Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Research Article

Influence of the cervical spine manipulation in the neck disability index in patients with chronic neck pain: A preliminary study

Miranda, Iã Ferreira; Facchini, Daniel

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Introduction: Neck pain is one of the major problems managed by chiropractors, therefore its common the use of spinal manipulation to manage this problem. Objective: To evaluate the influence of Cervical Spine Manipulation (CSM) in the Neck Disability Index (NDI) of patients with chronic neck pain compared to a manipulative sham group. Method: 15 patients with chronic neck pain, were randomly assigned into one of two groups. Experimental Group (EG), with 8 patients, mean age of 30.6(13.7) years and Sham Group (SG), with 7 patients, mean age of 38.9(17.0) years. All the patients signed a Voluntary Informed Consent Document, approved by the university’s research ethics committee (n°555.015). The NDI was used to evaluate the outcome. The EG intervention was the CSM, performed 4 times, along a mean of 39.2 days. The SG was subjected to a similar cervical manipulative sensory experience, also performed 4 times, along a mean of 30.6 days. Paired and unpaired Student’s t-test was used to assess intra and inter group differences, respectively. Results: Statistically significant differences (p=0.000) were found for NDI between the pre and post-treatment evaluations of both the EG (26.3(5.0) % pre; 10.9(7.1) % post) and the SG (30.1(3.7) % pre; 18.4(5.3) % post). There were no significant differences for NDI in the pre-treatment between groups (p=0.122), however statistically significant differences were found in the post-treatment between the EG and the SG (p=0.039). Conclusion: The result shows that after the treatment period both groups showed improvement for NDI, however the CSM in the EG resulted in an improved outcome in the treatment of patients with chronic neck pain.


Chiropractic manipulation, Neck pain, Chronic pain.


1. Coulter ID, Shekelle PG. Chiropractic in North America: a descriptive analysis. J Manipulative Physiol Ther [Internet]. 2005 Feb [cited 2015 Feb 10];28(2):83–9.

2. Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol [Internet]. 2010 Dec [cited 2015 Jan 28];24(6):783–92.

3. Borghouts JA., Koes BW, Vondeling H, Bouter LM. Cost-of-illness of neck pain in The Netherlands in 1996. Pain [Internet]. 1999 Apr [cited 2015 Feb 10];80(3):629–36.

4. Pikula JR. The effect of spinal manipulative therapy (SMT) on pain reduction and range of motion in patients with acute unilateral neck pain: a pilot study. J Can Chiropr Assoc. 1999;43(2):111–9.

5. Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther [Internet]. 2000 Feb [cited 2015 Feb 20];23(2):91–5.

6. Ernst E, Harkness E. Spinal Manipulation. J Pain Symptom Manage [Internet]. 2001 Oct [cited 2015 Feb 2];22(4):879–89.

7. Palmgren PJ, Sandström PJ, Lundqvist FJ, Heikkilä H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther [Internet]. 2006 Feb [cited 2015 Jan 20];29(2):100–6.

8. Saavedra-Hernández M, Ssavedra-Hernández M, Castro-Sánchez AM, Fernández-de-Las-Peñas C, Cleland JA, Ortega-Santiago R, et al. Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine. J Manipulative Physiol Ther [Internet]. 2011 Jan [cited 2014 Dec 19];34(3):144–52.

9. Lin JH, Shen T, Chung RCK, Chiu TTW. The effectiveness of Long’s manipulation on patients with chronic mechanical neck pain: a randomized controlled trial. Man Ther [Internet]. 2013 Aug [cited 2015 Jan 18];18(4):308–15.

10. Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther [Internet]. 2014 Jan [cited 2015 Jan 11];37(1):42–63.

11. McMorland G, Suter E. Chiropractic management of mechanical neck and low-nack pain: A retrospective, outcome-based analysis. J Manipulative Physiol Ther [Internet]. 2000 Jun [cited 2015 Mar 12];23(5):307–11.

12. Plastaras CT, Schran S, Kim N, Sorosky S, Darr D, Chen MS, et al. Complementary and alternative treatment for neck pain: chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais. Phys Med Rehabil Clin N Am [Internet]. 2011 Aug [cited 2015 Jan 17];22(3):521–37, ix.

13. Triano JJ. Biomechanics of spinal manipulative therapy. Spine J [Internet]. 2001 Mar [cited 2015 Mar 12];1(2):121–30.

14. Vernon H, MacAdam K, Marshall V, Pion M, Sadowska M. Validation of a sham manipulative procedure for the cervical spine for use in clinical trials. J Manipulative Physiol Ther [Internet]. 2005 Jan [cited 2015 Feb 10];28(9):662–6.

15. Tavel ME. The placebo effect: the good, the bad, and the ugly. Am J Med [Internet]. 2014 Jun [cited 2015 Jan 8];127(6):484–8.

16. Daligadu J, Haavik H, Yielder PC, Baarbe J, Murphy B. Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. J Manipulative Physiol Ther [Internet]. 2013 Oct [cited 2015 Feb 10];36(8):527–37.

17. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther [Internet]. 2011 Feb [cited 2015 Feb 10];34(2):88–97.

18. Leininger BD, Evans R, Bronfort G. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain. J Manipulative Physiol Ther [Internet]. 2014 Oct [cited 2015 Feb 10];37(8):593–601.

19. Palmer College of Chiropractic Technique Department. PALMER COLLEGE OF CHIROPRACTIC. 1998.

20. SARAIVA MC. Manual de técnicas quiropraticas. 2nd ed. Novo Hamburgo, Brazil: Feevale University; 2006.

21. Vernon HT, Triano JJ, Ross JK, Tran SK, Soave DM, Dinulos MD. Validation of a novel sham cervical manipulation procedure. Spine J [Internet]. 2012 Nov [cited 2015 Jan 18];12(11):1021–8.

22. Vernon H, Triano JT, Soave D, Dinulos M, Ross K, Tran S. Retention of blinding at follow-up in a randomized clinical study using a sham-control cervical manipulation procedure for neck pain: secondary analyses from a randomized clinical study. J Manipulative Physiol Ther [Internet]. 2013 Oct [cited 2015 Jan 18];36(8):522–6.

23. Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther [Internet]. 2008 Sep [cited 2015 Jan 25];31(7):491–502.

24. En MCC, Clair DA, Edmondston SJ. Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non-traumatic neck pain. Man Ther [Internet]. 2009 Aug [cited 2015 Jan 3];14(4):433–8.

25. Gay RE, Madson TJ, Cieslak KR. Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. J Manipulative Physiol Ther [Internet]. 2007 May [cited 2014 Dec 21];30(4):259–62.

26. Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain [Internet]. 2004 Dec [cited 2015 Jan 10];112(3):267–73.

27. Vernon H, Puhl A, Reinhart C. Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes. Chiropr Man Therap [Internet]. BioMed Central Ltd; 2011 Jan 11 [cited 2015 Feb 20];19(1):3.

28. Schneider A, Wartner E, Schumann I, Hörlein E, Henningsen P, Linde K. The impact of psychosomatic co-morbidity on discordance with respect to reasons for encounter in general practice. J Psychosom Res [Internet]. 2013 Jan [cited 2015 Mar 2];74(1):82–5.

29. de Moraes Vieira EB, de Góes Salvetti M, Damiani LP, de Mattos Pimenta CA. Self-efficacy and fear avoidance beliefs in chronic low back pain patients: coexistence and associated factors. Pain Manag Nurs [Internet]. 2014 Sep [cited 2015 Mar 2];15(3):593–602.

30. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain [Internet]. 2000 Apr [cited 2015 Mar 2];85(3):317–32.

31. Tseng Y-L, Wang WTJ, Chen W-Y, Hou T-J, Chen T-C, Lieu F-K. Predictors for the immediate responders to cervical manipulation in patients with neck pain. Man Ther [Internet]. 2006 Nov [cited 2015 Mar 2];11(4):306–15.

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