Abstract
(1) Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large −1.37 (95% CI, −2.41, −0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((−2.8 (46%) (95% CI, −2.1, −3.4) vs. −1.7 (30%) (95% CI, −1.1, −2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings.
Highlights
Acute neck pain is very common in the adult general population, as up to 50%experienced neck pain within the last year, and recurrence is frequent [1,2]
The interventions were conducted by physiotherapists or osteopaths, except one study, which recruited through 12 private physiotherapy, chiropractic, and osteopathy clinics combined
The main conclusion is that spinal manipulative therapy (SMT) alone or in combination with another modality is likely to be effective in the treatment of acute neck pain, and the randomized controlled trials (RCTs) reported few, mild and transient adverse events (AEs)
Summary
Acute neck pain is very common in the adult general population, as up to 50%experienced neck pain within the last year, and recurrence is frequent [1,2]. Acute neck pain is very common in the adult general population, as up to 50%. The point prevalence estimate of neck pain is 4.9–7.6% [5,6]. About one third of general practitioner (GP) consultations are due to musculoskeletal pain, mainly from neck- and lower back [8]. Topical NSAIDs can be beneficial and muscle relaxants are recommended as a reasonable treatment choice for acute neck pain [6,11]. In people refraining from medicine or in which medicine has an insufficient effect, manual therapy has traditionally been considered as an alternative treatment option. GPs refer about 8% of people with neck pain to manual therapy, which often includes spinal manipulative therapy (SMT) intervention [10]. Fear of complications associated with cervical SMT and limited support in current guidelines towards the evidence about the effectiveness are important barriers to referrals by GPs [10]
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