Manual Manipulation and Mobilization for Chronic Stiff Neck

In alleviating persistent neck discomfort, manual manipulation emerges as a potential solution, involving skilled hands-on techniques to adjust the cervical spine.

Manual Manipulation for Chronic Neck Aches and Stiffness

For chronic neck aches and stiffness, some people may find relief from manual manipulation, or having a medical professional use his or her hands to directly adjust the cervical spine (neck). There are 2 general methods of applying manual manipulations to the cervical spine:

Spinal manipulation. These high-velocity, low-amplitude (HVLA) thrusts, also called chiropractic adjustments or osteopathic manipulative treatments (OMT), are carefully performed by applying enough force to push the spinal joint beyond the restricted range of motion with the goal of improving the joint’s function, increasing range of motion, and reducing pain. When a high-velocity manipulation is performed on the spine, it typically involves a cracking or popping sound that can be heard. Some people report feeling relief or enjoying the cracking sound, whereas others do not.

Spinal mobilization. These low-velocity, low amplitude (LVLA) manipulations gradually work the spinal joints through their well-tolerable ranges of motion rather than forcing them beyond the normal limit. The practitioner’s hands gently move the vertebra and stretch each spinal level being worked. Spinal mobilization usually does not involve a neck-cracking sound.

There are numerous techniques for spinal manipulation and mobilization. Different techniques may be applied depending on the patient’s unique needs and preferences, as well as the practitioner’s skill set.

Additionally, if manipulations are performed on the cervical spine, they also tend to be performed on the thoracic spine (upper back) because these 2 regions are interconnected and can refer pain and stiffness back and forth.

See Chiropractic Manipulation for the Cervical Spine

Efficacy of Manual Manipulation and Mobilization

Many people have reported experiencing at least some neck pain relief and improved range of motion from having manual manipulation and/or mobilization performed. However, most studies that have looked at manual manipulation and mobilization have been small or not random controlled trials. For the studies that have found manipulation and/or mobilization to be beneficial for helping to relieve neck pain or improve neck function, the evidence has been weak and benefits have tended to be temporary. ¹ Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015 Sep 23;(9):CD004249. doi: 10.1002/14651858.CD004249.pub4.

A review of current literature has found that the relatively gentle spinal mobilization techniques have been at least as effective as the high-velocity spinal manipulations for treating neck pain and stiffness. ¹ Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015 Sep 23;(9):CD004249. doi: 10.1002/14651858.CD004249.pub4. Some evidence also suggests that manipulation or mobilization of the thoracic spine can help reduce neck pain and stiffness. ¹ Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015 Sep 23;(9):CD004249. doi: 10.1002/14651858.CD004249.pub4. ^{, 2} Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patient with neck pain: a randomized trial. Phys Ther. 2007; 87(4):431-40.

See Gentle Chiropractic Techniques for Neck Pain

Risks of Manual Manipulation and Mobilization

When performed by a medical professional who is licensed and trained in these techniques, manual manipulation and mobilization of the cervical spine are relatively safe. Since an HVLA manipulation involves moving a joint past its normal range of motion, it is important to rule out any serious underlying condition, such as spinal instability or cervical myelopathy, before performing a high-velocity manipulation in the cervical spine.

While extremely rare, there have been reports of stroke caused by vertebral artery dissection following manipulation of the cervical spine. ³ Kennell KA, Daghfai MM, Patel SG, DeSanto JR, Waterman GS, Bertino RE. Cervical artery dissection related to chirpractic manipulation: one institution’s experience. J Fam Pract. 2017; 66(9):556-62. It should also be noted that not all of these reports can verify the exact cause of the stroke. Some studies report that there is no difference in the clinical risk for stroke in patients who visit a chiropractor for neck pain compared with patients who visit a general practitioner (without manipulation) for neck pain. ⁴ Cassidy, J. D., Boyle, E., Cote, P., He, Y., Hogg-Johnson, S., Silver, F. L., &Bondy, S. J. (2008). Risk of vertebrobasilar stroke and chiropractic care. European Spine Journal, 17(Suppl 1), 176–183. ^{, 5} Gouveia LO1, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976). 2009 May 15;34(11):E405-13. doi: 10.1097/BRS.0b013e3181a16d63.