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Spinal Manipulation or Home Exercise More Effective Than Medication for Acute Neck Pain, Study Finds

A woman holds her neck in pain

© Matthew Lester

Spinal manipulation or home exercise was more effective than medication for treatment of acute to sub-acute neck pain, according to a recent NCCAM-funded study published in the Annals of Internal Medicine. Researchers from Northwestern Health Sciences University and the Minneapolis Medical Research Foundation randomly assigned 272 participants with neck pain, aged 18 to 65, to receive either spinal manipulation therapy, medication, or home exercise instruction.

In the study, spinal manipulation therapy consisted of various techniques, including spinal adjustments (low amplitude, high velocity) and mobilization (low velocity) of areas of the spine. Participants in the medication group received non-steroidal anti-inflammatory drugs, acetaminophen, or both; those who did not respond to these medications or could not tolerate them received narcotic medications. Home exercise with instruction focused on gentle self-controlled movement of the neck and shoulder joints, and participants were instructed to do the exercises six to eight times each day. In addition, participants in this group received two individualized hour-long sessions of one-on-one exercise instruction, as well as written directions for exercise at home.

The researchers observed significant short-term and long-term improvements in participant-rated pain in the spinal manipulation group compared with those receiving medication. At 12 weeks, 82 percent of participants in the spinal manipulation group (compared to 69 percent in the medication group) experienced reductions of pain of at least 50 percent. Similar findings occurred at 26 and 52 weeks. Additionally, the spinal manipulation group reported greater global improvement, participant satisfaction, and function than the medication group. Home exercise with instruction was just as effective as spinal manipulation at each time point.

Few studies exist to date on the management of neck pain with noninvasive methods, such as spinal manipulation, home exercise, or medications. According to the researchers, the findings from this study suggest that both spinal manipulation and home exercise may be viable treatment options for managing neck pain.


  • Bronfort G, Evans R, Anderson AV, et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain. Annals of Internal Medicine.
Publication Date: 
January 3, 2012

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This page last modified September 24, 2017