The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis.

This systematic review and meta-analysis asked whether combining manual therapy (hands-on techniques like joint mobilization) with exercise works better than either approach alone, or than other interventions, for people with nonspecific neck pain. Researchers pooled data from 22 studies published between 2000 and 2022, examining pain, disability, and quality of life outcomes, and rated the certainty of evidence for each comparison. Results were mixed depending on the comparison. Combined treatment showed no significant difference from manual therapy alone for pain or disability (3 studies, moderate certainty), but was significantly better than exercise alone for both pain (16 studies, low certainty) and disability (13 studies, low certainty), and better than control interventions for both outcomes (4 studies, moderate to low certainty).

For quality of life, combined treatment showed no difference compared to exercise alone (4 studies, high certainty). The main limitation is that most comparisons carried low to moderate certainty evidence, meaning these findings could change with further research.

This review looked at whether combining hands-on manual therapy with exercise helps neck pain more than either treatment alone. Researchers combined results from 22 studies conducted between 2000 and 2022, looking at pain, disability, and quality of life. The findings varied by comparison.

When combined treatment was compared to manual therapy alone, there was no significant difference in pain or disability, based on 3 studies with moderate certainty evidence. When compared to exercise alone, combined treatment showed significantly better results for both pain (16 studies) and disability (13 studies), though this evidence was rated low certainty.

Combined treatment also outperformed control interventions like placebo or standard care. For quality of life, there was no difference between combined treatment and exercise alone, based on 4 studies with high certainty evidence. Overall, adding exercise to manual therapy did not seem to add extra benefit beyond manual therapy alone, but the combination worked better than exercise by itself.

Because much of this evidence was rated low to moderate certainty, these results should be viewed as an early picture rather than a settled answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review pooled 22 studies (2000 to 2022) examining manual therapy plus exercise for nonspecific neck pain, using RoB 2 to assess risk of bias and GRADE-style certainty ratings across outcomes. The comparisons yielded differing certainty levels: combined treatment versus manual therapy alone showed no significant difference in pain or disability across only 3 studies (moderate certainty), while combined treatment versus exercise alone showed significant improvements in pain (16 studies, SMD -0.95) and disability (13 studies, SMD -0.59), both rated low certainty.

Versus control interventions, combined treatment showed significant reductions in pain (moderate certainty) and disability (low certainty) across 4 studies. Quality of life showed no difference between combined treatment and exercise alone across 4 studies, rated high certainty. The pattern suggests manual therapy's effect may be doing much of the work, with exercise addition offering limited incremental benefit over manual therapy alone, though this is based on a small number of studies.

The low to moderate certainty ratings across most comparisons, along with heterogeneity in the pooled control-group comparisons, indicate these findings warrant cautious interpretation rather than firm clinical conclusions.