Comparative study of hands-on therapy with active exercises vs education with active exercises for the management of upper back pain

J Manipulative Physiol Ther. 2006 Mar-Apr;29(3):228-35. doi: 10.1016/j.jmpt.2006.02.001.


Objective: The aim of this study was to compare hands-on therapy, including heat, massage, and active exercises with postural education that emphasized increased self-efficacy and postural self-awareness along with education about the physiology of the disorder, and prescribed daily active exercises.

Subjects: Twenty-four randomly selected women, 12 custodians and 12 students, with neck and shoulder pain and stiffness.

Methods: All subjects received a medical examination and x-ray before the study to rule out any pre-existing neurologic deficits and an evaluation that included history taking and self-reporting of pain according to a numeric pain scale. Student participants received education and exercise instructions to be continued daily. The custodial workers received once-per-week hands-on treatment.

Results: Data were compared using a nonparametric analysis (Wilcoxon signed rank test) and showed evidence of statistically significant reductions in neck, shoulder, and back stiffness and shoulder muscle tension for most of the study subjects.

Conclusion: Treatment of repetitive stress injuries that combines maintenance of daily active exercises prescribed and modeled by a professional therapist, which emphasize postural awareness to correct poor posture and provide a basic physiological understanding of the disorder, is as crucial to reducing upper back and neck pain and stiffness as hands-on therapy with active exercise provided in a clinical setting.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Cumulative Trauma Disorders / therapy*
  • Exercise Therapy*
  • Female
  • Hot Temperature / therapeutic use
  • Humans
  • Massage
  • Muscle Contraction
  • Musculoskeletal Manipulations*
  • Neck Pain / physiopathology
  • Neck Pain / therapy*
  • Patient Education as Topic*
  • Pliability
  • Posture*
  • Shoulder Pain / physiopathology
  • Shoulder Pain / therapy*
  • Surveys and Questionnaires
  • Treatment Outcome