Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain

Man Ther. 2014 Jun;19(3):215-21. doi: 10.1016/j.math.2013.12.002. Epub 2014 Jan 11.


Our purpose was to compare the effectiveness of three manual therapy techniques: high velocity, low amplitude (HVLA), mobilization (Mob) and sustained natural apophyseal glide (SNAG) in patients with chronic neck pain (CNP). The randomized controlled trial included patients with mechanically reproducible CNP, who were randomized to the treatment group. Outcome measures were the Visual Analogue scale (VAS), Neck Disability Index (NDI), Global Rating of Change (GROC) and Cervical Range of Motion (CROM). Two-way repeated measures analysis of variance compared outcomes at baseline, at the end of treatment and 1, 2 and 3 months after treatment. A total of 51 subjects completed the trial. No significant differences were found between HVLA, Mob and SNAG at the end of treatment and during the follow-up in any of the analysed outcomes. There were no differences in satisfaction for all techniques. The results lead to the conclusion that there is no long-term difference between the application of HVLA, Mob and SNAG in pain, disability and cervical range of motion for patients with CNP.

Keywords: Chronic neck pain; Manual therapy; Musculoskeletal manipulations; Randomized controlled trial.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Chronic Pain
  • Disability Evaluation
  • Double-Blind Method
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Musculoskeletal Manipulations / methods
  • Neck Pain / diagnosis
  • Neck Pain / rehabilitation*
  • Pain Measurement
  • Patient Positioning
  • Range of Motion, Articular / physiology*
  • Risk Assessment
  • Sensitivity and Specificity
  • Treatment Outcome