Mobilization, Manipulation, and Clinical Massage Are Effective Treatments for Neck Pain
Commentary by William J. Lauretti, DC
Mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain, according to a systematic review of the literature from 2000 to 2014. In contrast, the authors found that electroacupuncture, strain-counterstrain, relaxation massage, and other passive physical modalities (heat, cold, diathermy, hydrotherapy, ultrasound) are not effective for neck pain, as reported online ahead of print in The Spine Journal.
“In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) published a systematic review that synthesized the evidence on the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of neck pain,” said lead author Jessica J. Wong, BSc, DC, FCCS(C), Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). “Since 2008, the literature has advanced and the systematic review needed updating to inform evidence based care.”
Dr. Wong and colleagues from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration conducted a systematic review of randomized controlled trials, cohort studies, and case-control studies on the management of neck pain and associated disorders (NAD), which includes whiplash-associated disorders (WAD) and work-related neck pain, from 2000 to 2014. Of 8,551 citations on this topic, 38 studies were considered relevant and 22 had a low risk of bias and were included in the review.
“Our review clarifies the effectiveness of these interventions for clinicians, patients, and policymakers,” Dr. Wong said. “Clinicians may consider: 1) mobilization or manipulation for recent-onset neck pain (≤3 months duration); and 2) mobilization, manipulation, clinical massage, or low level laser therapy for persistent neck pain (>3 months duration). Based on other systematic reviews conducted by the OPTIMa Collaboration, effective interventions for the management of neck pain also include various types of exercise and some medications.” Treatment recommendations that were developed based on the evidence and other guiding factors are shown in the Table.
In contrast, “Many passive physical modalities, including clinic-based heat, cold, diathermy, hydrotherapy, and ultrasound, are not effective for the management of neck pain,” Dr. Wong said. “Electroacupuncture, strain-counterstrain, and relaxation massage are also not effective and should not be used to manage neck pain.”
William J. Lauretti, DC
Associate Professor of Chiropractic Clinical Sciences
New York Chiropractic College
Seneca Falls, NY
This study is an update on the landmark review performed in 2008 by the Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. For the most part, this update supports the findings of the Task Force’s original study: mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain.
This review has significant clinical implications because studies that offer head-to-head comparison of treatments for neck pain are rare, and much current clinical treatment of spinal pain is not highly evidence based.
While clarifying some issues, this review also illustrates the significant challenges that remain in judging the effectiveness of various treatments for spinal pain. In reading the details of this review, it is easy to get frustrated by the ambiguous and sometimes contradictory findings of the studies they review. No convincing “winner” has emerged between all the various therapies used to treat neck pain. Every neck pain patient is unique, and individual responses to therapy are difficult to predict. The “Holy Grail” of spinal care will be the ability to truly individualize care—to predict what specific therapy will work best for each patient. While some recent studies suggest we are tantalizingly close to advancing toward that goal, it is clearly still a long way away.
While the evidence supporting commonly used manual therapies and modalities for neck pain is less than compelling, it is important to view these findings in a broader context. Originally in 2008, the Neck Pain Task Force applied the same review methodology to other commonly used treatments for neck pain, such as pharmaceuticals and surgical procedures. It is important to note that none of those other treatments had any more evidence of effectiveness than manual therapies, and often had far less evidence, despite risk and cost profiles that were often significantly less favorable.