Manual but Not Instrument-Assisted Cervical Manipulation Reduces Pain and Disability in Subjects with Nonspecific Neck Pain: Double-Blinded, Randomized Clinical Trial

There is limited evidence comparing the effects of manual and instrumented-assisted manipulations among adults with neck pain. Our purpose was to determine the effects of a multisession regime of manual and instrument-assisted cervical manipulation on pain, disability, perception of change, and muscle properties in subjects with nonspecific neck pain. We conducted a double-blind, randomized, placebo-controlled study in 32 subjects with nonspecific neck pain. Two groups received three sessions of cervical (C3/C4) manipulation, one group manual and the other instrument-assisted, a third group received three sessions of sham manipulation, and a fourth group served as a control. Self-reported pain, pressure pain thresholds, neck disability, patient perception of change, and properties (tonus, stiffness, and elasticity) of the upper trapezius and biceps brachii were assessed at baseline, immediately after the first session and 15 days after the end of the intervention. After the end of the intervention, the percentage of changes in the visual analogue scale score, Neck Disability Index, and Patient Global Perception of Change score were significantly higher in the manual group in comparison with the other groups (p < 0.05). No between-group differences were observed in the percentage of changes in tonus, stiffness, and elasticity of the four muscles at the end of the intervention. We concluded that three sessions of C3/C4 manual manipulation improved pain and disability in subjects with nonspecific neck pain.