUALITY OF LIFE: cervical manipulation vs medicine.
4.27
4.27. Analysis
Comparison 4 Manipulation vs another treatment, Outcome 27 QUALITY OF LIFE: cervical manipulation vs exercise.
5.1
5.1. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 1 PAIN: cervical mobilisation vs medical injection ‐ trigger point.
5.2
5.2. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 2 PAIN: cervical mobilisation vs exercise.
5.3
5.3. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 3 PAIN: cervical mobilisation vs electrotherapy.
5.4
5.4. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 4 PAIN: cervical mobilisation vs sonic devices ‐ ultrasound, shock wave therapy.
5.5
5.5. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 5 PAIN: cervical mobilisation vs mechanical traction.
5.6
5.6. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 6 PAIN: cervical mobilisation vs acupuncture.
5.7
5.7. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 7 PAIN: cervical mobilisation vs varied multi‐modal approaches.
5.8
5.8. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 8 PAIN: cervical mobilisation ‐ 1 technique vs another technique.
5.9
5.9. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 9 PAIN: cervical mobilisation ‐ 1 technique vs another technique.
5.10
5.10. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 10 PAIN: cervical mobilisation vs massage.
5.11
5.11. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 11 FUNCTION: cervical mobilisation vs medical injection ‐ trigger point.
5.12
5.12. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 12 FUNCTION: cervical mobilisation vs exercise.
5.13
5.13. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 13 FUNCTION: cervical mobilisation vs electrotherapy.
5.14
5.14. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 14 FUNCTION: cervical mobilisation vs sonic devices ‐ shock wave therapy.
5.15
5.15. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 15 FUNCTION: cervical mobilisation vs acupuncture.
5.16
5.16. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 16 FUNCTION: cervical mobilisation vs varied multi‐modal approaches.
5.17
5.17. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 17 FUNCTION: cervical mobilisation vs massage.
5.18
5.18. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 18 FUNCTION: cervical mobilisation ‐ 1 technique vs another technique.
5.19
5.19. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 19 QUALITY OF LIFE: mobilisation vs electrotherapy.
5.20
5.20. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 20 PATIENT SATISFACTION: cervical mobilisation vs varied multi‐modal approaches.
5.21
5.21. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 21 PATIENT SATISFACTION: cervical mobilisation vs electrotherapy.
5.22
5.22. Analysis
Comparison 5 Mobilisation versus another treatment, Outcome 22 GLOBAL PERCEIVED EFFECT: cervical mobilisation ‐ 1 technique vs another technique.
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Saayman 2011 {published data only}
    1. Saayman L, Hay C, Abrahamse H. Chiropractic manipulative therapy and low‐level laser therapy in the management of cervical facet dysfunction: a randomized controlled study. Journal of Manipulative and Physiological Therapeutics 2011;34(3):153‐63. - PubMed
Savolainen 2004 {published data only}
    1. Savolainen A, Ahlberg J, Nummila H, Nissinen M. Active or passive treatment for neck‐shoulder pain in occupational health care? A randomized controlled trial. Occupational Medicine 2004;54:422‐4. - PubMed
Schomacher 2009 {published data only}
    1. Schomacher J. The effect of an analgesic mobilization technique when applied at symptomatic or asymptomatic levels of the cervical spine in subjects with neck pain: a randomized controlled trial. Journal of Manual and Manipulative Therapy 2009;17(2):101‐8. - PMC - PubMed
Shin 2006 {published data only}
    1. Shin BC, Kim SD, Lee MS [Letter to the editor]. Comparison between the effects of Chuna manipulation therapy and cervical disc traction treatment on pain in patients with herniated cervical disc: a randomized clinical pilot trial. American Journal of Chinese Medicine 2006;34(5):923‐5. - PubMed
Sillevis 2010 {published data only}
    1. Sillevis R, Cleland J. Immediate effects of the audible pop from a thoracic spine thrust manipulation on the autonomic nervous system and pain: a secondary analysis of a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2011;34(1):37‐45. - PubMed
    1. Sillevis R, Cleland J, Hellman M, Beekhuizen K. Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial. Journal of Manual and Manipulative Therapy 2010;18(4):181‐90. - PMC - PubMed
Sloop 1982 {published data only}
    1. Sloop PR, Smith DS, Goldenberg E, Dore C. Manipulation for chronic neck pain: a double‐blind controlled study. Spine 1982;7(6):532‐5. - PubMed
Sterling 2010 {published data only}
    1. Sterling M, Pedler A, Chan C, Puglisi M, Vuvan V, Vicenzino B. Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: a pilot randomised controlled trial. Manual Therapy 2010;15:149‐53. - PubMed
Strunk 2008 {published data only}
    1. Strunk RG, Hondras MA. A feasibility study assessing manual therapies to different regions of the spine for patients with subacute or chronic neck pain. Journal of Chiropractic Medicine 2008;7:1‐8. - PMC - PubMed
van Schalkwyk 2000 {published data only}
    1. Schalkwyk R, Parkin‐Smith GF. A clinical trial investigating the possible effect of the supine cervical rotatory manipulation and the supine lateral break manipulation in the treatment of mechanical neck pain: a pilot study. Journal of Manipulative and Physiological Therapeutics 2000;23(5):324‐31. - PubMed
von Piekartz 2011 {published data only}
    1. Piekartz H, Lüdtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single‐blind, randomized controlled study. Journal of Craniomandibular Practice 2011;29(1):1‐14. - PubMed
Wood 2001 {published data only}
    1. Wood TG, Colloca CJ, Matthews R. A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction. Journal of Manipulative and Physiological Therapeutics 2001;24(4):260‐71. - PubMed
Youssef 2013 {published data only}
    1. Youssef EF, Al ‐Sayed AS. Mobilization versus massage therapy in the treatment of cervicogenic headache: a clinical study. Journal of Back and Musculoskeletal Rehabilitation 2013;26:17‐24. - PubMed
Yurkiw 1996 {published data only}
    1. Yurkiw D, Mior S. Comparison of two chiropractic techniques on pain and lateral flexion in neck pain patients: a pilot study. Chiropractic Technique 1996;8(4):155‐62.

References to studies excluded from this review

Allan 2003 {published data only}
    1. Allan M, Brantingham JW, Menezes A. Stretching as an adjunct to chiropractic manipulation of chronic neck pain ‐ before, after, or not at all? A perspective, randomized controlled clinical trial. European Journal of Chiropractic 2003;50:41‐52.
Allison 2002 {published data only}
    1. Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico‐brachial pain syndrome ‐ a pilot study. Manual Therapy 2002;7(2):95‐102. - PubMed
Bablis 2008 {published data only}
    1. Bablis P, Pollard H, Bonello R. Neuro emotional technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial. Chiropractic & Osteopathy 2008;16(4). - PMC - PubMed
Björklund 2012 {published data only}
    1. Björklund M, Djupsjöbacka M, Svedmark A, Häger C. Effects of tailored neck‐shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial. BMC Musculoskeletal Disorders 2012;13(75):1‐14. - PMC - PubMed
Bonk 2000 {published data only}
    1. Bonk AD, Ferrari R, Giebel GD, Edelmann M, Huser R. Prospective randomized controlled study of activity versus collar and the natural history for whiplash injury in Germany. Journal of Musculoskeletal Pain 2000;8(1‐2):123‐32.
Borman 2008 {published data only}
    1. Borman P, Keskin D, Ekici B. The efficacy of intermittent cervical traction in patients with chronic neck pain. Clinical Rheumatology 2008;27:1249‐53. - PubMed
Borusiak 2010 {published data only}
    1. Borusiak P, Biedermann H, Boberhoff S, Opp J. Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: result of a prospective, randomized, placebo‐controlled and blinded trial. Headache 2010;50:224‐30. - PubMed
Bosmans 2011 {published data only}
    1. Bosmans JE, Pool JJM, Vet HCW, Tulder MW, Oselo RWJG. Is behavioural graded activity cost‐effective in comparison with manual therapy for patients with subacute neck pain? An economic evaluation alongside a randomized clinical trial. Spine 2011;36(18):E1179‐86. - PubMed
Boyles 2010 {published data only}
    1. Boyles RE, Walker MJ, Young BA, Strunce JB, Wainner RS. The addition of cervical thrust manipulations to a manual physical therapy approach in patients treated for mechanical neck pain: a secondary analysis. Journal of Orthopaedic & Sports Physical Therapy March 2010;40(3):133‐40. - PubMed
Briem 2007 {published data only}
    1. Briem K, Huijbregts P, Thorsteinsdottir M. Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain: a pilot study. Journal of Manual and Manipulative Therapy 2007;15(2):82‐92. - PMC - PubMed
Brodin 1985 {published data only}
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Brønfort 2001 {published data only}
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Chiu 2011 {published data only}
    1. Chiu T, Ng J, Walther‐Zhang B, Lin R, Ortelli L, Chua SW. A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain. Clinical Rehabilitation 2011;25(9):814‐22. - PubMed
Cleland 2007a {published data only}
    1. Cleland J, Flynn T, Childs J, Eberhart S. The audible pop from thoracic spine thrust manipulation and its relation to short‐term outcomes in patients with neck pain. Journal of Manual & Manipulative Therapy 2007;15(3):143‐54. - PMC - PubMed
Cleland 2009 {published data only}
    1. Cleland JA, Fritz JM, Brennan GP, Magel J. Does continuing education improve physical therapists' effectiveness in treating neck pain? A randomized clinical trial. Physical Therapy 2009;89(1):38‐47. - PubMed
Cleland 2010 {published data only}
    1. Cleland J, Mintken P, Christopher K, Fritz J, Glynn P, Whitman J, et al. Examination of a clinical prediction rule to Identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi‐centre randomized clinical trial. Physical Therapy 2010;90(9):1239‐53. - PubMed
Conforti 2013 {published data only}
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Cross 2011 {published data only}
    1. Cross K, Kuenze C, Grindstaff T, Hertel J. Thoracic spine thrust manipulation improves pain, range of motion, and self‐reported function in patients with mechanical neck pain: a systematic review. Journal of Orthopaedic & Sports Physical Therapy 2011;41(9):633‐42. - PubMed
Cunha 2008 {published data only}
    1. Cunha ACV, Burke TN, Franca FJR, Marques AP. Effect of global posture re‐education and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. Clinics 2008;63(6):763‐70. - PMC - PubMed
De Hertogh 2009 {published data only}
    1. Hertogh W, Vaes P, Devroey D, Louis P, Carpay H, Truijen S. Preliminary results, methodological considerations and recruitment difficulties of a randomised clinical trial comparing two treatment regimens for patients with headache and neck pain. BMC Musculoskeletal Disorders 2009;10(115). - PMC - PubMed
Donkin 2002 {published data only}
    1. Donkin RD, Parkin‐Smith GF, Gomes AN. Possible effect of chiropractic manipulation and combined manual traction and manipulation on tension‐type headache: a pilot study. Journal of the Neuromusculoskeletal System 2002;10(3):89‐97.
Dostal 1997 {published data only}
    1. Dostal C, Pavelka K, Lewit K. Ibuprofen in the treatment of the cervico‐cranial syndrome in combination with manipulative therapy. Fysiatrickay a Reumatologickay Vestniak [Czech] 1997;56:258‐63. - PubMed
Durianova 1977 {published data only}
    1. Durianova J. Functional muscle changes and their influence by physiatric means. Fysiat Revmatol Vestn [Slovak] 1977;55:16‐21. - PubMed
Dziedzic 2005 {published data only}
    1. Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay E. Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics. American College of Rheumatology 2005;53:214‐22. - PubMed
Evans 2012 {published data only}
    1. Evans J, Bronfort G, Schulz C, Maiers M, Branda Y, Svendsen K, et al. Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine 2012;15(37):903‐14. - PubMed
Fang 2010 {published data only}
    1. Fang J. Observation of curative effect on fixed spin reduction of spinal manipulation therapy for cervical vertigo. Zhongguo Gu Shang 2010;23(2):99‐101. - PubMed
Fernandez 2004 JWR {published data only}
    1. Fernandez‐de‐las‐Penas C, Fernandez‐Carnero J, Palomeque del Cerro L, Miangolarra‐Page JC. Manipulative treatment vs. conventional physiotherapy treatment in whiplash injury: a randomized controlled trial. Journal of Whiplash & Related Disorders 2004;3:73‐90.
Fernandez 2008 {published data only}
    1. Fernández‐de‐las‐Peñas C, Alonso‐Blanco C, Cleland JA, Rodríguez‐Blanco C, Alburquerque‐Sendín F. Changes in pressure pain thresholds over C5‐C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. Journal of Manipulative and Physiological Therapeutics 2008;31(5):332‐7. - PubMed
Fitz‐Ritson 1994 {published data only}
    1. Fitz‐Ritson D. Efficacy of low energy laser therapy for extensor neck muscles and sleep pattern improvement after "whiplash" injury. Journal of Manipulative and Physiological Therapeutics 1994;17(4):277‐8.
Gemmell 2008 {published data only}
    1. Gemmell H, Allen A. Relative immediate effect of Ischaemic compression and activator trigger point, therapy on active upper trapezius points: a randomised trial. Clinical Chiropractics 2008;11(4):174‐81.
Giebel 1997 {published data only}
    1. Giebel GD, Edelmann M, Huser R. Cervical disc derangement: early function vs immobilizing treatment [Die distorsion der halswirbelsaule: Fruhfunktionalle vs. ruhigstellende behandlung (German)]. Zentralbl Chir 1997;122:517‐21. - PubMed
Giles 2003 {published data only}
    1. Giles LGF, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003;28(14):1490‐502. - PubMed
Goldie 1970 {published data only}
    1. Goldie I, Landquist A. Evaluation of the effects of different forms of physiotherapy in cervical pain. Scandanavian Journal of Rehabilatation Medicine 1970;2(3):117‐21. - PubMed
Grunnet‐Nilsson 1999 {published data only}
    1. Grunnet‐Nilson N, Bove G. Manipulation of episodic neck pain [Manipulationsbehandling af episodisk spaendings‐type‐hovedpine (Dutch)]. Ugeskr Laeger 2000;162:174‐7. - PubMed
Gustavsson 2006 {published data only}
    1. Gustavsson C, Koch L. Applied relaxation in the treatment of long‐lasting neck pain: a randomized controlled pilot study. Journal of Rehabilitation Medicine 2006;38:100‐7. - PubMed
Haas 2003 {published data only}
    1. Haas M, Groupp E, Panzer D, Parna L, Lumsden S, Aickin M. Efficacy of cervical end‐play assessment as an indicator for spinal manipulation. Spine 2003;28(11):1091‐8. - PubMed
Hakkinen 2007 {published data only}
    1. Hakkinen A, Salo P, Tarvainen U, Wiren K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. Journal of Rehabilitation Medicine 2007;39:575‐9. - PubMed
Hemmila 2005 {published data only}
    1. Hemmila HM. Bone setting for prolonged neck pain: a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2005;28:508‐15. - PubMed
Hodgson 2006 {published data only}
    1. Hodgson L, Fryer G. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. International Journal of Osteopathic Medicine 2006;9:27‐46.
Hong 2005 {published data only}
    1. Hong ES, Deng MY, Cheng LH, Zhou S, Wang B, Zhang A, et al. Effect of vertebral manipulation therapy on vertebro‐basilar blood flow in cervical spondylosis of vertebral artery type. Zhongguo Zhong Xi Yi Jie He Za Zhi 2005;25(8):742‐4. - PubMed
Hoving 2002 {published data only}
    1. Hoving JL, Koes BW, Vet HCW, Windt DAWM, Assendelft WJJ, Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. Annals of Internal Medicine 2002;136(10):713‐59. - PubMed
    1. Hoving JL, Koes BW, Vet HCW, Windt DAWM, Assendelft WJJ, Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: long‐term results from a pragmatic randomized clinical trial. Clinical Journal of Pain 2006;22(4):370‐7. - PubMed
    1. Hoving JL, Vet HCW, Koes BW, Mameren H, Deville WJLM, Windt DAWM, et al. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long‐term results from a pragmatic randomized trial. In: Hoving JL editor(s). Thesis. 1st Edition. Wageningen: Pons & Looijen bv, 2001:59‐73.
    1. Korthals‐de Bos IBC, Hoving JL, Tulder MW, Rutten‐van Molken MPMH, Ader HJ, Vet HC, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial. British Medical Journal 2003;326:1‐6. - PMC - PubMed
    1. Korthals‐de Bos IBC, Hoving JL, Tulder MW, Rutten‐van Molken MPMH, Ader HJ, Vet HC, et al. Manual therapy is more cost‐effective than physical therapy and GP care for patients with neck pain. Thesis. 1st Edition. Wageningen: Pons & Looijen bv, 2001:75‐89.
Hurwitz 2005 {published data only}
    1. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine 2005;30(13):1477‐84. - PubMed
Hurwitz 2006 {published data only}
    1. Hurwitz EL, Goldstein MS, Morgenstern H, Chiang LM. The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: results from the UCLA Neck Pain Study. Disability and Rehabilitation 2006;28(21):1319‐29. - PubMed
Jahanshahi 1991 {published data only}
    1. Jahanshahi M, Sartory G, Marsden CD. EMG biofeedback treatment of torticollis: a controlled outcome study. Biofeedback and Self Regulation 1991;16:413‐48. - PubMed
Jensen 1990 {published data only}
    1. Jensen OK, Nielsen FF, Vosmar L. An open study comparing manual therapy with the use of cold packs in the treatment of post‐traumatic headache. Cephalgia 1990;10:241‐50. - PubMed
Jensen 1995 {published data only}
    1. Jensen I, Nygren A, Goldie I, Westerholm P, Jonsson E. The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: a controlled cost‐effectiveness study. Scandanavian Journal of Rehabilitation Medicine 1995;27(1):19‐26. - PubMed
Jensen 2009 {published data only}
    1. Jensen IB, Busch H, Bodin L, Hagberg J, Nygren A, Bergstrom G. Cost effectiveness of two rehabilitation programmes for neck pain and back pain patients: a seven year follow‐up. Pain 2009;142:202‐8. - PubMed
Jiang 2012 {published data only}
    1. Jiang CB, Wang J, Zheng ZX, Hou JS, Ma L, Sun T. Efficacy of cervical fixed‐point traction manipulation for cervical spondylotic radiculopathy: a randomized controlled trial. Journal of Chinese Integrative Medicine 2012;10(1):54‐8. - PubMed
Jing 2006 {published data only}
    1. Jing FJ, Zhang J. Clinical effect of Yi‐Nao manipulation in the treatment of cervical spondylosis of vertebral artery type. Chinese Journal of Clinical Rehabilitation 2006;10(39):27‐9.
Jordan 1998 {published data only}
    1. Jordan A, Bendix T, Nielsen H, Hansen FR, Host D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective single‐blind randomized clinical trial. Spine 1998;23(3):311‐9. - PubMed
Jull 2001 {unpublished data only}
    1. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2001;27(17):1845‐3. - PubMed
Jull 2007 {published data only}
    1. Jull G, Sterling M, Kenardy J, Beller E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? A preliminary RCT. Pain 2007;129:28‐34. - PubMed
Karlberg 1996 {published data only}
    1. Karlberg M, Magnusson M, Eva‐Maj M, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Archives of Physical Medicine and Rehabilitation 1996;77:874‐82. - PubMed
Khoury 2002 {published data only}
    1. Khoury MA, Deall AJ. A comparative study to determine the most effective chiropractic treatment protocol in the management of cervicogenic headache. European Journal of Chiropractic 2002;49:104‐5.
Ko 2010 {published data only}
    1. Ko T, Jeong U, Lee K. Effects of the inclusion thoracic mobilization into cranio‐cervical flexor exercise in patients with chronic neck pain. Journal of Physical Therapy Science 2010;22:87‐91.
Koes 1992 {published data only}
    1. Koes B, Bouter LM, Knipshild PG. The effectiveness of manual therapy, physiotherapy and continued treatment by general practitioner for chronic nonspecific back and neck complaints. Journal of Manipulative and Physiological Therapeutics 1991;14:498‐502. - PubMed
    1. Koes BW. Efficacy of manual therapy and physiotherapy for back and neck complaints (thesis). den Haag: Cip‐Gegevens Koninklijke Bibliotheek, 1992a.
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    1. Koes BW, Bouter LM, Mameren H, Esser AH, Verstegen GM, Hofhuizen DM, et al. A blind randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures. Journal of Manipulative Physiological Therapeutics 1992e;15(1):16‐23. - PubMed
    1. Koes BW, Bouter LM, Mameren H, Esser AH, Verstegen GM, Hofhuizen DM, et al. Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow‐up. British Medical Journal 1992b;304:601‐5. - PMC - PubMed
Kogstad 1978 {published data only}
    1. Kogstad OA, Karterud S, Gudmundsen J. Cervicobrachialgia. A controlled trial with conventional treatment and manipulation [Cervicobrachialgi (Danish)]. Tidiskr Nor Loegeforen 1978;98(16):845‐8. - PubMed
Kongsted 2007 {published data only}
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Krugh 2010 {published data only}
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Langevin 2012 {published data only}
    1. Langevin P, Roy JS, Desmeules F. Cervical radiculopathy: study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen. BMC Musculoskeletal Disorders 2012;13(10). - PMC - PubMed
Leboeuf 1987 {published data only}
    1. Leboeuf C, Grant BR, Maginnes GS. Chiropractic treatment of repetitive stress injuries: a preliminary prospective outcome study of SMT versus SMT combined with massage. Journal of the Australian Chiropractors Association 1987;17(1):11‐4.
Lee 2010 {published data only}
    1. Lee MJ. Impairment based treatment of neck pain with trunk strengthening following inefficacious manual therapy intervention. Journal of Manual and Manipulative Therapy 2010;18(4):229‐30.
Levoska 1993 {published data only}
    1. Levoska S, Keinanen‐Kiukaanneimi S. Active or passive physiotherapy for occupational cervicobrachial disorders? A comparison of two treatment methods with a 1‐year follow‐up. Archives of Physical Medicine and Rehabilitation 1993;74:425‐30. - PubMed
Li 2006 {published data only}
    1. Li DJ, Wang J, Gao Q, Hou JS. Interventional effects of cervical local‐point traction, manipulation plus silver needle heat conductive treatment for cervical spinal canal stenosis. Chinese Journal of Clinical Rehabilitation 2006;10(43):7‐10.
Lindell 2008 {published data only}
    1. Lindell O, Johansson SE, Strender LE. Subacute and chronic, non‐specific back and neck pain: cognitive‐behavioural rehabilitation versus primary care. A randomized controlled trial. BMC Musculoskeletal Disorders 2008;9:59‐63. - PMC - PubMed
Linton 2001 {published data only}
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Maduro de Camargo 2011 {published data only}
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Maiers 2007 {published data only}
    1. Maiers MJ, Hartvigsen J, Schulz C, Schulz K, Evans RL, Bronfort G. Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials. BMC Musculoskeletal Disorders 2007;8(94):1‐9. - PMC - PubMed
Maiers 2013 {published data only}
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Manca 2007 {published data only}
    1. Manca A, Dumville JC, Torgerson DJ, Klaber Moffett JA, Mooney MP, Jackson DA, et al. Randomized trial of two physiotherapy interventions for primary care back and neck patients: cost‐effectiveness analysis. Rheumatology 2007;46:1495‐501. - PubMed
Mansilla‐Feragut 2009 {published data only}
    1. Mansilla‐Ferragut P, Fernández‐de‐las Peñas C, Alburquerque‐Sendín F, Cleland JA, Boscá‐ Gandía JJ. Immediate effects of atlanta‐occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain. Journal of Manipulative and Physiological Therapeutics 2009;32:101‐6. - PubMed
Mansilla‐Ferragud 2008 {published data only}
    1. Mansilla‐Ferragud P, Bosca Gandia JJ. Effect of the manipulation of the occipito‐atlanto‐axial joint complex on mouth opening [Efecto de la manipulacion de la charnela occipito‐atlo‐axiodea en la apertura de la boca (Spanish)]. Osteopathia Cientifica 2008;3(2):45‐51.
McClatchie 2009 {published data only}
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McKinney 1989 {published data only}
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McReynolds 2005 {published data only}
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Mealy 1986 {published data only}
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Metcalfe 2006 {published data only}
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Mezaki 1995 {published data only}
    1. Mezaki T, Kaji R, Kimura J, Mannen T. Dose‐response relationship in the treatment of cervical dystonia with botulinum toxin type A (AGN 191622): a phase II study. Brain and Nerve 1995;4:857‐62. - PubMed
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Moodley 2002 {published data only}
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Murphy 2010 {published data only}
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Nagrale 2010 {published data only}
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Palmgren 2006 {published data only}
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Persson 2001 {published data only}
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Pool 2010 {published data only}
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Provinciali 1996 {published data only}
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Reginiussen 2000 {published data only}
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Reid 2014 {published data only}
    1. Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of Mulligan sustained natural apophyseal glides and Maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Physical Therapy 2010;94(4):466‐77. - PubMed
Rubinstein 2007 {published data only}
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Rupert 2002 {published data only}
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Schenk 1994 {published data only}
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Scholten‐Peeters 2003 {published data only}
    1. Scholten‐Peeters GGM, Verhagen AP, Neeleman‐van der Steen, Hurkmans JCAM, Wams RWA, Oosterdorp RAB. Randomized clinical trial of conservative treatment for patients with whiplash‐associated disorders: considerations for the design and dynamic treatment protocol. Journal of Manipulative Physiological Therpeutics 2003;26:412‐20. - PubMed
Schwerla 2008 {published data only}
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Skargren 1998 {published data only}
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Sterling 2001 {published data only}
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References to studies awaiting assessment

Casanova‐Mendez 2014 {published data only}
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Izquierdo‐Perez 2014 {published data only}
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Demircio 2011 {published data only}
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Groeneweg 2010 {published data only}
    1. Groeneweg R, Kropman H, Leopold H, Assen L, Mulder J, Tulder MW, et al. The effectiveness and cost‐evaluation of manual therapy and physical therapy in patients with sub‐acute and chronic non specific neck pain. Rationale and design of a randomized controlled trial (RCT) [study protocol]. BMC Musculoskeletal Disorders 2010;11(14). - PMC - PubMed
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Langevin 2015 {published data only}
    1. Langevin P, Roy JS, Desmeules F. Cervical radiculopathy: study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044]. BMC Musculoskeletal Disorders 2012;13:1‐8. - PMC - PubMed
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Scott‐Dawkins 1997 {published data only}
    1. Scott‐Dawkins C. The comparative effectiveness of adjustments versus mobilisation in chronic mechanical neck pain. Proceedings of the Scientific Symposium. Tokyo, Japan, June 2‐8, 1997.
Shammsuddin 2010 {published data only}
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Snodgrass 2012 {published data only}
    1. Snodgrass S, Rivett D, Vicenzino B, Sterling M. Dose optimization for spinal treatment effectiveness (the dose study): higher applied mobilization force associated with reduced pain and spinal stiffness in patients with chronic neck pain [Abstract]. The International Federation of Orthopaedic Manipulative Physical Therapists 2012.
    1. Snodgrass SJ, Rivett DA, Sterling M, Vicenzino B. Dose optimisation for spinal treatment effectiveness: a randomised controlled trial investigating the effects of high and low mobilisation forces in patients with neck pain. Journal of Orthopaedic & Sports Physical Therapy 2014;44(3):141‐52. - PubMed
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Tanaka 1995 {published data only}
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Vihstadt 2014 {published data only}
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