Manual therapy and neck-specific exercise are equally effective for treating non-specific neck pain

Key points

1. 01No differences between groups were found on any individual outcome measure (pain, disability, quality of life, kinesiophobia, CCFT) at any time point.
2. 02Patients in the manual therapy group were more likely to be classified as responders than those in the exercise group at all follow-up time points when the full sample was analysed.
3. 03When the analysis was restricted to exercise participants with adherence of 95% or higher, the between-group difference in responder rates disappeared.
4. 04Treatment outcome in the exercise group was directly associated with exercise adherence, making adherence a critical moderator of effectiveness.
5. 05Four weeks of either intervention (one session per week) produced meaningful improvement in chronic non-specific neck pain.

How it was conducted

Design

Single-blind parallel randomised controlled trial (ACTRN12620000711910), reported per CONSORT guidelines

Participants

65 adults with chronic non-specific neck pain, randomly allocated 1:1 to two groups

Manual therapy group

Four 30-minute manual therapy sessions, once per week for four weeks

Exercise group

Four-week neck-specific exercise programme with physiotherapist-led sessions and daily home exercises

Outcomes

Pain intensity, disability (NDI), patient-perceived improvement (PGIC), quality of life, kinesiophobia, and craniocervical flexion test performance

Follow-up

Baseline, 2 weeks, 4 weeks, and 12 weeks post-treatment

What they found

• No statistically significant between-group differences were found on any individual continuous outcome measure (pain intensity, disability, quality of life, kinesiophobia, CCFT) at any measured time point.
• Patients in the manual therapy group were more likely to be classified as responders than those in the exercise group at all measured time points in the intention-to-treat analysis.
• Mean exercise adherence in the exercise group was 95% (SD 8.2).
• When only participants with exercise adherence of 95% or greater were analysed, between-group differences in responder classification were no longer present.
• Treatment outcome in the exercise group was associated with exercise adherence level.

Limitations

• Sample size of 65 is smaller than the originally planned 80 participants, partly due to COVID-19 pandemic restrictions reducing patient access, which may limit statistical power.
• Single-blind design means treating clinicians were not blinded, and complete blinding of participants is not possible for this type of intervention comparison.
• The exercise adherence threshold of 95% that equalised outcomes is very high, and achieving this level in routine clinical practice may be challenging.
• The trial was conducted at a single centre, which may limit generalisability to other settings or populations.

Why it matters

For patients

If you commit fully to a home exercise programme for neck pain, you can expect results similar to hands-on manual therapy treatment.

For clinicians

Exercise is as effective as manual therapy for chronic non-specific neck pain, but only when patients complete at least 95% of prescribed home exercises; strategies to maximise adherence are essential.

For readers

This trial highlights exercise adherence as a key moderator of outcomes, suggesting that comparisons of exercise and manual therapy that do not account for adherence may underestimate the true potential of exercise.