Manual therapy, physical therapy, or continued care by a general practitioner for patients with Neck Pain.
Neck pain affects 10-15% of the general population and can become a costly and disabling condition. A variety of therapies are commonly prescribed for neck pain, however these methods have never been directly compared. Hoving et al (Ann Intern Med 2002;136:713-722) conducted a randomized, controlled trial to compare the efficacies of manual therapy, physical therapy, and continued care by a general practitioner.
Methods: One hundred eighty-three patients were randomly assigned to one of the following treatment regimens: 6 weeks of manual therapy once a week, physical therapy twice a week, or continued care by a general practitioner. In the study, manual therapy consisted of “hands-on” muscular mobilization techniques, specific articular mobilization techniques, and coordination or stabilization techniques. Physical therapy consisted mainly of active exercise. In general, manual therapy was passive (i.e. performed by the therapist) while physical therapy was active (i.e. performed by the patient). The patients whose therapy was managed by a general practitioner received counseling, education and analgesics.
Summary: Measurements were taken at baseline and at 3 and 7 weeks. Treatment was considered successful if the patient reported being “completely recovered” or “much improved” on an ordinal six-point scale. Also measured were physical dysfunction, pain intensity and disability. At 7 weeks manual therapy yielded a 68.3% success rate, while the physical therapy and continued care groups had 50.8% and 35.9% success rates, respectively. Differences in pain intensity, on a scale of 0 to 10, were 0.9-1.5 better in the manual therapy group compared to the other two groups. This was a statistically significant difference. Manual therapy scored consistently better on most outcome measures. Physical therapy scored better than continued care on some outcome measure, but the differences were not statistically significant.
Conclusion: Thus, for patients with neck pain, “manual therapy” appears to be a better treatment option than physical therapy or continued care, as defined by these investigators.
Editorial Comment: Chronic neck and low back pain are common in older patients. However, few studies are available that have rigorously looked at the efficacy of various treatment modalities in relieving pain in these areas. This trial by Hoving et al is one such study. Hands-on manipulation of neck muscles and joints was more effective than physical therapy (mainly supervised neck exercises by the patient) and tincture of time. Differences among treatments were modest, however, and tincture of time may still be the most important intervention for chronic neck pain.