Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial.
BACKGROUND
Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation.


METHODS
182 participants with acute and sub-acute neck pain will be recruited from physiotherapy, chiropractic and osteopathy practices in Sydney, Australia. Participants will be randomly allocated to treatment with either manipulation or mobilisation. Randomisation will occur after the treating practitioner decides that manipulation is an appropriate treatment for the individual participant. Both groups will receive at least 4 treatments over 2 weeks. The primary outcome is number of days taken to recover from the episode of neck pain. Cox regression will be used to compare survival curves for time to recovery for the manipulation and mobilisation treatment groups.


CONCLUSIONS
This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain.
Leaver
Andrew M
AM
Back Pain Research Group, Discipline of Physiotherapy, University of Sydney, PO Box 170 Lidcombe NSW 1825 Australia. A.Leaver@fhs.usyd.edu
Refshauge
Kathryn M
KM
Maher
Christopher G
CG
Latimer
Jane
J
Herbert
Rob D
RD
Jull
Gwendolen
G
McAuley
James H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D020526:Brain Stem Infarctions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D002574:Cervical Vertebrae / Q000503:physiopathology; D002985:Clinical Protocols / Q000592:standards; D004185:Disability Evaluation; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007407:Interviews as Topic; D020393:Manipulation, Spinal / Q000009:adverse effects / Q000706:statistics & numerical data*; D008405:Massage / Q000009:adverse effects / Q000592:standards / Q000639:trends; D008875:Middle Aged; D009334:Neck Muscles / Q000503:physiopathology; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D018579:Patient Selection; D016896:Treatment Outcome