04/06/2026
๐ง Neck Pain: What Does the Latest Evidence Say?
A 2025 Cochrane Review examined the effects of combining manual therapy and exercise for chronic neck pain.
๐ Key findings:
โ
Compared to no treatment, manual therapy + exercise resulted in:
โข Reduced pain levels
โข Improved physical function
โข Better quality of life
โ
Manual therapy can:
โข Reduce pain and discomfort
โข Improve mobility and movement quality
โข Increase confidence in movement
โข Support participation in exercise and rehabilitation
โ
Exercise can:
โข Improve strength and mobility
โข Enhance movement control
โข Build long-term resilience
โข Support recovery and function
๐ก The takeaway:
โข Manual therapy and exercise work best together.
โข Hands-on treatment can help create opportunities for movement and recovery.
โข Exercise can help maintain and build on those improvements.
โข A personalised approach can produce the best outcomes.
Manual therapy and exercise donโt compete with each otherโthey complement each other.
At Move Centric, we combine hands-on therapy with corrective exercise to help our clients move better, recover better, and stay active for the activities they enjoy.
๐ก๐ฒ๐ฐ๐ธ ๐ฃ๐ฎ๐ถ๐ป ๐ฎ๐ป๐ฑ ๐ ๐ฎ๐ป๐๐ฎ๐น ๐ง๐ต๐ฒ๐ฟ๐ฎ๐ฝ๐ + ๐๐
๐ฒ๐ฟ๐ฐ๐ถ๐๐ฒ: ๐ช๐ต๐ฎ๐ ๐๐ผ๐ฒ๐ ๐๐ต๐ฒ ๐๐๐ถ๐ฑ๐ฒ๐ป๐ฐ๐ฒ ๐ฆ๐ฎ๐?
โผ๏ธ Neck pain is a widespread and disabling condition that can significantly impact daily life and lead to substantial economic and healthcare costs.
โผ๏ธ A 2025 Cochrane Database systematic review evaluated whether combining manual therapy with exercise is an effective and safe treatment for adults suffering from acute to chronic neck pain.
๐ช๐ต๐ฎ๐ ๐๐ผ๐ฒ๐ ๐๐ต๐ฒ ๐ง๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐ ๐๐ป๐๐ผ๐น๐๐ฒ?
โผ๏ธ Manual therapy includes hands-on techniques, such as joint manipulation and tissue mobilization, performed by healthcare providers.
โผ๏ธ The exercise component involves purposeful physical activities prescribed to improve symptoms, such as stretching, strengthening, motor control, cardiovascular training, or mind-body exercises like yoga.
๐ ๐ง๐ต๐ฒ ๐ฅ๐ฒ๐๐ถ๐ฒ๐'๐ ๐ฆ๐ฐ๐ผ๐ฝ๐ฒ
โผ๏ธ Researchers analyzed data from nine randomized controlled trials involving a total of 694 adults across North America, Europe, Central Asia, East Asia, and the Pacific.
โผ๏ธ The average participant was 46 years old, and 76% of the participants were female.
โผ๏ธ The vast majority of the included studies focused specifically on individuals with chronic neck pain, which is pain lasting longer than 12 weeks.
๐ ๐๐ฒ๐ ๐๐ถ๐ป๐ฑ๐ถ๐ป๐ด #๐ญ: ๐ ๐ฎ๐ป๐๐ฎ๐น ๐ง๐ต๐ฒ๐ฟ๐ฎ๐ฝ๐ ๐ฎ๐ป๐ฑ ๐๐
๐ฒ๐ฟ๐ฐ๐ถ๐๐ฒ ๐๐. ๐ฃ๐น๐ฎ๐ฐ๐ฒ๐ฏ๐ผ
โผ๏ธ When compared to a placebo (sham) treatment at short-term follow-up (closest to four weeks), the combined therapy showed mixed results.
๐น Pain
โผ๏ธ The treatment resulted in little or no difference in pain reduction compared to a placebo, improving by less than a single point on a 0 to 10 scale.
๐น Function
โผ๏ธ There was a moderate increase in physical function, with participants improving by an average of 10.20 points on a 100-point scale.
๐น Quality of Life
โผ๏ธ The therapy yielded little or no improvement in health-related quality of life.
๐ ๐๐ฒ๐ ๐๐ถ๐ป๐ฑ๐ถ๐ป๐ด #๐ฎ: ๐ ๐ฎ๐ป๐๐ฎ๐น ๐ง๐ต๐ฒ๐ฟ๐ฎ๐ฝ๐ ๐ฎ๐ป๐ฑ ๐๐
๐ฒ๐ฟ๐ฐ๐ถ๐๐ฒ ๐๐. ๐ก๐ผ ๐ง๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐
โผ๏ธ The benefits were much clearer when the intervention was compared to receiving a wait list or no treatment at all.
๐น Pain
โผ๏ธ Participants experienced a large reduction in pain, improving by an average of 2.44 points on a 10-point scale.
๐น Function
โผ๏ธ The treatment led to a moderate improvement in physical function, translating to a 14% absolute benefit over doing nothing.
๐น Quality of Life
โผ๏ธ There was a moderate improvement in health-related quality of life, equating to an absolute improvement of 25% on a 100-point scale.
๐ฆ๐ฎ๐ณ๐ฒ๐๐ ๐ฎ๐ป๐ฑ ๐๐ฑ๐๐ฒ๐ฟ๐๐ฒ ๐๐๐ฒ๐ป๐๐
โผ๏ธ The treatment appears to be relatively safe, as there was little to no difference in non-serious adverse events when compared to the control groups.
โผ๏ธ There was only a 2% absolute risk increase for mild, transient issues such as treatment-related soreness, dizziness, or headaches.
โผ๏ธ Additionally, no serious adverse events were reported in any of the studies, though detecting such rare events would likely require a much larger sample size.
โ ๏ธ ๐๐ถ๐บ๐ถ๐๐ฎ๐๐ถ๐ผ๐ป๐ ๐ผ๐ณ ๐๐ต๐ฒ ๐๐๐ถ๐ฑ๐ฒ๐ป๐ฐ๐ฒ
โผ๏ธ The review authors rated the certainty of the evidence as low to very low.
โผ๏ธ This was primarily due to non-modifiable challenges in rehabilitation research, such as the impossibility of "blinding" therapists and patients to whether they were administering or receiving physical therapy.
โผ๏ธ Other issues that lowered the evidence quality included small study sample sizes, reliance on self-reported outcomes, and a complete lack of trial data for patients with acute neck pain.
๐ฏ ๐ง๐ต๐ฒ ๐๐ถ๐ป๐ฎ๐น ๐ง๐ฎ๐ธ๐ฒ๐ฎ๐๐ฎ๐
โผ๏ธ If you are struggling with chronic neck pain, combining manual therapy with exercise is significantly better than doing nothing at all, offering large reductions in pain and noticeable improvements in daily function.
โผ๏ธ However, when compared to a convincing placebo, the benefits are mostly limited to a moderate increase in physical function rather than actual pain relief.
โผ๏ธ Ultimately, patients who are willing to adhere to an exercise routine, can tolerate manual manipulation, and have the resources to attend multiple sessions a week may find this combined approach to be a valuable option for managing their symptoms.
