Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial

Abstract

Background Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment modalities described for its management, the most common approach is based on manual therapy and specific therapeutic exercise, which have shown a moderate effect on subjects with chronic non-specific neck pain. However, the effect times of these treatments have not been accurately detailed. Our study aims to break down and compare the effects of two experimental treatments based on manual therapy and therapeutic exercise. Methods The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain were studied. The sample was randomized divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of our research, we studied (a) pain, based on the visual analog scale and the pressure pain threshold, and (b) cervical disability, through the Neck Disability Index (NDI). Outcomes were registered on week 1, week 4, and week 12. The findings were analyzed statistically considering a 5% significance level ( P ≤ 0.05). Results No statistically significant differences ( P 0.05) were obtained between the experimental groups, if they exist against the control group. Nonetheless, we found that manual therapy improved perceived pain before than therapeutic exercise, while therapeutic exercise reduced cervical disability before than manual therapy. Effect size ( R 2 ) shows medium and large effects for both experimental treatments. Conclusion There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy. Clinical improvement could potentially be influenced by central processes. Trial registration Brazilian Clinical Trial Registry, RBR-2vj7sw. Registered on 28 November 2018.

Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial

“…A classification in NDI, under moderate disability, has been shown to predict avoidance of chronic disability after whiplash in 55.7% of the patients ( Nederhand et al, 2004 ). A recent study, which compared the efficacity of manual therapy vs exercise in chronic neck pain, has shown an effect side at three months of 0.18 in the NDI, which is less than the 0.59 obtained in the current study ( Bernal-Utrera et al, 2020 ).…”

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

“…These findings suggest that the application of only one neural mobilization technique might be sufficient to improve NP in clinical practice. Hence, the time spent on manual therapy techniques could be reduced in favor of other alternative approaches, such as therapeutic exercise or therapeutic education [ 60 ].…”

The effect of physical therapy in daily life and work activities for people with chronic cervical pain syndrome

“…Research has shown that both methods reduce the pain intensity and the disability degree after 12 weeks, with therapeutic exercises having a faster effect on reduced disability degree than manual therapy [22]. Sial et al (2016) researched the effectiveness of physical therapy and home exercise programs to reduce neck discomfort in the treatment of postural neck pain.…”