Neck Pain

There is moderate evidence that spinal manipulative the
rapy/mobilization are superior to general practitioner management for short-term pain reduction. Mobilization and/or manipulation, when used with exercise, is beneficial for persistent mechanical neck disorders with or without headache. Furthermore, specific strengthening exercises are very benefician for mechanical neck disorders. There is a large volume of moderate evidence to suggest that manual therapy is more cost effective when compared with traditional education and medication. Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches.

Over the past decade a large volume of moderate evidence has been compiled to suggest that manual therapy is more cost effective when compared with traditional education and medication for mechanical neck pain. Evidence suggests that chiropractic care, including spinal manipulation, improves migraine as well as acute and chronic cervicogenic headaches.

ESSENTIAL LITERATURE

EXERCISES FOR MECHANICAL NECK DISORDERS: A COCHRANE REVIEW UPDATE.
Gross et. al. 2016
Conclusion:
Specific strengthening exercises of the neck, scapulothoracic and shoulder for chronic NP and chronic CGH are beneficial. Future research should explore optimal dosage.

MANAGEMENT OF NECK PAIN AND ASSOCIATED DISORDERS: A CLINICAL PRACTICE GUIDELINE
Cote et. al. 2016
Conclusion:
Clinicians should rule out major structural or other pathologies as the cause of NAD. In the absence of major structural or other pathologies, clinicians should classify NAD as grades I, II, or III and determine the presence of prognostic factors for delayed recovery. The management of all patients should include education, advice, encouragement to stay active (including return to work where appropriate), and reassurance that NAD is typically of a time-limited nature. In the context of shared decision-making, clinicians should discuss with the patient the range of effective interventions available for the management of NAD. Supplementing self-management strategies with clinical care may be indicated provided the intervention is likely to enable recovery through symptom relief and improvement in function. For such interventions, there is no evidence that effectiveness can be increased through more frequent attendance or prolonged course of treatment 

MANIPULATION AND MOBILISATION FOR NECK PAIN CONTRASTED AGAINST AN INACTIVE CONTROL OR ANOTHER ACTIVE TREATMENT
Gross A et. al. 2015
Conclusion:
Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

EVIDENCE-BASED GUIDELINES FOR THE CHIROPRACTIC TREATMENT OF ADULTS WITH NECK PAIN
Bryans R et. al. 2014
Conclusion:
The studies included in this guideline indicate that cervical manipulation, mobilization, manual therapy, exercise, and massage can be recommended for the chiropractic treatment of nonspecific, mechanical neck pain. The strongest recommendations are typically made for the primary intervention in combination with another intervention, usually exercise and/or patient education. 

CLINICAL EFFECTIVENESS OF MANUAL THERAPY FOR MANAGEMENT OF MUSCULOSKELETAL CONDITIONS
 Christine Clar et. al. 2014 
Conclusion:
The evidence suggests there are similar improvements in the manipulation and/or mobilisation intervention groups compared to active treatment, however, some trials also found no improvement in comparison to a control group

CHIROPRACTIC USE IN THE MEDICARE POPULATION: 1-YEAR CHANGES IN HEALTH AND SATISFACTION WITH CARE
Weigel et.al. 2014
Conclusion:
This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

COST-EFFECTIVENESS OF MANUAL THERAPY FOR MUSCULOSKELETAL CONDITIONS
Tsertvadze et. al. 2014
Conclusion:
Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care

THE RELATIVE EFFECTIVENESS OF SEGMENT SPECIFIC LEVEL AND NON-SPECIFIC LEVEL SPINAL JOINT MOBILIZATION
Slaven et. al. 2013
Conclusion:
This systematic review supports the argument that joint mobilization to the spine does lead to an immediate effect on pain at rest and pain with the most painful movement. A meta-analysis of a subset of these studies did identify that the effect of mobilization relating to a specific level or non-specific level was different based on the region of the spine being treated; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization, indicating body location modified the relationship between specific versus non-specific mobilization with pain at rest. 

THE OUTCOMES OF MANIPULATION OR MOBILIZATION THERAPY COMPARED WITH PHYSICAL THERAPY OR EXERCISE FOR NECK PAIN
Schroeder et. al. 2013
Conclusion:
The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain.

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SPINAL MANIPULATION, MEDICATION, OR HOME EXERCISE WITH ADVICE FOR ACUTE AND SUBACUTE NECK PAIN: A RANDOMIZED TRIAL
Bronfort, Gert; Evans 2012
Conclusion:
For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine, National Institutes of Health.

EVIDENCE-BASED GUIDELINES FOR THE CHIROPRACTIC TREATMENT OF ADULTS WITH HEADACHE
Bryans R et. al. 2011
Conclusion:
Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.