Short-term effects of manipulative treatment versus a therapeutic home exercise protocol for chronic cervical pain: A randomized clinical trial

J Back Musculoskelet Rehabil. 2018 Feb 6;31(1):133-145. doi: 10.3233/BMR-169723.


Background: While both manipulative treatment and physical exercises are used to treat cervical pain, it remains unclear which is most effective.

Objective: To compare the short-term effects of high-velocity, low-amplitude manipulation techniques (MT) with those of home-exercise (HE) with stretching and low-intensity (10% of max) isometric contractions on pain and function.

Methods: Single-blind randomized clinical trial was performed. A total of 27 asymptomatic subjects were randomly assigned to 2 groups: manipulation techniques (MT, n= 13) and home exercise (HE, n= 14). The visual analogue scale (VAS); neck disability index (NDI); pressure pain thresholds; cervical spine range of motion and electromyography during the cranio-cervical flexion test was measured before and one week after the intervention.

Results: After the intervention, both groups showed improved (P< 0.05) NDI and VAS scores and flexion in both rotation ranges compared with the pre-intervention values. For the NDI, pain intensity, and neck flexion, the effects sizes were large; for the majority of the other measurements, the effect sizes were small to moderate. The MT group showed significantly better results than the HE group for 2 out of 17 tests.

Conclusions: Both interventions improved function and pain after one week, with only marginal between-group differences in favor of MT.

Keywords: Spinal manipulation; cervical vertebrae; electromyography; neck pain; thoracic vertebrae.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chronic Pain / diagnosis
  • Chronic Pain / physiopathology
  • Chronic Pain / rehabilitation*
  • Electromyography
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Neck Pain / diagnosis
  • Neck Pain / physiopathology
  • Neck Pain / rehabilitation*
  • Pain Measurement
  • Pain Threshold / physiology*
  • Single-Blind Method
  • Time Factors
  • Treatment Outcome
  • Young Adult