Efficacy and Safety of Spinal Manipulation for Acute Neck Pain

Date Posted:

March 2026

Study Title:

Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta‑analysis

Authors:

Diao Y, Liu Y, Pan J, et al.

 

Cervical spine pain is the fourth most common cause of disability worldwide, affecting approximately 30% of the world’s population. Acute neck pain (ANP) typically occurs suddenly, often following injury, and can develop into a severely painful and disabling condition. ANP may improve with or without treatment, although about half of cases will develop chronic or episodic pain (3).

Various clinical guidelines include spinal manipulative therapy (SMT) as part of their recommended protocols for the treatment of neck pain, including acute and sub-acute cases. Guidelines also typically encourage the inclusion of other therapies, such as exercise and education, alongside SMT. Nonetheless, even though the clinical benefits of SMT have been well-documented, further studies are needed to determine the precise magnitude of its efficacy in alleviating pain, reducing disability, and improving function.

SMT for neck pain has been the subject of previous meta-analyses, but patients with acute, sub-acute, and chronic neck pain were included without appropriate discrimination. Since there are significant differences in treatment responses between these phases of neck pain, the results of these meta-analyses may not have been representative of what patients with ANP would experience.

Therefore, the aim of this current review was to evaluate the effectiveness of SMT in alleviating pain in patients with ANP, with pain as the primary outcome, and improving cervical range of motion and reducing disability as secondary outcomes. Also, the safety of cervical SMT was assessed.