Laurie's Blogs.

Let’s talk about neck mobilizations for a wee while.  There are so few canine studies in this area… okay, I looked, there are precisely zero!!!  So, why not look at two legged guinea pig studies (i.e. those conducted on human patients) to guide us and help us learn when to use cervical manual therapy and what we might expect from such therapies.  Perhaps someone might even be inspired to duplicate a study or two on canine patients!  Wouldn’t that be something!!  Okay, here we go!

Wilhelm M, Cleland J, Carroll A, et al. The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis. J Man Manip Ther. 2023 Dec;31(6):393-407

Based on this systematic review and meta-analysis of 22 studies, a multi-modal treatment approach including exercise and manual therapy appears to provide similar effects as manual therapy alone, but is more effective than exercise alone or other interventions (control, placebo, ‘conventional physical therapy’, etc.) for the treatment of nonspecific neck pain and related disability.

Farrell G, Reily-Bell M, Chapple C, et al. Autonomic nervous system and endocrine system response to upper and lower cervical spine mobilization in healthy male adults: a randomized crossover trial. J Man Manip Ther. 2023 Dec;31(6):421-434. 

There was a statistically significant reduction in salivary cortisol (sCOR) concentration concentration following lower cervical spine mobilization 30 min following the intervention. This indicates that mobilizations applied to separate target locations within the cervical spine can differentially modulate the stress response.

Garcia JD, Arnold S, Tetley K, et al. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. 2016 Mar 21;7:40. 

Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from cervicogenic headache.

Savva C, Korakakis V, Efstathiou M, Karagiannis C. Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial. J Bodyw Mov Ther. 2021 Apr;26:279-289

66 patients with cervical radiculopathy ((pain down the arm due to neural irritiation from the neck)) were randomly allocated to: a group (n = 22) received cervical traction (CT) combined with neural mobilization (NM) (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). 

At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.  The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), and cervical spine mobility were improved with the combination treatment

 Conclusions

Fascinating, no?  Manual therapy is better than exercise therapies for neck pain.  But why not combine them?  30-minutes following lower cervical mobilizations, there is a reduction in salivary cortisol.  Mobilizations or manipulations to the neck can help with cervicogenic headaches.  I’m sure dogs can get headaches as well.  Traction in combination with nerve glides has a beneficial effect for neck pain with radiating symptoms.  Something to think about combining!

Okay… that’s it for this brain bursting installment.

Until next time… Cheers!

Laurie