{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:00:01Z","timestamp":1792044001130,"version":"4.4.0"},"reference-count":49,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Acute neck pain is common and usually managed by medication and\/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large \u22121.37 (95% CI, \u22122.41, \u22120.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((\u22122.8 (46%) (95% CI, \u22122.1, \u22123.4) vs. \u22121.7 (30%) (95% CI, \u22121.1, \u22122.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings.<\/jats:p>","DOI":"10.3390\/jcm10215011","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T23:51:36Z","timestamp":1635465096000},"page":"5011","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2566-5984","authenticated-orcid":false,"given":"Aleksander","family":"Chaibi","sequence":"first","affiliation":[{"name":"Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, 1478 Oslo, Norway"},{"name":"Department for Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, 0317 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4512-8000","authenticated-orcid":false,"given":"Knut","family":"Stavem","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1478 Nordbyhagen, Norway"},{"name":"Department of Pulmonary Medicine, Akershus University Hospital, 1478 L\u00f8renskog, Norway"},{"name":"Health Services Research Unit, Akershus University Hospital, 1478 L\u00f8renskog, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Bj\u00f8rn","family":"Russell","sequence":"additional","affiliation":[{"name":"Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, 1478 Oslo, Norway"},{"name":"Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1478 Nordbyhagen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1097\/BRS.0b013e31816445be","article-title":"Course and prognostic factors for neck pain in the general population: Results of the Bone and Joint Decade 2000\u20132010 Task Force on Neck Pain and Its Associated Disorders","volume":"33","author":"Carroll","year":"2008","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1097\/BRS.0b013e31816454c8","article-title":"The burden and determinants of neck pain in the general population: Results of the Bone and Joint Decade 2000\u20132010 Task Force on Neck Pain and Its Associated Disorders","volume":"33","author":"Carroll","year":"2008","journal-title":"Spine"},{"key":"ref_3","unstructured":"GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1545\u20131602."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1590\/bjpt-rbf.2014.0149","article-title":"Musculoskeletal pain in children and adolescents","volume":"20","author":"Kamper","year":"2016","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1136\/annrheumdis-2013-204431","article-title":"The global burden of neck pain: Estimates from the global burden of disease 2010 study","volume":"73","author":"Hoy","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cohen, S.P., and Hooten, W.M. (2017). Advances in the diagnosis and management of neck pain. BMJ, 358.","DOI":"10.1136\/bmj.j3221"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1001\/jama.2016.16885","article-title":"US Spending on Personal Health Care and Public Health, 1996\u20132013","volume":"316","author":"Dieleman","year":"2016","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kinge, J.M., Knudsen, A.K., Skirbekk, V., and Vollset, S.E. (2015). Musculoskeletal disorders in Norway: Prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet. Disord., 16.","DOI":"10.1186\/s12891-015-0536-z"},{"key":"ref_9","first-page":"23","article-title":"Management of acute neck pain in general practice: A prospective study","volume":"57","author":"Vos","year":"2007","journal-title":"Br. J. Gen. Pract. J. R. Coll. Gen. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dikkers, M.F., Westerman, M.J., Rubinstein, S.M., van Tulder, M.W., and Anema, J.R. (2016). Why Neck Pain Patients are Not Referred to Manual Therapy: A Qualitative Study among Dutch Primary Care Stakeholders. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157465"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.2147\/JPR.S217045","article-title":"A randomized, placebo- and active-controlled, multi-country, multi-center parallel group trial to evaluate the efficacy and safety of a fixed-dose combination of 400 mg ibuprofen and 100 mg caffeine compared with ibuprofen 400 mg and placebo in patients with acute lower back or neck pain","volume":"12","author":"Predel","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1136\/bmj.317.7162.875","article-title":"When placebo controlled trials are essential and equivalence trials are inadequate","volume":"317","author":"Tramer","year":"1998","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Chaibi, A., Saltyte Benth, J., and Bjorn Russell, M. (2015). Validation of Placebo in a Manual Therapy Randomized Controlled Trial. Sci. Rep., 5.","DOI":"10.1038\/srep11774"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gross, A., Langevin, P., Burnie, S.J., Bedard-Brochu, M.S., Empey, B., Dugas, E., Faber-Dobrescu, M., Andres, C., Graham, N., and Goldsmith, C.H. (2015). Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane database Syst. Rev., 9.","DOI":"10.1002\/14651858.CD004249.pub4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3233\/BMR-169615","article-title":"The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review","volume":"30","author":"Hidalgo","year":"2017","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"W-65","DOI":"10.7326\/0003-4819-151-4-200908180-00136","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration","volume":"151","author":"Liberati","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/BRS.0b013e31815e7f94","article-title":"A consensus approach toward the standardization of back pain definitions for use in prevalence studies","volume":"33","author":"Dionne","year":"2008","journal-title":"Spine"},{"key":"ref_18","unstructured":"Esposito, S., and Philipson, S. (2005). Spinal Adjustment Technique the Chiropractic Art, S. Philipson and S. Esposito."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1097\/BRS.0b013e3181ab6a78","article-title":"Empirical evidence of an association between internal validity and effect size in randomized controlled trials of low-back pain","volume":"34","author":"Suttorp","year":"2009","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1002\/(SICI)1521-4036(199912)41:8<901::AID-BIMJ901>3.0.CO;2-W","article-title":"An Alternative Method for Meta-Analysis","volume":"41","author":"Hartung","year":"1999","journal-title":"Biom. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.1002\/sim.1482","article-title":"Improved tests for a random effects meta-regression with a single covariate","volume":"22","author":"Knapp","year":"2003","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"IntHout, J., Ioannidis, J.P., and Borm, G.F. (2014). The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-25"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/jrsm.1297","article-title":"Methods for evidence synthesis in the case of very few studies","volume":"9","author":"Bender","year":"2018","journal-title":"Res. Synth. Methods"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/jrsm.1319","article-title":"Methods to calculate uncertainty in the estimated overall effect size from a random-effects meta-analysis","volume":"10","author":"Veroniki","year":"2019","journal-title":"Res. Synth. Methods"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Academic Press.","DOI":"10.4324\/9780203771587"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1136\/bmj.315.7121.1533","article-title":"Meta-analysis: Principles and procedures","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jmpt.2006.06.022","article-title":"Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: A randomized controlled trial","volume":"29","year":"2006","journal-title":"J. Manip. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20","DOI":"10.2519\/jospt.2009.2914","article-title":"Thoracic spine manipulation for the management of patients with neck pain: A randomized clinical trial","volume":"39","author":"Cleland","year":"2009","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.apmr.2010.06.006","article-title":"A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain","volume":"91","author":"Leaver","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"208","DOI":"10.2519\/jospt.2011.3640","article-title":"Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: A randomized clinical trial","volume":"41","author":"Puentedura","year":"2011","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"118","DOI":"10.2519\/jospt.2013.4221","article-title":"Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: A randomized clinical trial","volume":"43","author":"Masaracchio","year":"2013","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_35","first-page":"57","article-title":"Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: A randomized clinical trial","volume":"105","author":"McReynolds","year":"2005","journal-title":"J. Am. Osteopath. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jclinepi.2020.10.018","article-title":"Sample size, study length and inadequate controls were the most common self-acknowledged limitations in manual therapy trials: A methodological review","volume":"130","author":"Alvarez","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0004-9514(06)70049-6","article-title":"Selecting an appropriate placebo for a trial of spinal manipulative therapy","volume":"52","author":"Hancock","year":"2006","journal-title":"Aust J Physiother."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Chaibi, A., Knackstedt, H., Tuchin, P.J., and Russell, M.B. (2017). Chiropractic spinal manipulative therapy for cervicogenic headache: A single-blinded, placebo, randomized controlled trial. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2651-4"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1136\/emj.20.2.164","article-title":"Designing a research project: Randomised controlled trials and their principles","volume":"20","author":"Kendall","year":"2003","journal-title":"Emerg. Med. J. EMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1097\/BRS.0b013e3181644641","article-title":"Clinical practice implications of the Bone and Joint Decade 2000\u20132010 Task Force on Neck Pain and Its Associated Disorders: From concepts and findings to recommendations","volume":"33","author":"Guzman","year":"2008","journal-title":"Spine"},{"key":"ref_41","first-page":"1s","article-title":"Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining \"whiplash\" and its management","volume":"20","author":"Spitzer","year":"1995","journal-title":"Spine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.pain.2010.09.014","article-title":"Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care?","volume":"151","author":"Grotle","year":"2010","journal-title":"Pain"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Masaracchio, M., Kirker, K., States, R., Hanney, W.J., Liu, X., and Kolber, M. (2019). Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211877"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2017.0302","article-title":"Neck Pain: Revision 2017","volume":"47","author":"Blanpied","year":"2017","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_45","unstructured":"Bolette, S., Peter, D., Anne, G., Henrik, H.L., Alexander, I.-J., Martin, B.J., Alice, K., J\u00f8rgen, K., Steffan, W.C., and Charlotte, K. (2016). National Klinisk Retningslinje for Ikke-Kirurgisk Behandling af Nyopst\u00e5ede Uspecifikke Nakkesmerter, Sundhedsstyrelsen. Report No.: 1.0 Contract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1097\/BRS.0b013e31817e69d3","article-title":"Nonsteroidal anti-inflammatory drugs for low back pain: An updated Cochrane review","volume":"33","author":"Roelofs","year":"2008","journal-title":"Spine"},{"key":"ref_47","unstructured":"WHO (2005). Guidelines on Basic Training and Safety in Chiropractic, World Health Organization."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.msksp.2017.03.003","article-title":"Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs","volume":"29","author":"Chaibi","year":"2017","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1080\/07853890.2019.1590627","article-title":"A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review","volume":"51","author":"Chaibi","year":"2019","journal-title":"Ann. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5011\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:21:48Z","timestamp":1760167308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,28]]},"references-count":49,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10215011"],"URL":"https:\/\/doi.org\/10.3390\/jcm10215011","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,28]]}}}