The Immediate Effect of Manipulation vs. Mobilization on Pain and Range of Motion in the Cervical Spine

Authors Abstract


Objective – The main objective of this study is to compare the immediate results of manipulation to mobilization in neck pain patients.

Design – The patients were compared in a randomized controlled trial without long-term follow-up.

Setting – The study was conducted at an outpatient teaching clinic on primary and referred patients.

Patients – One hundred consecutive outpatients suffering from unilateral neck pain with referral into the trapezius muscle were studied. Fifty-two subjects were manipulated and 48 subjects were mobilized. The mean (SD) age was 34.5 (13.0) yr for the manipulated group and 37.7 (12.5) for the mobilized group. Sixteen subjects had neck pain for less than 1 week, 34 subjects had pain for between 1 wk and 6 mo and 50 subjects had pain for more than 6 mo. Seventy-eight subjects had a past history of neck pain. Thirty-one subjects had been involved in an injurious motor vehicle accident and 28 subjects had other types of minor trauma to the neck. There were no significant differences between the two treatment groups with respect to history of neck pain or level of disability as measured by the Pain Disability Index.

Intervention – The patients received either a single rotational manipulation (high-velocity, low-amplitude thrust) or mobilization in the form of muscle energy technique.

Main Outcome Measures – Prior to and immediately after the treatments, cervical spine range of motion was recorded in three planes, and pain intensity was rated on the 101-point numerical rating scale (NRS-101). Both pre- and post-test measurements were conducted in a blinded fashion.

Results – The results show that both treatments increase range of motion, but manipulation has a significantly greater effect on pain intensity. 85% of the manipulated patients and 69% of the mobilized patients reported pain improvement immediately after treatment. However, the decrease in pain intensity was more than 1.5 times greater in the manipulated group (p=.05).

Conclusion – This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain. Both treatments increase range of motion in the neck to a similar degree. Further studies are required to determine any long-term benefits of manipulation for mechanical neck pain.

Editors Summary


Neck pain with decreased mobility is a common condition that improves, for most cases, with time , but may persist in others as moderate or severe pain for several years after the initial onset. Many different treatments have been used to handle mechanical neck pain, but few clinical trials have been performed to establish their effectiveness. The purpose of this study is to compare the immediate results of manipulation and mobilization on pain and ROM in patients with unilateral mechanical neck pain. Subjects were patients suffering from unilateral, mechanical neck pain with radiation into the trapezius, and local cervical paraspinal tenderness. After the initial exam and before the treatment, patients rated their pain intensity on the NRS-101. Cervical ROM was measured next by a goniometer after which patients were randomized into two groups: Group 1- Cervical Manipulation- involved contacting the pillar on the painful side of the neck at the level of tenderness, passively rotating the neck away from the painful side as far as possible, and applying a high-velocity, low-amplitude thrust in the same direction. Group 2- Cervical Mobilization- involved application of muscle energy technique (active resisted isometric contraction held for 5 seconds and repeated four times with increasing rotation or lateral flexion of the neck; aims to improve mobility and pain via post-isometric relaxation) to hypertonic muscles responsible for restricting joint movement. All treatments were given once and were applied to the symptomatic side. Patients rated their pain intensity again within five minutes after the treatment, and the ROM exam was also repeated.

Results show that both manipulation and mobilization have the immediate effect of decreasing pain and increasing cervical ROM. Improvements were slightly higher in the manipulation group, and the overall pain improvement on the NRS-101 was 1.5 times greater than the mobilized group. The question is which treatment would give better results when considering long-term follow up and risk/benefit (manipulation may cause a cerebrovascular accident whereas mobilization will not, but mobilization may be of little therapeutic value).

In conclusion, this study proves that manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain, but both treatments increase cervical ROM to the same degree. Further studies should examine the long-term benefits of manipulation for mechanical neck pain.

Journal of Manipulative and Physiological Therapeutics 1992; 15:570-575. From the Department of Orthopedic Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.