Cervical manipulation and mobilisation produced similar changes. Either may provide immediate- or short-term change; no long-term data are available. Thoracic manipulation may improve pain and function. Optimal techniques and dose are unresolved. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Active or passive treatment for neck-shoulder pain in occupational health care? A randomized controlled trial.
To compare the effectiveness of thoracic manipulations with instructions for physiotherapeutic exercises for the treatment of neck pain in occupational health care.
                Seventy-five subjects aged 30-55 years from a random sample of 241 employees of the Finnish Broadcasting Company were randomly allocated to treatment in the form of four thoracic manipulations (n = 43), or instructions for physiotherapeutic exercises (n = 32). The subjects reported neck-shoulder pain on a structured pain questionnaire using a visual analogue scale (VAS, 0-10). Muscle tenderness and tender thoracic levels were evaluated by a blinded investigator (A.S.) at 6- and 12 month follow-ups.
                A statistically significant difference was found in self-reported worst pain by VAS at the 12 month follow-up in favour of the thoracic manipulation group.
                The natural course of the neck-shoulder pain in this study appears benign; pain was also reduced in the drop-out group. Both treatments were found effective at the 12 month follow-up. The effect of four manipulations was more favourable than the personal exercise program in treating the more intense phase of pain.