From the Guidelines
Cervical spinal manipulation (CSM) may be beneficial for patients with acute neck pain, providing short-term relief and improvement in range of motion, as supported by studies such as 1 and 1. However, due to potential risks, it should only be performed by a licensed and experienced practitioner. Patients with certain medical conditions, such as osteoporosis, rheumatoid arthritis, or a history of stroke, should exercise caution and consult their primary care physician before undergoing CSM.
Key Considerations
- Typically, a course of 6-12 sessions, 1-2 times per week, may be recommended, with ongoing evaluation to assess effectiveness and safety, as suggested by 1 and 1.
- Patients may be advised to combine CSM with other therapies, such as exercise and heat or cold therapy, to enhance benefits and minimize risks, as noted in 1 and 1.
- Medications like acetaminophen or ibuprofen may be used to manage pain and inflammation, with typical doses ranging from 500-1000mg every 4-6 hours for acetaminophen and 200-400mg every 4-6 hours for ibuprofen.
Important Notes
- The evidence for CSM is generally consistent across studies, with some variation in the magnitude of effects, as seen in 1.
- While CSM may be beneficial for some patients, it is essential to weigh the potential benefits against the potential risks and to carefully select patients who are likely to benefit from this treatment, as emphasized in 1.
From the Research
Benefits of Cervical Spinal Manipulation (CSM)
- Cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain, compared to oral analgesics 2
- CSM may provide short-term benefits for some patients with neck pain and headaches, with an estimated complication rate of 5-10 per 10 million manipulations 3
- A single session of cervical manipulation can induce self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain 4
- Cervical SMT was found to be more effective than recommended interventions for improving pain at short-term and long-term, and for reducing disability at short-term and long-term, with very low to low certainty evidence 5
- Manipulation was found to be more effective than mobilization in decreasing pain in patients with mechanical neck pain, with a single manipulation resulting in a greater decrease in pain intensity compared to mobilization 6
Effects on Pain and Range of Motion
- CSM was found to provide short-term relief for patients with tension-type headache, and to improve pain and range of motion in patients with neck pain 3
- A single session of cervical manipulation was found to increase range of motion in the neck, although the effect was not significant for most biomechanical variables 4
- Both manipulation and mobilization were found to increase range of motion in the neck, although manipulation had a significantly greater effect on pain intensity 6
Safety and Adverse Events
- Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy 2
- Serious adverse events, such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury, are rare but can cause significant disability or death 2
- The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations 3
- Transient side effects, such as muscle soreness, were found to be associated with cervical SMT, but no serious adverse events were reported 5