Chinese manipulation for mechanical neck pain: a systematic review

Objective: To assess whether Chinese manipulation improves pain, function/disability and global perceived effect in adults with acute/subacute/chronic neck pain. Data sources: CAJ Full-text Database (Chinese), Wanfang Database (Chinese), Cochrane Database (English) and Medline (English). Review methods: Literature searching was performed with the following keywords and their combination: 'manual therapy/bone setting/Chinese manipulation', 'neck/cervical pain', 'cervical vertebrae', 'cervical spondylosis/radiculopathy' and 'randomized controlled trial/review.' Two independent reviewers selected studies, extracted data and assessed risk of bias for each included study. Randomized controlled trials or quasi-randomized controlled trials on the effect of Chinese manipulation in treating adult patients with neck pain were selected. Mean differences with 95% confidence intervals (CI) were calculated. Quality of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: Four studies (610 participants) were included in this review. There was very low-quality evidence suggesting that, compared to cervical traction in sitting, Chinese manipulation produced more immediate post-intervention pain relief (mean difference: -1.06; 95% CI: -1.37 similar to -0.75; P < 0.001) and improvement of global signs and symptoms (mean difference: -3.81; 95% CI: -4.71 similar to -2.91; P < 0.001). Very low-quality evidence showed that Chinese manipulation alone was superior to Chinese traditional massage in immediate post-intervention pain relief (mean difference: -2.02; 95% CI: -2.78 similar to -1.26; P < 0.001). Conclusions: There was limited evidence showing Chinese manipulation could produce short-term improvement for neck pain.