OBJECTIVE: The purpose of this study was to investigate the effects of cervical joint mobilization techniques (JMTs) on pain and disability in adults with nonspecific neck pain. DESIGN: This study is an intervention systematic review with meta-analysis and meta-regression of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, Cochrane CENTRAL, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Web of Science databases, including references from other reviews or clinical practice guidelines up to October 16, 2024. STUDY SELECTION CRITERIA: Eligible RCTs evaluated JMTs compared to routine physiotherapy, minimally active interventions, or no treatment. The primary outcome was pain; secondary outcomes were disability, Global Perceived Effect (GPE), quality of life, psychosocial status, and adverse events. DATA SYNTHESIS: Meta-analyses and meta-regression were conducted for pain, disability, and GPE. The risk of bias was assessed with Cochrane RoB 2.0 Tool; the certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluations approach. We used The Template for the Intervention Description and Replication checklist to evaluate the quality of reporting of interventions delivered. RESULTS: Results from 16 RCTs were pooled (n = 1,157 participants), reporting nonclinically positive results on pain reduction (mean difference [MD] = -0.86 (95% confidence interval [-1.35, -0.36])), disability (MD=-2.11 [-3.31, -0.91]), and GPE (standardized mean difference = 0.11 ([-0.15, 0.37]) and high heterogeneity. The meta-regressions did not identify any covariates associated with the treatment effects. Minor side effects (increased neck pain and headache) were reported. CONCLUSION: There was very low certainty evidence supporting the efficacy of JTMs for reducing pain and improving disability in people with NSNP. J Orthop Sports Phys Ther 2025;55(3):1-20. Epub 12 February 2025. doi:10.2519/jospt.2025.12836.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician | |
Physician rater
This good methodological quality systematic review shows that there is very low certainty of evidence supporting using joint mobilizations for managing acute or chronic nonspecific neck pain. Also, the effect of its isolated use was small to decrease pain intensity. It means that physiotherapists should not rely only on joint mobilizations to treat patients with nonspecific neck pain. It is always important to include exercise, education, and self-management strategies.
Physician rater
The results are limited by insufficient information on the intervention and diverse type of treatments, even self-mobilization. Moreover, manual mobilization is not recommended as a single treatment alone. The review does not give any new information compared with previous reviews on the subject. Also, acute and subacute pain are often cured without any treatment.
Rehab Clinician (OT/PT) rater
It is not advised to use this intervention as sole intervention. Better are combinations with exercises, education, and dependent on the dominant pain mechanism (myofascial, articular, ...)
Rehab Clinician (OT/PT) rater
Another useless study. There is no attempt to sub-classify patients to try to give a treatment that will prove useful.
Rehab Clinician (OT/PT) rater
The study's conclusion was one that most of us know. One technique alone is insufficient to treat nonspecific neck pain (NSNP). There must be a multimodal approach to treatment and we must use all the tools that we have in our tool box. We must also monitor and pay close attention to the results of treatment so that we do not get stuck on one treatment, such as joint mobilizations, in our treatment of nonspecific neck pain. There was very little certainty of evidence for the use of joint mobilization or high velocity thrust techniques for the study population. Their search of the literature and the screening process to rule articles in or out seemed robust. Overall, it was an interesting article because it brought into question the usefulness of techniques, that many of us hold dear, to treat NSNP. We must rethink our approach to these clients.
Rehab Clinician (OT/PT) rater
This well designed study reporting evidence ranged from low to very low for most pain and disability outcomes, preventing definitive conclusions regarding the effectiveness of JMTs on individuals with NSNP. However joint mobilization was reported to be safe; as a physical therapist, I find cervical joint mobs are certainly a treatment in our toolbox worth considering in a multi-model treatment approach.
Rehab Clinician (OT/PT) rater
The meta regression method is relatively new in this area.
Rehab Clinician (OT/PT) rater
This study emphasises that joint mobilizastion techniques cannot be used as a treatment strategy alone in patients with nonspecific neck pain. This is important, because the perception that these applications, which are trending especially due to the influence of social media and certificate programs, can serve as a standalone treatment modality—may mislead physiotherapists and result in incomplete patient care.
, McMaster University