Short-term effects of manipulative treatment versus a therapeutic home exercise protocol for chronic cervical pain: a randomized clinical trial

Background: While both manipulative treatment and physical exercises are used to treat cervical pain, it remains unclear which is most effective. Objective: To compare the short-term effects of high-velocity, low-amplitude manipulation techniques (MT) with those of home-exercise (HE) with stretching and low-intensity (10% of max) isometric contractions on pain and function. Methods: Single-blind randomized clinical trial was performed. A total of 27 asymptomatic subjects were randomly assigned to 2 groups: manipulation techniques (MT, n= 13) and home exercise (HE, n= 14). The visual analogue scale (VAS); neck disability index (NDI); pressure pain thresholds; cervical spine range of motion and electromyography during the cranio-cervical flexion test was measured before and one week after the intervention. Results: After the intervention, both groups showed improved (P< 0.05) NDI and VAS scores and flexion in both rotation ranges compared with the pre-intervention values. For the NDI, pain intensity, and neck flexion, the effects sizes were large; for the majority of the other measurements, the effect sizes were small to moderate. The MT group showed significantly better results than the HE group for 2 out of 17 tests. Conclusions: Both interventions improved function and pain after one week, with only marginal between-group differences in favor of MT.