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.
Manipulation for chronic neck pain. A double-blind controlled study.
Twenty-one with symptomatic cervical spondylosis or nonspecific neck pain were given an amnesic dose of diazepam before manipulation of the cervical spine. Eighteen patients served as controls and also received diazepam but no manipulation. Results were obtained in a randomized, double-blind fashion. Statements of outcome by patients and mean visual analog scales for pain and activity showed no significant differences between manipulation and control groups, though both tests favored manipulation. Control subjects subsequently treated by manipulation showed no consistent favorable response. Questionnaires dealing with personality, life events, social and medical histories, etc., provided no correlations with outcome, nor did radiographic findings. Diffuse local tenderness correlated with high pain scores after treatment. The authors conclude that the value of a single manipulation of the cervical spine has not been established and that further exploration of indications is needed. The use of intravenous diazepam should be considered because it allows a double-blind experimental design.