Effectiveness of the manual therapy (manipulations and mobilizations) in non-specific neck pain. Scientific evidence

Objective. To evaluate vertebral manual therapy (manipulations and mobilizations) effectiveness and safety in no specific cervical pain. Strategy of research. Electronic in the principals basis of information, and handed in Journal of Manipulative and Physiological Therapeutics, Manual Therapy, Physiotherapy, Spine and Rehabilitación (Madrid), until 2005 December. Selection of the studies. Only meta-analysis and systematic reviews of randomised controlled trials (RCTs). Results. 1990, 5 RCTs, therefore we can not conclude. Between 1991-1993, 24 RCTs, contradict evidence results. Between 1994-1995, 14 RCTs, no RCTs for manipulations and 3 for mobilizations, we can not conclude. Between 1995-1997, 20 RCTs, better results with manual therapy and exercise. Betweem 1998-2002, 33 RCTs, no evidence that manipulations are better. Between 2003-2005, 12 RCTs, 4 with positive conclusions and 8 with negative conclusions. Safety: most estimations show that the incidence of severe accidents is rare (1 per million and year). Conclusions. Long term RCTs are needed in order to establish vertebral manual therapy effectiveness and safety. There is not evidence about the effectiveness of vertebral manipulations and there is limited evidence against for passive mobilizations in acute cervicalgia. There is strong evidence for multimodal care and there is strong evidence against for manipulation and/o mobilizations isolate, in mechanical, subacute or chronic neck disorders with or without headache. There is not evidence about the manual therapy role in the radicular cervical disorders