Do mobilization or manipulation techniques help relieve neck pain?

Photo of physiotherapy (PantherMedia / Erwin Wodicka)

Manual therapy techniques applied to the neck or upper back area are used to relieve neck pain in the short term. But there aren't enough good-quality studies to be able to draw any reliable conclusions about the effect of these techniques.

Manipulation and mobilization are manual therapy techniques based on specific skilled hand movements. The aim of these techniques is to relieve pain and improve the mobility of joints. In mobilization, the therapist slowly moves the joint within its normal range of movement. Manipulation therapy, on the other hand, involves using short, sharp movements to push a joint beyond its normal range of movement. This is also known as chiropractic adjustment.

For the treatment of neck pain, manipulation and mobilization techniques can be used on both the neck (cervical spine) and the upper back (thoracic spine). It is important to make sure that the physiotherapist or doctor has had special training in manual therapy.

Research on mobilization and manipulation for neck pain

Researchers from the Cochrane Collaboration, an international network of researchers, wanted to find out whether manipulation or mobilization of the neck or upper back can relieve neck pain. To do so, the researchers looked for studies that compared these techniques with things like a dummy treatment (placebo) or another treatment. In the placebo groups the therapists applied a "fake" treatment, for example by only pretending to mobilize a joint.

Many of the studies had methodological flaws and were too small to draw reliable conclusions. An average of less than 70 people took part in the studies. This means that any conclusions drawn from the studies are only weak evidence, and further research could lead to other conclusions.

Mobilization or manipulation of the cervical spine (neck)

Three of the studies looked at whether using a manipulation technique on the neck just once can relieve acute and chronic neck pain. Overall, the results indicated that this treatment can reduce pain immediately after it is applied, but this effect didn't last long.

The researchers didn't find any studies that compared mobilization of the neck with a placebo treatment. But two studies compared manipulation and mobilization of the neck with each other. There were no differences between the outcomes of the two treatments here. Because the studies were fairly small, though, we can't be absolutely certain that there are no differences between them.

Mobilization or manipulation of the thoracic spine (upper back)

One study indicated that manipulation of the upper back could also relieve chronic neck pain in the short term. But the study didn't look into how long this effect lasted. The researchers didn't find any studies that looked at mobilization of the upper back.

In the rest of the studies that the researchers found, different types of manipulation or mobilization techniques were either compared with each other or with other treatments for pain relief. Examples of the other treatments include acupuncture, painkillers, heat therapy and TENS (transcutaneous electrical nerve stimulation). They didn't find that any of the treatments had clear advantages over others. But the same is true here: Bigger and more conclusive studies are needed to be able to determine how the various manipulation and mobilization techniques compare to each other, as well as how they compare to other treatments.

The U.S. Agency for Healthcare Research and Quality (AHRQ) also analyzed studies on manual therapy. They came to the same conclusion: More research is needed to be able to reliably assess how effective manual therapy is in the treatment of neck pain.

Side effects

Manual therapy techniques may make the pain worse and cause temporary side effects such as headaches or dizziness at first. There have been a few reports of blood vessel injuries and strokes following manipulation of the spine. But these kinds of complications are extremely rare.