Cervical manipulation accelerates recovery and further correction of cervical alignment in mechanical neck pain (MNP) patients with neck exercise: A randomized controlled trial

Mechanical neck pain (MNP) is often associated with changes in cervical sagittal alignment, causing pain and functional limitations. This study evaluated the additional effects of cervical manipulation in patients with MNP undergoing neck retraction exercise. Patients with MNP were randomly assigned to either the cervical manipulation plus neck retraction exercise group (CM + NRE) or the neck retraction exercise group (NRE). Both groups completed their respective regimens over an 8-week period. Primary outcomes include visual analogue scale (VAS) and cervical range of motion (CROM). Secondary outcomes include neck disability index (NDI), neck muscle strength, and cervical sagittal alignment (relative rotation angles [RRA]; absolute rotation angles [C2-7ARA]; cervical sagittal vertical axis [c2-7SVA]). The statistical analysis applied intention-to-treat (ITT) and per-protocol (PP) analyses. In the ITT analysis, the CM + NRE group demonstrated more pronounced changes in VAS and CROM after the first treatment (VAS: d = 1.83, P = 0.001; CROM: d = 1.92, P = 0.001), at 4 weeks (VAS: d = 0.98, P = 0.001; CROM: d = 1.05, P = 0.001), 8 weeks (VAS: d = 1.05, P = 0.001; CROM: d = 0.93, P = 0.001), and at a 4-week follow-up (VAS: d = 1.16, P = 0.001; CROM: d = 0.91, P = 0.001). In the assessments of NDI, RRA, and C2-7ARA, the CM + NRE group showed significantly greater changes compared to the NRE group (p < 0.05). These results were consistent with the PP analysis. Cervical manipulation enhances the effectiveness of neck retraction exercise, which promotes rapid recovery from neck pain and stiffness and further facilitates the correction of cervical sagittal alignment in patients with MNP.