A person with neck pain.

Manual Therapy for Neck Pain

Doctors of chiropractic often approach neck pain with manual therapy as the primary form of treatment. However, there are several types of manual therapy, including high velocity, low amplitude (HVLA) thrust manipulation; mobilization; and/or soft tissue techniques.

Is one type of manual therapy superior when it comes to managing neck pain? What does the research show?

A 2017 systematic review of 23 randomized controlled trials compared various manual therapy techniques on their own (or combined), with or without the addition of specific exercise recommendations.

For acute (recent onset) to sub-acute neck pain, the review concluded:
• High-velocity, low-amplitude thrust manipulation combined with exercise resulted in better outcomes when treatment was applied to the cervical vs. the thoracic spine.
• High-velocity, low-amplitude thrust manipulation combined with soft tissue techniques and exercise applied to both the neck and mid-back led to better outcomes than when soft tissue techniques plus exercise only targeted the neck.

For chronic neck pain, the data show:
• Both HVLA thrust manipulation and soft tissue techniques in addition to exercise are more effective than either manual therapy or exercise alone for improving pain and function.
• Thrust manipulation applied to the neck and mid-back was more effective for improving neck mobility than mobilization.
• Mobilization and soft tissue techniques are both more effective than no treatment for improving pain and disability.

This systematic review favors all types of manual therapies for the management of all stages of neck pain (acute, sub-acute, chronic), especially when combined with exercise. The data also suggests that incorporating treatment of the mid-back may lead to better outcomes.


Our office is a member of ChiroTrust and has taken The ChiroTrust Pledge:
“To the best of my ability, I agree to provide my patients convenient, affordable, and mainstream Chiropractic care. I will not use unnecessary long-term treatment plans and/or therapies.”
Toronto Neck and Back Pain Clinic
1849 Yonge Street #412 Toronto ON M4S1Y2
Mon 8-10, 12-1, 3-6
Tue 8-10, 12-1
Wed 3-6
Thu 8-10, 12-1, 3-6
Walk-Ins Welcome or To Make an Appointment,
Call 416-960-9355
Or visit www.torontoneckandbackpain.com