February 2023

Manual but Not Instrument-Assisted Cervical Manipulation Reduces Pain and Disability in Subjects with Nonspecific Neck Pain: Double-Blinded, Randomized Clinical Trial

Authors: Nuno Nogueira 1, Natalia Oliveira-Campelo 2, Rui Torres 2, Andreia S. P. Sousa 2, Fernando Ribeiro 3


  1. Vale do Sousa Higher School of Health, Polytechnic Health School of the North, CESPU, 4585-116 Gandra, PRD, Portugal
  2. Physiotherapy Department, School of Heath, Polytechnic Institute of Porto, Center for Rehabilitation Research- Center of Human Studies and Human Activity, 4200-072 Porto, Portugal
  3. Institute of Biomedicine – iBiMED and School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal

Journal: Applied Sciences - February 2023, Volume 13, Issue 5, Article no. 2770 (DOI: 10.3390/app13052770)

There is limited evidence comparing the effects of manual and instrumented-assisted manipulations among adults with neck pain. Our purpose was to determine the effects of a multisession regime of manual and instrument-assisted cervical manipulation on pain, disability, perception of change, and muscle properties in subjects with nonspecific neck pain.

We conducted a double-blind, randomized, placebo-controlled study in 32 subjects with nonspecific neck pain. Two groups received three sessions of cervical (C3/C4) manipulation, one group manual and the other instrument-assisted, a third group received three sessions of sham manipulation, and a fourth group served as a control. Self-reported pain, pressure pain thresholds, neck disability, patient perception of change, and properties (tonus, stiffness, and elasticity) of the upper trapezius and biceps brachii were assessed at baseline, immediately after the first session and 15 days after the end of the intervention.

After the end of the intervention, the percentage of changes in the visual analogue scale score, Neck Disability Index, and Patient Global Perception of Change score were significantly higher in the manual group in comparison with the other groups (p < 0.05). No between-group differences were observed in the percentage of changes in tonus, stiffness, and elasticity of the four muscles at the end of the intervention.

We concluded that three sessions of C3/C4 manual manipulation improved pain and disability in subjects with nonspecific neck pain.


Keywords: spinal thrust, perception of change, muscle parameters, neck pain

Three sessions of pre-selected C3/C4 manual manipulation improved pain and disability in young adults with nonspecific neck pain. We found no changes in tone, elasticity, or stiffness, so the changes in pain and disability were not related to changes in muscle mechanic parameters. The results of our study should be taken with caution until future studies with bigger sample sizes confirm these findings.