Manual Therapy for Persistent, Non-Cancer Back and Neck Pain: A Review of Clinical Effectiveness

Key Message

Four systematic reviews with meta-analyses (that included 27 unique relevant primary studies) were identified regarding the clinical effectiveness of manual therapy for adults with chronic non-cancer back and neck pain.

The systematic reviews were largely well-conducted (despite the methodological limitations of their included primary studies), and all evaluated the clinical effectiveness of various manual therapies compared with sham interventions (i.e., placebo) or no treatment. The effectiveness of manual therapy for chronic non-cancer back and neck pain was unclear due to variation in findings, significant clinical heterogeneity (e.g., differences in type of manual therapy, frequency and duration of treatments, length of follow-up), and concerns with the methodological quality of relevant primary studies. In most cases, treatment with manual therapy did not result in statistically significant differences when compared to sham therapy or no treatment in adults with persistent or chronic non-cancer back and neck pain; however, there was some evidence that suggested treatment with manual therapies improved pain, functional status, and health-related quality of life. Overall, manual therapies and their comparators (sham treatment or no treatment) were well-tolerated but were associated with mild transient adverse events such as discomfort and tiredness.

No evidence was identified regarding the comparative clinical effectiveness of manual therapies versus pharmacological interventions for adults with chronic non-cancer back and neck pain. The limitations of the included literature (e.g., high risk of performance bias due to a lack of blinding, lack of long-term follow-up data, substantial heterogeneity) should be considered when interpreting the findings of this report.