The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial

Abstract

Objective: The main objective of this study is to compare the immediate results of manipulation to mobilization in neck pain patients.

Design: The patients were compared in a randomized controlled trial without long-term follow-up.

Setting: The study was conducted at an outpatient teaching clinic on primary and referred patients.

Patients: One hundred consecutive outpatients suffering from unilateral neck pain with referral into the trapezius muscle were studied. Fifty-two subjects were manipulated and 48 subjects were mobilized. The mean (SD) age was 34.5 (13.0) yr for the manipulated group and 37.7 (12.5) yr for the mobilized group. Sixteen subjects had neck pain for less than 1 wk, 34 subjects had pain for between 1 wk and 6 mo and 50 subjects had pain for more than 6 mo. Seventy-eight subjects had a past history of neck pain. Thirty-one subjects had been involved in an injurious motor vehicle accident and 28 subjects had other types of minor trauma to the neck. There were no significant differences between the two treatment groups with respect to history of neck pain or level of disability as measured by the Pain Disability Index.

Intervention: The patients received either a single rotational manipulation (high-velocity, low-amplitude thrust) or mobilization in the form of muscle energy technique.

Main outcome measures: Prior to and immediately after the treatments, cervical spine range of motion was recorded in three planes, and pain intensity was rated on the 101-point numerical rating scale (NRS-101). Both pre- and post-test measurements were conducted in a blinded fashion.

Results: The results show that both treatments increase range of motion, but manipulation has a significantly greater effect on pain intensity. Eighty-five percent of the manipulated patients and 69% of the mobilized patients reported pain improvement immediately after treatment. However, the decrease in pain intensity was more than 1.5 times greater in the manipulated group (p = .05).

Conclusion: This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain. Both treatments increase range of motion in the neck to a similar degree. Further studies are required to determine any long-term benefits of manipulation for mechanical neck pain.