The effect of manual and instrument applied cervical spine manipulation on mechanical neck pain

This thesis investigated the effect of two different cervical manipulation techniques on mechanical neck pain (MNP) in adults. Results from studies investigating manually applied manipulation (MAM) and instrument applied manipulation (IAM) are often grouped together, with no clear indication from clinical practice guidelines if there is benefit of using one over the other. Sixty-five participants with MNP, between the ages of 18 and 35 years, were randomly allocated to one of three groups. Group 1: standardised active stretching (S); Group 2: ‘S’ plus a single MAM applied to the cervical spine; and Group 3: ‘S’ plus a single IAM applied to the cervical spine. Results indicate that MAM decreases subjective pain levels immediately and at 7 days while IAM does not. This suggests that the two techniques affect pain levels differently. Future research investigating the possibility of a threshold of force required to elicit beneficial changes and exploring other biomechanical factors such as pre- load force, acceleration and thrust amplitude will improve the efficiency of cervical manipulation.