Neck Pain

Hazel J Jenkins et al. (2026) · Chiropractic & manual therapies

This pilot randomised trial with 20 patients and 11 chiropractors explored whether it is practical to run a large study asking a simple question: does taking spinal x-rays change outcomes for people receiving chiropractic care for back or neck pain? In medical settings, trials have found routine imaging does not improve non-specific low back pain, yet chiropractors use x-rays at widely varying rates (8% to 84%), partly to screen for reasons spinal manipulation might be unsuitable. No randomised trial had tested imaging where manipulation is also part of care, so the authors first tested whether such a trial could work. Chiropractors in Sydney, Australia, invited adults with a new episode of spinal pain, where the chiropractor was unsure whether an x-ray was needed. A computer randomly assigned each consenting patient to get spinal radiographs or not, and everything else, including manipulation, was decided between chiropractor and patient. Pain, disability (Roland Morris Disability Questionnaire for the back, Neck Disability Index), satisfaction and side effects were collected at 2, 6 and 12 weeks, and chiropractors were interviewed about the experience. Recruitment was the main difficulty: 135 patients were screened, 33 (24%) were eligible and 20 took part, short of the 50 planned. Three of 10 patients assigned to imaging did not get it, and 2 of 10 assigned to no imaging did, always after a clinical change. Follow-up fell from 90% of patients at 2 weeks to 75% at 12 weeks. Pain and disability fell in both groups, but differences between groups were small and the trial was too small to compare them. Mild, short-lived side effects such as muscle soreness affected 4 of 20 participants (1 imaging, 3 no imaging). The authors judged that most criteria for a larger trial were met but recruitment and cross-over would need strategies, since COVID-19, time pressure and discomfort explaining diagnostic uncertainty to patients limited enrolment. Limitations include a self-selected group of chiropractors, probably non-consecutive recruitment and mostly young, low-disability participants.

Salma Bouqartacha et al. (2026) · Chiropractic & manual therapies

This randomized mechanistic cross-over trial with 89 adults explored how two hands-on neck treatments differ right after they are delivered. Chronic neck pain, defined here as pain lasting at least 12 weeks, is one of the leading causes of disability worldwide. Spinal manipulation (SM) is a single quick, shallow thrust applied to a joint, and spinal mobilization (Smob) is a slower, repeated rocking pressure on the same area. Both are recommended in clinical guidelines, but they are often lumped together, so little was known about how their effects on pain, movement and muscle activity compare. Participants were aged 18 to 65, with an average of 35 years, and 65% were women. They were recruited in Zurich, Switzerland, and Trois-Rivieres, Canada. Each person attended two sessions three days apart, receiving SM in one and Smob in the other in random order. SM was one thrust to the most painful neck joint while lying face up, and Smob was 30 seconds of repeated pressure on the same level while lying face down. Pain was rated from 0 to 10, and neck movement, tenderness to pressure, grip strength and muscle electrical activity were measured before and after. Pain dropped by 0.79 points after SM and 0.37 points after Smob, a gap of 0.41 points (p = 0.002), which stayed below the 1.3 points considered clinically meaningful. Neck movement improved after both treatments, by about 4.6 degrees after SM and 3.7 degrees after Smob in bending forward and back, with no difference between them. Neck muscles responded more strongly during SM, with activity in the sternocleidomastoid about six times higher (0.144 versus 0.023). Tenderness and grip strength changed inconsistently, and the grip decrease of 1.13 kg was far under the 6 kg detectable change. Participants' own global impression of change favored SM (p < 0.001) but also stayed below the clinical threshold. Upper trapezius activity was likewise higher during SM (0.083 versus 0.024). No serious adverse events were reported. The authors state that statistically significant differences did not reach clinical significance, so the trial cannot support conclusions about which treatment works better in practice. Only immediate effects after one session were measured, many outcomes were tested, participants could tell the treatments apart, and baseline disability was mostly mild to moderate. Clinician training also differed between sites. The authors propose that future trials examine several sessions of each treatment, since a multi-session or combined approach may reach clinical relevance.

Taewoo Kang et al. (2022) · Medicine

This single-blind randomized controlled trial with 41 adults explored two ways of treating chronic neck pain (CNP) -- pain lasting more than three months, often traced to a forward head posture that overloads the cervical spine. The researchers focused on the scapulothoracic region, the muscles connecting the shoulder blade to the rib cage and spine, because weakness in the middle and lower trapezius combined with tightness in the upper trapezius creates a muscle imbalance that drives neck pain and reduced neck mobility. One group performed a resistance exercise program targeting the weakened muscles directly; the other received trapezius massage targeting the tight ones, and both were compared head-to-head over four weeks. Adults aged 29 to 66 (mean 47.9, 22 men, 19 women) with confirmed chronic neck pain were split into a resistance-exercise group (21 people) and a massage group (20 people) at a South Korean clinic, training five days a week for four weeks. The exercise group used elastic bands for eight movements -- chin tucks, rows, and scapular retraction among them -- building from 10-15 up to 15-20 repetitions per set. The massage group received a standardized 20-minute trapezius massage combining myofascial release, trigger-point work, and friction techniques. Pain, neck motion, muscle tone, disability, and quality of life were all measured. Both approaches worked: pain, disability, and quality-of-life scores improved significantly within each group (p<.05 throughout). But head-to-head, resistance exercise pulled ahead on several measures. Pain dropped further with exercise (VAS change 2.67 vs. 2.30 points, p=.02), and disability scores on the Neck Disability Index fell more as well (p=.04). Quality of life improved more on both the physical (p=.04) and mental (p<.001) subscales. Muscle tone and stiffness in the upper trapezius -- the very muscle massage directly targets -- actually decreased more in the exercise group (p=.01 to .03), suggesting that strengthening the weakened muscles around it relieved tension more effectively than massaging the tight muscle itself. Cervical rotation, often the most functionally limited movement in this condition, also improved more with exercise (p<.001 to .02). Flexion, extension, and side-bending improved to a similar degree in both groups, with no meaningful difference in muscle elasticity. For people managing chronic neck pain, a structured resistance program targeting the shoulder-blade stabilizers may offer more relief than massage alone, particularly for pain, disability, quality of life, and neck rotation -- and it requires only elastic bands, making home practice feasible. The trial did not track adverse events or follow participants beyond the 4-week program, so how long the gains last is unknown. It also did not directly measure whether the weakened muscles actually got stronger, so the exact mechanism behind the improvement is inferred rather than proven. Larger studies with longer follow-up periods are needed.

Fatma Shewail et al. (2023) · BMC musculoskeletal disorders

This randomized trial with 33 college students compared two popular hands-on treatments for chronic neck pain: classic myofascial release, where a therapist applies sustained manual pressure into the connective tissue, and instrument-assisted soft tissue mobilization (IASTM), where the same work is done with smooth, contoured metal or plastic tools. The students, averaging 21 years old, had all developed persistent mechanical neck pain while studying remotely during COVID-19 restrictions — the classic screen-hunched population. Each participant received eight sessions over four weeks targeting the upper trapezius and levator scapulae — the muscles running from neck to shoulder blade that carry most desk-posture strain. Researchers measured pain on a visual analog scale, day-to-day function with the Neck Disability Index, and pressure pain threshold with an algometer, an instrument that quantifies how much pressure the tissue tolerates before hurting. Both groups got better on all three measures — but neither treatment beat the other. The between-group comparison showed no statistically significant difference in pain, function, or pressure threshold (p>0.05). The researchers were refreshingly honest about the catch: with no untreated control group, the improvements both groups experienced cannot be confidently credited to the treatments rather than natural recovery or the simple passage of four weeks. They grade their own evidence at level 2b — a candor worth noting, since many small trials in this space claim more than their design supports, and this one deliberately does not. For anyone weighing these therapies, the takeaway is practical: IASTM's specialized tools showed no advantage over a skilled therapist's hands for chronic mechanical neck pain, so choose based on practitioner expertise, comfort, and cost rather than technique hype. And for the field, this study marks a gap worth filling — a three-arm trial adding a control group would answer whether either technique beats watchful waiting, which this design honestly could not.