ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M.

ISSN: 2789-5009

Leading Ecuadorian research in science, technology, engineering, arts, and mathematics.

Spinal Manipulation as a Treatment for Neck Pain: A Systematic Review of Randomized Controlled Trials

Published date: Sep 25 2024

Journal Title: ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M.

Issue title: Volume 3, Issue 4

Pages: 207–227

DOI: 10.18502/espoch.v3i4.17174

Authors:

David Marcelo Guevara Hernándezdavidzguevara@icloud.comFacultad de Ciencias de la Salud, Carrera de Fisioterapia, Universidad Nacional de Chimborazo, Av. Antonio José de Sucre, 060108 Riobamba, Ecuador

Shirley Mireya Ortiz PérezFacultad de Ciencias de la Salud, Carrera de Fisioterapia, Universidad Nacional de Chimborazo, Av. Antonio José de Sucre, 060108 Riobamba, Ecuador

Sonia Alexandra Álvarez CarriónFacultad de Ciencias de la Salud, Carrera de Fisioterapia, Universidad Nacional de Chimborazo, Av. Antonio José de Sucre, 060108 Riobamba, Ecuador

María Belén Pérez GarcíaFacultad de Ciencias de la Salud, Carrera de Fisioterapia, Universidad Nacional de Chimborazo, Av. Antonio José de Sucre, 060108 Riobamba, Ecuador

Abstract:

Background: Cervical pain is one of the most common pathologies in physiotherapy consultations. Currently, there are countless techniques, protocols, and treatments ranging from conservative to invasive. The intervention includes orthopedic manual therapy techniques in patients who present the pathology. To date, several studies apply spinal manipulation as a treatment option for patients with neck pain; however, its effects on pain and disability are unknown. Methodology: A compilation, selection, and analysis of randomized clinical trials was carried out, and studies showed the effect of this technique on the type and origin of pain in patients with neck pain. Data extraction was formulated in tables, and the methodological quality was determined through the physiotherapy evidence database scale. Results: Thirty studies were included that were classified based on the type and origin of pain. In order to determine the effectiveness, it was applied as the only treatment technique or as part of a multimodal treatment. Conclusions: Spinal manipulation has a greater effect on pain and disability when considered as the only treatment technique in patients with acute pain. However, when applied as part of the multimodal protocol, it proves to be effective in chronic, radicular, mechanical, and nonspecific pain. The high heterogeneity of the studies is a limitation of our findings.

Keywords: spinal manipulation, neck pain, cervical vertebral, acute pain, chronic pain.

Resumen

Antecedentes: El dolor cervical es una de las patologías más comunes presente en la consulta de fisioterapia, en la actualidad existen un sin número de técnicas, protocolos y tratamientos que van desde lo conservador hasta lo invasivo, en la intervención se incluye técnicas de terapia manual ortopédica en pacientes que presentan la patología antes mencionada. Hasta la fecha, existen varios estudios que aplican manipulación espinal como opción de tratamiento para pacientes con dolor cervical, sin embargo, se desconocen sus efectos sobre dolor y la discapacidad. Metodología: se realizó la recopilación, selección y análisis de ensayos clínicos aleatorizados que en sus estudios se evidenció el efecto de esta técnica sobre el tipo y origen del dolor en pacientes con cervicalgia, la extracción de datos se formuló en tablas; la calidad metodológica fue determinada a través de la escala de Physiotherapy Evidence Database, Resultados: se incluyeron treinta estudios que fueron clasificados en base al tipo y origen del dolor, para determinar la efectivad, se tomó en cuenta si era aplicada como única técnica de tratamiento o siendo parte de un tratamiento multimodal. Conclusiones: la manipulación espinal tiene mayor eficacia sobre el dolor y la discapacidad al ser considerada como única técnica de tratamiento en pacientes con dolor agudo; sin embargo, cuando es aplicada como parte del protocolo multimodal demuestra ser eficaz en el dolor crónico, radicular, mecánico e inespecífico, la alta heterogeneidad de los estudios es una limitante para nuestros hallazgos.

Palabras Clave: manipulación espinal, cervicalgia, vértebras cervicales, dolor agudo, dolor crónico.

References:

[1] Nogueira N, Oliveira Campelo N, Torres R, Sousa ASP, Ribeiro F. Manual but not instrument assisted cervical manipulation reduces pain and disability in subjects with nonspecific neck pain: Double blinded, randomized clinical trial. Appl Sci. enero de 2023;13(5):2770.

[2] González Rueda V, López de Celis C, Bueno Gracia E, Rodríguez Sanz J, Pérez Bellmunt A, Barra López M, et al. Short and mid term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial. Clin Rehabil [Internet]. marzo de 2021 [citado 1 de mayo de 2023];35(3). Disponible en: https://pubmed.ncbi.nlm.nih.gov/33076707/

[3] Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. febrero de 2015;90(2):284-99.

[4] Romero Del Rey R, Saavedra Hernández M, Rodríguez Blanco C, Palomeque Del Cerro L, Alarcón Rodríguez R. Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: a randomized controlled trial. Disabil Rehabil. abril de 2022;44(8):1227-33.

[5] Aquaroli RS, Camacho ES, Marchi L, Pimenta L. Manual therapy and segmental stabilization in the treatment of cervical radiculopathy. Fisioter Em Mov. marzo de 2016;29:45-52.

[6] Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi center randomized clinical trial. BMC Musculoskelet Disord. 6 de febrero de 2016;17:64.

[7] Junaid M, Yaqoob I, Shakil Ur Rehman S, Ghous M. Effects of post isometric relaxation, myofascial trigger point release and routine physical therapy in management of acute mechanical neck pain: a randomized controlled trial. JPMA J Pak Med Assoc. octubre de 2020;70(10):1688-92.

[8] Sbardella S, La Russa C, Bernetti A, Mangone M, Guarnera A, Pezzi L, et al. Muscle energy technique in the rehabilitative treatment for acute and chronic non specific neck pain: A systematic review. Healthc Basel Switz. 17 de junio de 2021;9(6):746.

[9] Bernal-Utrera C, Gonzalez-Gerez JJ, Anarte-Lazo E, Rodriguez-Blanco C. Manual therapy versus therapeutic exercise in non specific chronic neck pain: A randomized controlled trial. Trials. 28 de julio de 2020;21(1):682.

[10] Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non specific neck pain: A systematic review. J Back Musculoskelet Rehabil. 6 de noviembre de 2017;30(6):1149-69.

[11] Rodríguez Sanz J, Malo Urriés M, Corral de Toro J, López de Celis C, Lucha López MO, Tricás Moreno JM, et al. Does the addition of manual therapy approach to a cervical exercise program improve clinical outcomes for patients with chronic neckpain in short- and mid term? A randomized controlled trial. Int J Environ Res Public Health. 10 de septiembre de 2020;17(18):6601.

[12] Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database Syst Rev. 24 de abril de 2017;4(4):CD011279.

[13] Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: Global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 3 de enero de 2022;23(1):26.

[14] Yu M, Wang X. Neck pain and proprioception deficit influence the cervical motion assessed by instantaneous axis of rotation. Acta Neurochir (Wien). junio de 2018;160(6):1265.

[15] Chaibi A, Stavem K, Russell MB. Spinal manipulative therapy for acute neck pain: A systematic review and meta analysis of randomised controlled trials. J Clin Med. 28 de octubre de 2021;10(21):5011.

[16] Alshami AM, Bamhair DA. Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: A randomized clinical trial. Trials. 18 de octubre de 2021;22:716.

[17] Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient’s pain experience? Pain Manag. noviembre de 2015;5(6):455-64.

[18] Bakken AG, Eklund A, Warnqvist A, O’Neill S, Axén I. The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial. BMC Musculoskelet Disord [Internet]. 2021 [citado 1 de mayo de 2023];22. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549416/

[19] Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. enero de 2006;29(1):14-21.

[20] Rabia Afzal. JPMA - Revista de la Asociación Médica de Pakistán [Internet]. [citado 30 de abril de 2023]. Disponible en: https://jpma.org.pk/articledetails/ 9303?article_id=9303

[21] Cb J, J W, Zx Z, Js H, L M, T S. Efficacy of cervical fixed point traction manipulation for cervical spondylotic radiculopathy: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao [Internet]. enero de 2012 [citado 1 de mayo de 2023];10(1). Disponible en: https://pubmed.ncbi.nlm.nih.gov/22237275/

[22] Ia Y, F P, J D, R L, La M. Immediate and short-term effects of thoracic spine manipulation in patients with cervical radiculopathy: A randomized controlled trial. J Orthop Sports Phys Ther [Internet]. mayo de 2019 [citado 1 de mayo de 2023];49(5). Disponible en: https://pubmed.ncbi.nlm.nih.gov/31021691/

[23] Hungund A, Metgud SC, Heggannavar A. Effect of myokinetic stretching technique and spinal mobilization with arm movement in subjects with cervical radiculopathy: A randomized clinical trial. Indian J Phys Ther Res. 7 de enero de 2020;2(2):134.

[24] Ayub A, Osama M, Ahmad S. Effects of active versus passive upper extremity neural mobilization combined with mechanical traction and joint mobilization in females with cervical radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil. 2019;32(5):725-30.

[25] Shafique S, Ahmad S, Shakil Ur Rehman S. Effect of Mulligan spinal mobilization with arm movement along with neurodynamics and manual traction in cervical radiculopathy patients: A randomized controlled trial. JPMA J Pak Med Assoc. noviembre de 2019;69(11):1601-4.

[26] Afzal R, Ghous M. Comparison between manual traction, manual opening technique and combination in patients with cervical radiculopathy: Randomized Control Trial. J Pak Med Assoc.

[27] Malo Urriés M, Tricás Moreno JM, Estébanez de Miguel E, Hidalgo García C, Carrasco Uribarren A, Cabanillas Barea S. Immediate effects of upper cervical translatoric mobilization on cervical mobility and pressure pain threshold in patients with cervicogenic headache: A randomized controlled trial. J Manipulative Physiol Ther. 2017;40(9):649-58.

[28] Gregoletto D, Martínez CMC. Effects of spinal manipulation in patients with mechanical neck pain. Coluna/Columna. diciembre de 2014;13:269-74.

[29] Ortega Santiago R, Martínez Segura R, de la Llave Rincón AI, Pérez Bruzón JD, Fernández de las Peñas C. Efectos hipoalgésicos y de movilidad cervical tras la manipulación vertebral cervical o la manipulación vertebral dorsal en pacientes con cervicalgia mecánica subaguda. Fisioterapia. 1 de marzo de 2012;34(2):51-8.

[30] Gorrell LM, Beath K, Engel RM. Manual and instrument applied cervical manipulation for mechanical neck pain: A randomized controlled trial. J Manipulative Physiol Ther. junio de 2016;39(5):319-29.

[31] Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, et al. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: A multicenter randomized clinical trial. Spine J. 1 de febrero de 2021;21(2):284-95.



[32] M M, Ja C, M H, M H. Short term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther [Internet]. marzo de 2013 [citado 1 de mayo de 2023];43(3). Disponible en: https://pubmed.ncbi.nlm.nih.gov/23221367/

[33] Arsh A, Darain H, Iqbal M, Rahman M, Ullah I, Khalid S. Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non specific neck pain; a randomized controlled trial. J Pak Med Assoc. 2020;(0):1.

[34] Valera Calero A, Lluch Girbés E, Gallego Izquierdo T, Malfliet A, Pecos Martín D. Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: A randomized controlled trial. Eur J Phys Rehabil Med. diciembre de 2019;55(6):792-805.

[35] Paanalahti K, Holm LW, Nordin M, Höijer J, Lyander J, Asker M, et al. Three combinations of manual therapy techniques within naprapathy in the treatment of neck and or back pain: A randomized controlled trial. BMC Musculoskelet Disord. 23 de abril de 2016;17(1):176.

[36] Maiers M, Bronfort G, Evans R, Hartvigsen J, Svendsen K, Bracha Y, et al. Spinal manipulative therapy and exercise for seniors with chronic neck pain. Spine J. 1 de septiembre de 2014;14(9):1879-89.

[37] Corum M, Aydin T, Medin Ceylan C, Kesiktas FN. The comparative effects of spinal manipulation, myofascial release and exercise in tension type headache patients with neck pain: A randomized controlled trial. Complement Ther Clin Pract. mayo de 2021;43:101319.

[38] Seo J, Song C, Shin D. A single center study comparing the effects of thoracic spine manipulation vs mobility exercises in 26 Office workers with chronic neck pain: A randomized controlled clinical study. Med Sci Monit Int Med J Exp Clin Res. 8 de julio de 2022;28:e937316-1-e937316-10.

[39] Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain. Ann Intern Med. 3 de enero de 2012;156(1_Part_1):1-10.

[40] Leininger BD, Evans R, Bronfort G. Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation, Home Exercise, and Medication for Acute and Subacute Neck Pain. J Manipulative Physiol Ther. 1 de octubre de 2014;37(8):593-601.

[41] Puentedura EJ, Landers MR, Cleland JA, Mintken PE, Huijbregts P, Fernándezde- Las-Peñas C. Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. abril de 2011;41(4):208-20.

[42] Arjona Retamal JJ, Fernández Seijo A, Torres Cintas JD, de la Llave Rincón AI, Caballero Bragado A. Effects of Instrumental, Manipulative and Soft Tissue Approaches for the Suboccipital Region in Subjects with Chronic Mechanical Neck Pain. A Randomized Controlled Trial. Int J Environ Res Public Health. 16 de agosto de 2021;18(16):8636.

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