Chiropractors approach neck pain with manual therapy as the primary form of treatment. There are several types of manual therapy, including high velocity, low amplitude (HVLA) thrust manipulation; mobilization; and/or soft tissue techniques. Is one type of manual therapy greater when it comes to managing neck pain? What does the research show? A systematic review of 23 randomized controlled trials compared various manual therapy techniques in 2017. These include on their own, with, or without the addition of specific exercise recommendations.
Acute to Sub-Acute Review
- High-velocity, low-amplitude thrust manipulation combined with exercise resulted in better outcomes when applied to the cervical vs. the thoracic spine.
- High-velocity, low-amplitude thrust manipulation combined with soft tissue techniques and exercise applied to the neck and mid-back led to better outcomes than soft tissue techniques.
Chronic Neck Pain Data
- HVLA thrust manipulation and soft tissue techniques in addition to exercise are more effective. This can be compared to manual therapy or exercise alone for improving pain and function.
- Thrust manipulation applied to the neck and mid-back are more effective for improving neck mobility than mobilization.
- Mobilization and soft tissue techniques are both more effective than no treatment at all.
This systematic review favors all types of manual therapies for the management of all stages of neck pain when combined with exercise. The results suggest that incorporating treatment of the mid-back may lead to better outcomes.
While manual therapies can benefit the neck pain, the approach a chiropractor takes depends on the patient’s unique case (based on patient history and exam findings) and preferences. A patient may prefer gentle, low-force techniques or their chiropractor may use a combination of manual therapies.
