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Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2014 (Jan);   37 (1):   42–63

Roland Bryans, DC, Philip Decina, DC, Martin Descarreaux, DC, PhD, Mireille Duranleau, DC, Henri Marcoux, DC, Brock Potter, BSc, DC, Richard P. Ruegg, PhD, DCs, Lynn Shaw, PhD, OT, Robert Watkin, BA, LLB, Eleanor White, MSc, DC

Guidelines Development Committee (GDC) Chairman; Chiropractor, Clarenville, Newfoundland, Canada.


OBJECTIVE:   The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults.

METHODS:   Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations.

RESULTS:   Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain.

CONCLUSIONS:   Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.


Thanks to Dynamic Chiropractic for these comments from their article:
The Science of Treating Neck Pain

Following a literature search of controlled clinical trials through December 2011, 560 studies were narrowed to 41 that met the authors’ inclusion criteria and served as the basis for their treatment recommendations, graded as strong, moderate or weak based on the number, quality and consistency of research results.

Treatment strategies given strong recommendations for chronic neck pain included manipulation, manual therapy and exercise in combination with other modalities; as well as stretching, strengthening and endurance exercises alone.

Mobilization, as well as massage in combination with other therapies, received moderate recommendations for chronic neck pain.

Manipulation and mobilization in combination with other modalities received moderate recommendations for treating acute neck pain.

Here are the recommendations:


Acute Neck Pain


  • Manipulation / Multimodal:   “Spinal manipulative therapy is recommended for the treatment of acute neck pain for both short- and long-term benefit (pain and the number of days to recover) when used in combination with other treatment modalities (advice, exercise, and mobilization;
    (grade of recommendation – moderate).”

  • Mobilization/ Multimodal:   “Mobilization is recommended for the treatment of acute neck pain for short-term (up to 12 weeks) and long-term benefit (days to recovery, pain) in combination with advice and exercise
    (grade of recommendation – moderate).”

  • Exercise:   “Home exercise with advice or training is recommended in the treatment of acute neck pain for both long- and short-term benefits
    (neck pain; grade of recommendation – weak).”


Chronic Neck Pain

  • Manipulation / Multimodal:   “Spinal manipulative therapy is recommended in the treatment of chronic neck pain as part of a multimodal approach (including advice, upper thoracic high-velocity low-amplitude thrust, low-level laser therapy, soft-tissue therapy, mobilizations, pulsed short-wave diathermy, exercise, massage, and stretching) for both short- and long-term benefit
    (pain, disability, cROMs; grade of recommendation – strong).”

  • Manual Therapy / Multimodal:   “Manual therapy is recommended in the treatment of chronic neck pain for the short- and long-term benefit (pain, disability, cROM, strength) in combination with advice, stretching, and exercise
    (grade of recommendation – strong).”

  • Exercise:   “Regular home stretching (3-5 times per week) with advice / training is recommended in the treatment of chronic neck pain for long- and short-term benefits in reducing pain and analgesic intake
    (grade of recommendation – strong).”

  • Exercise / Multimodal:   “Exercise (including stretching, isometric, stabilization, and strengthening) is recommended for short- and long-term benefits (pain, disability, muscle strength, QoL, cROM) as part of a multimodal approach to the treatment of chronic neck pain when combined with infrared radiation, massage, or other physical therapies
    (grade of recommendation – strong).”

  • Mobilization:   “Mobilization is recommended for the treatment of chronic neck pain for short-term (immediate) benefit
    (pain, cROM; grade of recommendation – moderate)”

  • Massage / Multimodal:   “Massage is recommended for the treatment of chronic neck pain for short-term (up to 1 month) benefit (pain, disability, and cROM) when provided in combination with self-care, stretching, and/or exercise (grade of recommendation – moderate).”

  • Manipulation:   “Spinal manipulative therapy is recommended in the treatment of chronic neck pain for short- and long-term benefit
    (pain, disability; grade of recommendation – weak).”


In their conclusion, the authors note that their findings suggest “interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain” and that “increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”


There are more articles like this @ our:

Clinical Model for the Diagnosis and Management Page and the:

Chronic Neck Pain and Chiropractic Page

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