Reviewed by Mark Boyland PT, DPT, CSCS

This study sought to explore the effect times of manual therapy alone vs therapeutic exercise alone as well as to break down and compare the effects of these two interventions in the short and mid term.

The authors compared visual analog scale, pressure pain threshold, cervical disability through the Neck Disability Index Outcomes.  These values were assessed at evaluation, week 1, week 4, and week 12.

The participants were split into 1 of 3 intervention groups; Manual Therapy, Therapeutic Exercise, or Sham.  At the end of the trial the study was able to analyze date across 67 participants, 22 in the Manual Therapy Group, 23 in the Therapeutic Exercise Group, and 20 in the Sham treatment group. Demographic date was relatively similar between groups, however there were more female participants than males. 

The interventions were listed for each group.  The manual therapy group included frequency of interventions, grading of mobilizations/manipulations, speed of mobilization, duration of mobilization, and sets of mobilizations.  The therapeutic exercise group include progressions of exercises from week 1 and 2 and the exercises after week 2.  Exercise descriptions included patient position with equipment required, and duration/frequency of exercises.  The authors also provided a description for how the sham treatment was provided.  It is noted that the sham treatment group did receive either manual therapy or therapeutic exercise interventions only after completion of the study.  The study was conducted by researchers from the University of Seville, Seville, Spain and potential mistranslations may be present when reviewing the applied interventions.

The intervention groups had significant improvements in VAS at weeks 1,4, and 12.  Both intervention groups had significant changes for the NDI at weeks 1 and 4.  However, the manual therapy group was able to maintain these improvements into week 12 with no statistical difference and the therapeutic exercise group had a poorer score relative to the 4 week evaluation however the 12 week score was still lower than the patient’s initial score.  The pain pressure threshold was only reduced in the manual therapy group at 4 weeks, however at 12 weeks both intervention groups showed improvements.  The control group demonstrated no significant changes throughout the study.

In regards to selection of these interventions as stand alone treatments, therapeutic exercise may improve function more quickly whereas manual therapy may improve pain more quickly, both interventions can have similar results in the mid term.  The authors note that a larger sample size may refute their findings and that treatment of chronic non specific neck pain should include multiple interventions not limited to only manual therapy and therapeutic exercise but could also include patient education and pain science education.   The authors also note that there is no method that guarantees patients complete their home exercises.

For patients:  Physical therapy for non specific chronic neck pain can be treated with hands on and an exercise approach and there can be significant changes made within just 4 weeks that can last up to twelve weeks but there is some work on your part that has to be done as well in the short, mid, and long-term