Manual Therapy for Neck Pain: What the Evidence Says Now

Why This Matters

Neck pain remains one of the most common musculoskeletal complaints in clinical practice — yet nearly half to three-quarters of patients with acute episodes go on to develop chronic symptoms. This umbrella review brings together the current best evidence on manual therapy interventions for three common neck pain conditions: nonspecific neck pain (NSNP), cervical radiculopathy (CR), and cervicogenic headache (CGH).

What the Research Found

This 2024 umbrella review analyzed 35 systematic reviews published between 2016 and 2023. It looked at manual therapy interventions — including mobilization, manipulation, soft tissue work, and neuromobilization — applied to the cervical and thoracic spine.

Key findings included:

      • NSNP: High-quality evidence supports the combined use of manual therapy and exercise, with outcomes superior to either intervention alone.
      • Cervical Radiculopathy: Moderate-quality evidence supports neural mobilization, distraction, and mobilization/manipulation of the cervical and thoracic spine.
      • Cervicogenic Headache: High-confidence evidence supports cervical spine mobilization/manipulation, soft tissue techniques, and manual therapy with exercise.

    While some reviews had limitations due to variability in study quality, the general consensus is that manual therapy—when appropriately applied—is effective for short-term pain and disability reduction in these populations.

Clinical Takeaways

    • For patients with persistent neck pain, referring to providers trained in manual therapy plus exercise may enhance outcomes.
    • Multimodal care is key — manual therapy appears most effective when paired with active rehabilitation.
    • Upper thoracic mobilization can play a valuable role even when symptoms are predominantly cervical.
    • Neural mobilization techniques may be beneficial in radiculopathy cases where central sensitization is suspected or imaging doesn’t fully explain symptoms.

Where Collaborative Spine Care May Support This

As a chiropractic physician specializing in manual and mobilization-based treatment, I often work in conjunction with primary care, pain management, and physical therapy to support patients with complex or recurrent cervical complaints. Gentle techniques like flexion distraction, soft tissue mobilization, and neurodynamic work can be useful tools in a broader, patient-centered care plan.

Reference
Reynolds B,McDevitt A,Kelly J,Mintken P,Clewley D. Manual physical therapy for neck disorders: an umbrella review. The journal of manual & manipulative therapy. 2024;():45309. 10.1080/10669817.2024.2425788

View on Pubmed:  https://pubmed.ncbi.nlm.nih.gov/39607420/;
Full Text:  https://www.tandfonline.com/doi/full/10.1080/10669817.2024.2425788

ABSTRACT:

INTRODUCTION: Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50-85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. RESULTS: A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs. CONCLUSION: Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.