A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain
From: Arch Phys Med Rehabil. 2010 Sep;91(9):1313-1318
To determine whether neck manipulation is more effective for neck pain than mobilization, a randomized controlled trial with blind assessment of outcome was undertaken by the authors. The setting was Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.
Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks, from which the number of days taken to recover from the episode of neck pain.
The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization. The authors concluded that neck manipulation is not appreciably more effective than mobilization. The authors further noted that the use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.
It would be interesting to note a similar number of patients without any neck manipulation or mobilization and the number of median days to recover from nonspecific neck pain of less than 3 months duration. Additionally, the conclusion that “the use of neck manipulation therefore cannot be justified on the basis of superior effectiveness” should include – for nonspecific neck pain less than 3 months in duration with 4 treatments over a 2 week period. Without the entire article, one can only speculate why 4 treatments over 2 weeks would be deemed reasonable treatment for a nonspecific entity with either modality.
I presume the full article would delineate the criteria for being deemed suitable for treatment with manipulation or mobilization by the treating practitioner and if the evaluation methods were uniform between practitioners. Furthermore, the article should indicate specific analysis to reach a broad conclusion that manipulation cannot be justified on the basis of superior effectiveness – in fact, the abstract should have indicated that mobilization was more effective than manipulation for nonspecific neck pain of less than 3 months duration in a heterogeneous group of treating practitioners performing 4 treatments over a 2 week period.
