Assessment of long-term effects of adding osteopathic manipulative treatment to neck exercise

The upshot

Does adding osteopathic manipulative treatment (OMT) to neck exercises provide better long-term pain relief and function than exercises alone for chronic neck pain?

Adding OMT to a 4-week neck exercise program did not produce better pain or disability outcomes than exercises alone at 3 or 6 months. Both groups improved significantly from baseline, but there was no meaningful difference between them at either follow-up point.

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Primary study90 ParticipantsModerate evidence

Key points

OMT plus exercises was no better than exercises alone for pain at 3 months (P = .1) or 6 months (P = .4)
OMT plus exercises was no better than exercises alone for disability at 3 months (P = .2) or 6 months (P = .9)
Both groups showed clinically meaningful within-group reductions in pain (NPRS reduced by about 2 points) and disability (NDI reduced by about 8 points) at 6 months
No significant between-group differences were found for any secondary outcome (range of motion, pressure pain threshold, fear-avoidance beliefs, pain self-efficacy)
Treatment adherence was higher in the OMT group (71%) than the exercise-only group (51%), possibly reflecting the motivating effect of patient-provider contact

How it was conducted

Design: Randomized controlled trial, dual-blind (blinded assessors, unblinded treating therapists), intention-to-treat analysis
Participants: 90 adults aged 18-65 with non-specific chronic neck pain for at least 3 months, NPRS score of 2 or more, and NDI score of 10 or more
Groups: Exercise group (EG, n = 45): supervised neck stretching and strengthening once per week plus home exercise for 4 weeks; OMT plus exercise group (OMT/EG, n = 45): same exercise program plus full-body osteopathic treatment once per week for 4 weeks
Primary outcomes: Pain intensity (NPRS 0-10) and disability (Neck Disability Index 0-50)
Secondary outcomes: Cervical rotation range of motion, pressure pain threshold, Fear-Avoidance Beliefs Questionnaire, Pain Self-Efficacy Questionnaire
Follow-up: 3 months and 6 months after treatment completion; 72% completed 3-month follow-up, 61% completed 6-month follow-up

What they found

Pain (NPRS): no significant between-group difference at 3 months (mean difference -0.9, 95% CI -2.0 to 0.1, P = .1) or at 6 months (mean difference 0.6, 95% CI -0.8 to 1.9, P = .4)
Disability (NDI): no significant between-group difference at 3 months (mean difference -2.2, 95% CI -6.2 to 1.5, P = .2) or at 6 months (mean difference 0.1, 95% CI -4.0 to 2.2, P = .9)
Within-group pain reduction (NPRS baseline to 6 months): OMT/EG reduced by 2.1 points (95% CI 1.1-3.1, P < .001); EG reduced by 2.5 points (95% CI 1.5-3.4, P < .001)
Within-group disability reduction (NDI baseline to 6 months): OMT/EG reduced by 7.9 points (95% CI 5.3-10.5, P < .001); EG reduced by 8.0 points (95% CI 4.5-11.5, P < .001)
Pressure pain threshold: no significant between-group difference at 3 months (P = .8) or 6 months (P = .6)
Fear-avoidance beliefs (work and physical activity) and pain self-efficacy: no significant between-group differences at 3 or 6 months (all P > .05)
Treatment adherence: 71% in OMT/EG vs 51% in EG

Limitations

High dropout rate (38% overall did not complete treatment; only 61% completed 6-month follow-up), which may have introduced unmeasured bias despite intention-to-treat analysis
No sham treatment control group, so benefits in the exercise-only arm cannot be distinguished from placebo or natural history effects
Physical activity outside the protocol was not monitored during the 6-month follow-up, potentially diluting group differences
A 4-week treatment course may have been insufficient to detect long-term differences; the optimal OMT dose and frequency remain unknown

Why it matters

For patients: People with chronic neck pain can expect meaningful improvement in pain and disability from a structured neck exercise program, but adding osteopathic manipulative treatment to that program is unlikely to produce additional long-term benefit.
For clinicians: This trial does not support routinely combining OMT with exercise over exercises alone for long-term outcomes in non-specific chronic neck pain, though short-term advantages of OMT seen in prior work may still guide early management decisions.
For readers: Exercise appears to be the active ingredient for sustained neck pain improvement; whether the hands-on component of OMT adds durable value beyond its motivational or short-term analgesic effects remains an open question.

Source

doi:10.1016/j.jcm.2023.10.003

Read the original paper

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