Effectiveness of Musculoskeletal Manipulations in Patients with Neck Pain

Using two or more manual therapy techniques improves neck pain and should be combined with exercise and education.

Context

  • This study aimed to rank manual therapy interventions for adults with neck pain.
  • It was based on their ability to reduce pain intensity, improve disability and increase cervical range of motion (ROM).

Methods

Search Strategy: 101 RCTs were selected from eight major databases (including PubMed, Cochrane and Embase) published from January 2013 to May 2025.

Participants: 7633 Adults with neck pain were included.

Interventions: Seven categories of intervention were analysed:

  • Manipulation
  • Manual therapy
  • Soft tissue techniques
  • Mobilisation
  • Multimodal treatment (combining two or more manipulations)
  • Active control (education/exercise)
  • No treatment

Note: definitions of each intervention are provided within the study itself.

Outcomes:

  • Primary: Neck pain intensity (VAS or NPRS).
  • Secondary: Neck Disability Index (NDI), Cervical ROM and any adverse events.

Results

  • Multimodal treatment (combining techniques) was the most effective intervention for reducing neck pain intensity and disability scores.
  • Exercise and education, manual therapy and soft tissue techniques showed significant pain reduction compared to no treatment.
  • Manipulation was the most effective intervention for improving Cervical ROM in the short term.
  • No serious adverse events were reported across the included studies.

Reference

Gong Z, et al. (2025) Effectiveness of musculoskeletal manipulations in patients with neck pain: a systematic review and network meta-analysis. British Medical Journal Open; 15: e098682. doi: 10.1136/bmjopen-2024-098682

27 April 2026

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