Monthly Archives: February 2014

Cervical Manipulation… Is the Juice Worth the Squeeze? (Part 2)

And here’s part 2 of John Snyder’s blog post on cervical manipulation. Again, the comments are also worth a read.

Orthopedic Manual Physical Therapy


In Part 1, the relative risks and important screening areas prior to cervical manipulation were discussed. In this second installment, the effectiveness and a theoretical framework for utilizing cervical manipulation will be laid out.

According to the Neck Pain Guidelines published by Cleland et al, manual therapy (mobilization and manipulation) was graded both an ‘A’ (strong evidence) and a ‘1’ (evidence from high-quality RCT, prospective, or diagnostic studies) in the treatment of neck pain. These guidelines advocate both manipulative and lower grade mobilization in reducing neck pain and cervicogenic headache symptoms. Published in the same year as the clinical guidelines, Walker et al conducted a RCT looking into the effectiveness of manual therapy and exercise in the management of mechanical neck pain. Those randomized to the manual therapy and exercise group (MTE) received treatments that ranged from cervical manipulation to soft-tissue mobilization and every technique in between. The…

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Cervical Manipulation… Is the Juice Worth the Squeeze? (Part 1)

Another thoughtful and detailed blog post from John Snyder about the controversy that continues to surround cervical manipulation. The comments are worth a read too!

Orthopedic Manual Physical Therapy

Neck pain is a debilitating and all too common issue worldwide. According to a systematic review published by Cote et al, the annual prevalence of neck pain in Quebec City is 48%, 27% in Norway, and 34% in the UK. Subsequently, a limitation in activities of daily living was found in between 11-14% of individuals. An additionally alarming statistic is that 50% of these individuals who suffer from neck pain still have symptoms 12 months after onset. Silverstein et al looked at workers compensation claims in the state of Washington between the years of 1990 and 1998. According to their data, 40.1/10,000 full-time equivalents (FTEs) reported claims for soft-tissue neck pain. This same study found that 19.1/10,000 FTEs missed 4 or more days of work secondary to neck pain. This tells us that neck pain is anything but a ‘self limiting’ disorder, but what are we doing to treat…

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