NEW YORK (Reuters Health) - For some nagging neck pain, so-called manual therapy may be more effective than exercise, painkillers and other standard treatments, new study findings suggest.

This "hands-on" technique, in which the neck is manipulated to improve mobility, worked better than exercise therapy or routine care from a doctor for patients with neck pain due to muscle or joint strain.

Researchers led by Dr. Jan Lucas Hoving of Monash University in Victoria, Australia, report the findings in the May 21st issue of the Annals of Internal Medicine.

Manual therapy is commonly used by chiropractors, physical therapists, massage therapists and doctors known as osteopaths. Unlike exercise therapy, in which patients perform a given activity, manual therapy demands that the patient be "passive" as the therapist moves the neck.

In this study, the researchers used specific "mobilization" techniques--which refers to moving the joint within a patient's range of motion, using slowly applied pressure.

They assigned 183 patients to have either manual therapy, exercise therapy or to continue routine care from their doctors--including advice on home exercises and prescriptions for pain medication--over 6 weeks. All patients were allowed to continue on any pain medication they had been taking.

At the end of the study, about 68% of manual-therapy patients said they were "completely recovered" or "much improved," according to the report. That compared with 51% of those on exercise therapy and 36% of patients continuing their usual care.

"Manual therapy seems to be a favourable treatment option for patients with neck pain," Hoving's team concludes.

However, the study has "drawbacks" that make applying the findings "difficult," Drs. Joel Posner and Catherine Glew of MCP Hahnemann University in Philadelphia, Pennsylvania, write in an accompanying editorial.

For one, it relied on patients' subjective perceptions of their recovery. In addition, the editorialists assert, because the study authors are "advocates of manual therapy," the role of "therapeutic enthusiasm should not be underestimated."

But, Posner and Glew add, if the manual therapy in this study was indeed more effective, more research should look into which specific aspects worked.

In addition to mobilization techniques like that in the study, manual therapy can involve so-called manipulation--in which "high-velocity thrusts" are used to push the joint beyond the range patients can manage on their own.

One recent study in Canada suggested that chiropractic neck manipulation can potentially cause tears in the inside wall of neck arteries that often lead to stroke. The American Chiropractic Association refuted that link, saying the study failed to demonstrate neck manipulation as the cause of stroke among the 38 patients.

SOURCE: Annals of Internal Medicine 2002;136:713-722, 758-759.

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