Hands-on Approach Best for Neck Pain

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

May 20, 2002 -- A popular but little-studied method of easing neck pain by moving the patient's neck in specific ways may be more effective than traditional physical therapy or a physician's care. A new study shows manual therapy -- practiced in the U.S. by chiropractors, osteopaths, and some physical and massage therapists -- was best in improving neck mobility and reducing pain.

Neck pain is common health problem, especially among older adults, and affects between 10% and 15% of the population. Although a variety of therapies are used to treat the condition, few studies have compared their effectiveness.

In this study, researchers compared three common treatments for neck pain in 183 patients with chronic neck pain: continued, routine care by a doctor (usually pain medications and rest), manual therapy, and physical therapy. Manual therapy consisted of a trained specialist manipulating the patient's neck, while physical therapy involved use of a trained therapist who assisted the patient in performing a series of active exercises.

After 7 weeks of treatment, 68.3% of the patients in the manual therapy group said they felt either completely recovered or much improved compared with 50.8% of the patients in the physical therapy group and 35.9% of the patients under their doctor's care alone.

"We found that manual therapy was more effective than continued care, and our results consistently favored manual therapy on almost all outcome measures," writes study author Jan Lucas Hoving, PhD, and colleagues from Cabrini Medical Centre in Victoria, Australia. "Although physical therapy scored slightly better than continued care, most of the differences were not statistically significant."

Their complete report appears in the May 21 issue of the Annals of Internal Medicine.

Disability levels improved among all three groups, but there were no significant differences between the groups. Range of motion improved more among the manual and physical therapy groups. And patients receiving manual therapy had fewer absences from work than the others.

In an editorial that accompanies the study, Joel Posner, MD, and Catherine Glew, MD, of MCP Hahnemann University in Philadelphia, say the findings are encouraging but more research is needed.

"Given the widespread used of manual therapy and the paucity of controlled studies, the study by Hoving and coworkers is not without importance," they write. But they point out that since the manual therapy approach used in the study was self-described as "eclectic," it's difficult to know which aspects were effective and which were not.