An estimated 70% of people will have neck pain at some point in their lives with 54% of individuals having neck pain within the last six months. Physical therapy is considered to be one of the main conservative treatment options for neck pain and up to 25% of outpatient physical therapy treatments are allocated towards patients with cervical spine issues. Limited data exist on the effectiveness of the MDT for patients with neck pain.

Using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar the inclusion criteria were patients receiving physical therapy treatment, usage of MDT, pain in the cervical region only, any subtype of cervical pain, and records of pain outcomes (0-10 scale including VAS and the NPRS) and disability outcomes (NDI). Only level I randomized controlled trials (RCTs) were included in this systematic review. Exclusion criteria were no interventions using the MDT, pain outcomes not on a 0-10 scale, disability outcomes other than the NDI, pediatric patients, and thoracic pain concurrent with cervical pain.

A meta-analysis was conducted to compare continuous outcomes between studies for patients who received MDT or control interventions (conventional physiotherapy, isometric exercises, or other exercises/interventions).

A total of 1955 articles were retrieved and in the end 11 entered in the review. A total of 677 adult patients were examined within the 11 RCTs with a total of 289 patients receiving MDT for neck pain.

McKenzie Versus Control Interventions Outcomes

When analyzing the post-treatment pain levels following treatment, MDT had a statistically insignificant 1.56- point pain improvement when compared to conventional physical therapy alone.

Mild-to-Moderate Versus Moderate-to-Severe Pain Levels

When comparing post-treatment pain differences between MDT and control groups in patients with mild-to-moderate neck pain, there was a non-significant mean pain level improvement of 0.06 points. However, when comparing post-treatment pain in the five studies with moderate-to-severe pain, a statistically and clinically significant difference of 2.06 points was seen with the use of MDT as compared to improvement from the control interventions.

Conclusions

MDT can provide small but statistically significant improvements in pain, but not disability, in adult patients with neck pain as compared to control interventions. MDT is more effective in patients with higher levels of neck pain (greater or equal to 5/10) compared to controls, whereas the superiority of MDT minimized in patients with mild neck pain (less than 5/10). Therefore, this study can only recommend MDT as superior to control interventions for adult patients with moderate-to-severe neck pain.

Limitations

More research is needed to determine the impact of the MDT based on clinician training and certification. it is possible that differing levels of training in MDT can impact effectiveness. This study only examined patients who exclusively had non-specific neck pain and was not specific for neck pain primarily due to cervical radiculopathy.

Comments

MDT is effective in neck pain especially in moderate to severe incidents. MDT can change pain levels but struggles with disability. Maybe this happens because of the training level of the clinicians that took place in the RCTs of this systematic review. More RCTs with better trained MDT clinicians are needed to change data in the future.

Cervical: Reviews