Reynolds Breanna, McDevitt Amy, Kelly Joseph, Mintken Paul, Clewley Derek
School of Physical Therapy, South College, Knoxville, TN, USA.
Physical Therapy Program, Physical Medicine and Rehabilitation Department, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Man Manip Ther. 2025 Feb;33(1):18-35. doi: 10.1080/10669817.2024.2425788. Epub 2024 Nov 28.
Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50-85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool.
A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs.
Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.
颈部疼痛是一种常见的肌肉骨骼疾病，2019年的患病率（年龄标准化）为每1000人中有27.0例。大约50-85%的急性颈部疼痛患者症状无法完全缓解，从而发展为慢性疼痛。手法治疗是一种广泛应用于非特异性颈部疼痛（NSNP）、神经根型颈椎病（CR）和颈源性头痛（CGH）的治疗方法。本伞形综述综合了针对颈部疾病患者进行手法物理治疗的系统评价。
遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，并在国际系统评价注册平台Prospero（CRD42022327434）进行注册。检索了四个数据库，时间跨度为2016年1月至2023年5月，以查找有关对任何阶段颈部疼痛患者进行手法治疗的系统评价，无论是否有Meta分析。干预措施包括对颈椎或胸椎的任何手法物理治疗以及上肢的神经松动术。主要结局包括疼痛和功能障碍。两名评价员筛选纳入标准并完成数据提取。使用多重系统评价评估（AMSTAR 2）工具评估方法学质量。
共纳入35项系统评价：15项针对非特异性颈部疼痛，7项针对神经根型颈椎病，9项针对颈源性头痛，4项针对合并诊断的样本。系统评价的AMSTAR 2评分显示，10项评价结果的可信度高，12项评价结果的可信度中等，13项评价结果的可信度低至极低。对于非特异性颈部疼痛，结果显示手法治疗联合运动优于单独使用任何一种治疗方法，可信度高。对于神经根型颈椎病，神经松动术、牵引、软组织治疗以及对颈椎和胸椎的松动/整复，结果的可信度中等。对于颈源性头痛，结果支持使用颈椎松动/整复、软组织松动以及手法治疗联合运动，可信度高。系统评价的原作者报告的原始研究质量参差不齐，缺乏一致的高质量/低偏倚风险设计。
手法治疗联合运动、颈椎或胸椎的松动和整复、神经松动术以及其他类型的手法治疗，被认为是短期内治疗非特异性颈部疼痛、颈源性头痛或神经根型颈椎病患者疼痛和功能障碍的有效干预措施。
