Various complications have been reported, including instances of death and permanent disability. The incidence of complications is difficult to ascertain, but appears to be very low. The lack of data from RCTs on the benefit of manipulation for acute neck pain means that recommendations cannot be made. The limited literature available on mobilisation indicates that this may be beneficial for some patients with acute neck pain, at least when used in combination with other treatments. Manipulation, mobilisation or physiotherapy are probably all more effective than muscle relaxants or usual medical care in producing short term pain relief among people with subacute or chronic neck pain.
Manipulation is probably slightly more effective than mobilisation or physiotherapy.
The sparsity and poor quality of the data on the effects of manipulation or mobilisation for people with headaches prevent a firm conclusion from being reached. More high quality research is needed before definitive recommendations can be made regarding the use of manipulation or mobilisation for neck pain and headache. Because it is common in clinical practice to use manual therapies in conjunction with other treatments, factorial study designs should be seriously considered. The methods and findings of this systematic review have been clearly laid out, and the authors have provided useful guidance about factors to bear in mind when interpreting the data they present. Good quality research is needed to ascertain the effectiveness of cervical manipulation and mobilisation for people with neckache and headache.