Effectiveness of musculoskeletal manipulations in patients with neck pain: a systematic review and network meta-analysis.

Neck pain affects millions of people worldwide and is a leading cause of disability. Researchers conducted a comprehensive review of 101 studies involving 7,633 adults with neck pain to determine which hands-on treatments work best. The study examined various musculoskeletal manipulations—physical techniques performed by healthcare providers to treat pain and improve movement.

The researchers found that multimodal treatment, which combines two or more types of manual therapy techniques, was most effective for reducing both neck pain intensity and disability. Other beneficial treatments included manual therapy, soft tissue techniques, and mobilization. For improving neck flexibility and range of motion, spinal manipulation showed the best results.

It's important to note that this study specifically examined musculoskeletal manipulations such as chiropractic adjustments, physical therapy techniques, and manual therapy—not acupuncture. While acupuncture is also a hands-on treatment often used for neck pain, it works through different mechanisms involving needling specific points rather than joint or soft tissue manipulation.

For patients considering treatment for neck pain, this research suggests that approaches combining multiple manual techniques may provide the greatest relief. However, acupuncture remains a viable complementary option, particularly for those seeking non-manipulative treatments. Many patients benefit from integrative approaches that may include both manual therapies and acupuncture, depending on individual needs and preferences.

If you're considering acupuncture for neck pain, seek care from a licensed acupuncturist who can assess whether acupuncture alone or in combination with other therapies is appropriate for your condition.

This systematic review and network meta-analysis examined 101 RCTs (n=7,633) comparing musculoskeletal manipulations for neck pain. Primary outcome was pain intensity measured by VAS/NRS; secondary outcomes included neck disability index and cervical range of motion. Risk of bias was high in 61.3% of studies, with some concerns in 17.8% and low risk in 20.7%.

Multimodal treatment demonstrated superior efficacy for pain reduction (WMD: -36.65, 95% CI -61.02 to -12.28; SUCRA=100%) and disability improvement (SUCRA=96.3%) compared to no treatment, with moderate to very low certainty evidence. Manipulation showed greatest effectiveness for cervical flexion (SUCRA=81.3%) and extension (SUCRA=78.2%). Other effective interventions included manual therapy (WMD: -35.85), soft tissue techniques (WMD: -28.72), and mobilization (WMD: -20.23).

Clinical implications: This review did not evaluate acupuncture but provides context for multimodal care approaches. Practitioners may consider integrating acupuncture with manual therapies for comprehensive neck pain management.