Cervical Manipulation vs Mobilization Round 2! | Modern Manual Therapy Blog

Cervical Manipulation vs Mobilization Round 2!


JOSPT made a pamphlet for patients which we'll be putting in our waiting room. The study's results mirrors other similar research presented last year. Cervical and upper thoracic thrust manipulation improves pain and ROM in patients with cervical pain within the first 48 hours better than mobilization or non-thrust techniques do. I don't have the article yet, but I'm sure if further studied, it would also show in the long term, that there were no significant differences in the approach. This is great for those clinicians who are not proficient or unwilling to perform thrust manipulation. However, the advantages are clear, especially in the acute stages

  • thrust manipulation is a fast and effective treatment
  • it is statistically safe (spontaneous death from exercise is more common)
  • the acute patients are what we want, but typically don't get because they slip through the system, getting ineffective medications
  • acute uncomplicated neck (and back) pain are usually 2-6 visit cases
  • make them better, and your referrals increase due to a happy patient!

via Annals of Internal Medicine as posted by @SigMik

This study looked at SMT vs Meds vs HEP/advice

  • SMT was more effective for pain reduction than Meds at short, intermediate, and long term follow ups
  • it was not significantly different than HEP and advice
  • the HEP consisted of generalized mobility exercises/stretches for the cervical and scapulothoracic areas, and was based on Treat Your Own Neck 
    • There didn't seem to be a directional preference, but that may have been moot as the participants read the MDT text anyway
  • the only difference was that SMT patients were more satisfied with their treatment (that matters to me as a private practice owner)
Combine the results of both of these studies
  • for acute patients, SMT works faster than mobilization within the first 48 hours
    • that is a time frame a patient is coming to you looking for you to make fast improvements!
  • using MDT, we would educate the patient on directional preference and choose 1 exercise like cervical retraction, or retraction with extension to be performed repeatedly throughout the day
  • using the best of MDT and OMPT, you get the perfect combination of rapid change plus the repeated motion and prevention strategies for the HEP
  • educate patients that if their Sx return, make sure they are performing all their HEP as instructed (lumbar roll, cervical retraction, etc), if it doesn't change within 1-2 days, call ASAP!
I know the purist MDT practitioners out there would argue that you don't need the mobs or thrust manipulation at all, but that is also entirely dependent on getting the patient to end range. Different strokes for different folks, some are very adverse to being touched, others only "believe" in hands on. I choose based on my evaluation and how the patient presents physically and mentally. 


  1. E.,
    Good summary on both of these articles! I do like your last comment about how the patient presents both mentally and physically. I plan to write a post on my thoughts on this soon. Being able to address this component as a physical therapist is what puts the art in the science.

  2. Dr. Erson Religioso IIIJanuary 9, 2012 at 10:53 AM

    Thanks Harrison! Looking forward to your take on the research.

  3. Favorite quote "I know the purist MDT practitioners out there would argue that you don't need the mobs or thrust manipulation at all, but that is also entirely dependent on getting the patient to end range."

    Post immobilization for cervical fractures, I greatly appreciated the hands on techniques my therapist used to get me to end range. It was the mobilization and hands on PNF that allowed me to get past what I could do on my own. Prior to those manual techniques I couldn't break past my sticking point.

    I love MDT, but don't think I'll ever be a "purist" at least when it comes to treating the c-spine because of my personal experience trying to reach end range on my own and just not getting there.

    Thanks for sharing!