Neck Pain Patient Decision Aid: Step 2

This page is part of the 'Should I receive manual therapy and exercise for my neck pain?: A patient decision aid' resource for patients. Please see the main project page for further information, or proceed to Step 1 below to describe your neck pain.


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Neck pain alone for less than 6 weeks[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research. Neck pain with headache for less than 6 weeks Neck pain with headache for less than 6 weeks

Neck pain with headache for less than 6 weeks[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research.

Neck pain after whiplash injury for less than 6 weeks[edit | edit source]

Neck mobilizations and range of motion exercises performed frequently within your limits of pain provide greater pain relief in the short-term when compared to using analgesic medication and collar.[1][2]

Outcome Follow-up Number of people experiencing greater change with manual therapy and exercise in comparison to analgesic medication and collar treatment Average difference in improvement between groups
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Neck pain alone for more than 12 weeks[edit | edit source]

Neck exercises plus mobilization with or without manipulations or massage can help you in the short- and long-term. Moderate to high quality evidence suggests:

  • Greater short-term pain relief than exercise alone, but no long-term difference in pain, function, or quality of life (QoL)[3][4][5].
    • Greater short- and long-term improvements in pain and quality of life with manual therapy and exercise in comparison to manual therapy alone[3][6]
  • Greater long-term improvements in pain and function in comparison to advice[7]
  • Similar benefit to advice and care from your doctor a year after the pain is started[4][8]
  • Manipulation and mobilization appear to have similar effects for improving pain and function in the intermediate-term[9]

Exercise alone is also effective in the short- and long-term

  • Neck and upper back range of motion and low-load strengthening exercises provide reductions in pain, improvements in function, and patient satisfaction. There is no difference in global perceived effect or quality of life[3][10][11][12]


Upper extremity stretching, strengthening and endurance training do not provide any additional benefit to normal activities in terms of neck pain and function[13]

    • Qigong exercises are more effective than being on a wait-list for that treatment[14][15]


Neck pain with headache for more than 12 weeks[edit | edit source]

Manual therapy and exercise provide greater short and long-term improvements in pain and function compared to no treatment[16]


Exercise also provides greater short and long-term improvements in pain and function compared to no treatment[17]


Neck pain after whiplash injury for more than 12 weeks[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research.


Neck pain with pain numbness and tingling down your arm[edit | edit source]

There is low quality evidence available. Definitive recommendations cannot be made from this research.

  1. ↑ Giebel GD, Edelmann M, Huser R. Diedistorsionderhalswirbelsaule: Fruhfunk-tionalle vs.ruhigstellendebehandlung. Zentralbibliotak Chiropractic 1997;122:517-21.
  2. ↑ Mealy K, Brennan H, Fenelon GC. Early mobilisation of acute whiplash injuries. Br Med J 1986;92:656-7.
  3. ↑ 3.0 3.1 3.2 Bronfort G, Evan R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001;26(7):788-99.
  4. ↑ 4.0 4.1 Hoving JL, Koes BW, deVet HCW,vanderWindt DAWM, Assendelft WJJ, van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized controlled trial. Ann Int Med 2002;136:713-22.
  5. ↑ Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2001;27(17):1835-43.
  6. ↑ Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-7.
  7. ↑ Ylinen J, Takala EP, Nykanen M, Hakkinen A, Malkia E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women. JAMA 2003;289(19):2509-16.
  8. ↑ Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine 2008;33(22):2371-8.
  9. ↑ Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Research and Practice 2002;92(10):1634-41.
  10. ↑ Chiu TTW, Hui-chan CWY, Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil 2005;19:850-60.
  11. ↑ Franca DLM., Senna-Fernades V., Martins Cortez C., Jackson MN., Bernardo-Filho M., and Guimaraes MAM. Tension neck syndrome treated by acupuncture combined with physiotherapy: A comparative clinical trial (pilot study).. Complementary Therapies in Medicine 2008;16:268-277.
  12. ↑ Martel J., Dugas C., Dubois JD., Descarreaux M.. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain. BMC Musculoskeletal Disorders 2011;12:41-54.
  13. ↑ Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomized controlled trial. BMJ. 2003;327:475-479.
  14. ↑ von Trott P., Wiedemann A, Ludtke R., reibhauer A., Willich ST., and Witt CM.. Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): A randomized controlled study. J Pain 2009;10(5):501-508.
  15. ↑ Rendant D, Pach D, Ludtke R, Reishauer A, Mietzner A, Willich SN, Witt CM. Qigong versus exercise versus no therapy for patients with chronic neck pain. Spine 2011;36(6):419-29.
  16. ↑ Jull 2001
  17. ↑ Jull 2001



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