Neck Manipulation

Neck Manipulation For Pain Relief

Neck manipulation is a technique for treating cervical spine conditions. It is often used by Osteopaths, Chiropractors and increasingly being used by Physical Therapists and even Medical Doctors.

Manipulation has been considered an effective treatment for managing neck pain. However, clinical observation showed that it is not effective for every patient. It helps to know the signs for identifying patients with neck pain who are likely to respond to this type of manual therapy.

Neck pain and related problems occur frequently in modern societies and have a considerable impact on individuals and the society. Manipulation is one of the manual techniques for treating mechanical neck pain. Although the pain relief effect of cervical spine manipulation has been demonstrated in many studies, it was reported not to be particularly effective in others.

Some studies showing positive effects of manipulation might have included more patients with factors favoring manipulation, while others that failed to show the positive effect of neck manipulation might have included fewer patients with such factors. But, some general findings are interesting.

It must be remembered that “manipulation” is a generalized term, and mechanical neck pain is an uncomplicated, non-specific term. Chiropractors have been noted for many specific techniques that may fall under the category of manipulation, however, many use specific methods of “adjusting”, especially for more complicated conditions.

Chiropractic Manipulation For Neck Pain Relief: A Study

  • In Manual Therapy 11 (2006) 306-315 “Predictors for the immediate responders to cervical manipulation in patients with neck pain”, the study was to identify the predictors for patients with neck pain who would respond immediately to the manipulation treatment.

neck manipulationPatients who were referred for treatment of their neck pain had diagnoses of cervical spondylosis with or without cervical radiculopathy, herniated disc, myofascial pain syndromes and neck related headaches.

Patients were not chosen if they had vertebral basilar insufficiency, progressive neurological deficits, severe osteoporosis, history of neck fracture or surgery, diagnoses of psychological disorders, systemic diseases, or other problems that were contraindications to cervical manipulation. All potential study participants were initially screened by their referred physicians.


The study identified six important predictors including the “score of the Neck Disability Index of less than 11.50”, “having bilateral involvement pattern” (both sides), “not performing sedentary work greater than 5 hours per day”, “feeling better while moving the neck”, “without feeling worse while extending the neck” (bending the head backward), and the “diagnosis of spondylosis without radiculopathy” for immediate respondents to the treatment.

The odds for patients with the initial Neck Disability Index score less than 11.50 obtaining a successful treatment are 3.84 times the odds for those who score greater than 11.50. The odds of relief for a single manipulation for patients with bilateral involvement pattern were 4.40 times higher than for those without the bilateral pattern. Sedentary work greater than 5 h per day came as an adverse factor in patients who received the manipulation treatment. With regards to the movement related factors, feeling better while moving the neck and without feeling worse while extending the neck were significantly associated with better neck pain relief outcomes.

Another significant factor that was positively associated with immediate neck pain relief to a single manipulation was “without feeling worse while extending the neck”. This means that patients who felt worse while extending the neck might not obtain immediate relief from the manipulation. The odds of obtaining relief from manipulation for patients with a diagnosis of spondylosis without radiculopathy were 7.22 times higher than for those who had other diagnoses.

There have been various factors associating with good prognosis for clinical course of neck pain, which included younger age, male gender, less pain, shorter duration of current episode, lower disability status at entry, not stressful work-related factors, and lower psychological stress.

This study also revealed that lower disability status at entry, i.e. lower score of the Neck Disability Index, and the work demands not requiring prolonged sedentary work were significant factors for predicting relief using manipulation. However, age, gender, pain intensity, and duration of current episode, and psychological status did not show significant predictability.

Six predictors were identified to significantly predict relief for cervical spine manipulation.

  1. Initial scores on Neck Disability Index less than 11.5
  2. Having bilateral involvement pattern
  3. Not performing sedentary work more than 5 hours a day
  4. Feeling better while moving the neck
  5. Without feeling worse while extending the neck
  6. Diagnosis of spondylosis without radiculopathy

The presence of four or more of these increased the probability of success with cervical spinal manipulation to 89%. Dramatic increases of the responded probabilities of successful manipulations were revealed by having 3 or more of these predictors.

These predictors may significantly enhance the decision to seek professional care for spinal manipulation as an appropriate intervention for mechanical neck pain.

So, you can take our Neck Disability Index on this site and see if you have some of these 6 factors which can help determine if you will get pain relief from neck manipulation.

Author Bio

Stephen Ornstein, D.C. has treated thousands of neck, shoulder and back conditions since graduating Sherman Chiropractic College in 1987 and during his involvement in Martial Arts. He holds certifications as a Peer Review Consultant from New York Chiropractic College, Physiological Therapeutics from National Chiropractic College, Modic Antibiotic Spinal Therapy from Dr. Hanne Albert, PT., MPH., Ph.D., Myofascial Release Techniques from Logan Chiropractic College, and learned Active Release Technique from the founder, P. Michael Leahy, DC, ART, CCSP.