Joint Manipulation: Cervical Spine

Introduction

This course describes joint manipulation techniques for the cervical spine (neck manipulation). Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion and specifically glide or slide). Research does imply that manipulations likely affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a relatively rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes mobilization techniques that intend to improve excessive stiffness of the cervical spine and upper thoracic spine stiffness, improve spine range of motion (ROM) restrictions, and reduce cervicothoracic and upper extremity dysfunction. For example, cervical dysfunction has been correlated with lateral epicondylitis, and manipulations of the cervical spine have been correlated with reduced pain and improved function, such as increased grip strength. These techniques may also be used in an integrated approach for cervicothoracic dysfunction, and upper body dysfunction (UBD) including cervicogenic headache, shoulder impingement syndrome (SIS), lateral epicondylitis (tennis elbow), chronic thoracic pain, chronic neck pain, and acromioclavicular dysfunction, and postural dysfunctions including rounded shoulder posture, forward head posture, thoracic kyphosis, or an anterior pelvic tilt. Some evidence and clinical outcomes even suggest that addressing cervical dysfunction and forward head posture can improve long-term outcomes for low back pain patients.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Upper-cervical Manipulation
• Mid-cervical Manipulation
• Cervicothoracic Junction Manipulation

Related Courses

Additional Joint Mobilization Courses

• Joint Manipulation: Cervical Spine
• Joint Manipulation: Thoracic Spine
• Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis
• Joint Manipulation: Elbow (Radial Head) and Wrist
• Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Walker, B. F., Hebert, J. J., Stomski, N. J., Losco, B., & French, S. D. (2013). Short-term usual chiropractic care for spinal pain: a randomized controlled trial. Spine, 38(24), 2071-2078.
2. Passmore, S. R., Burke, J. R., Good, C., Lyons, J. L., & Dunn, A. S. (2010). Spinal manipulation impacts cervical spine movement and Fitts' task performance: a single-blind randomized before-after trial. Journal of manipulative and physiological therapeutics, 33(3), 189-192.
3. Krauss, J., Creighton, D., Ely, J. D., & Podlewska-Ely, J. (2008). The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 16(2), 93-99.
4. Martínez-Segura, R., De-la-Llave-Rincón, A. I., Ortega-Santiago, R., Cleland, J. A., & Fernandez-De-Las-Penas, C. (2012). Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 42(9), 806-814.
5. Saavedra-Hernández, M., Arroyo-Morales, M., Cantarero-Villanueva, I., Fernández-Lao, C., Castro-Sánchez, A. M., Puentedura, E. J., & Fernández-de-las-Peñas, C. (2013). Short-term effects of spinal thrust joint manipulation in patients with chronic neck pain: a randomized clinical trial. Clinical rehabilitation, 27(6), 504-512.
6. Gorrell, L. M., Beath, K., & Engel, R. M. (2016). Manual and instrument applied cervical manipulation for mechanical neck pain: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 39(5), 319-329.
7. Jiang, C. B., Wang, J., Zheng, Z. X., Hou, J. S., Ma, L., & Sun, T. (2012). Efficacy of cervical fixed-point traction manipulation for cervical spondylotic radiculopathy: a randomized controlled trial. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 10(1), 54-58.
8. Bronfort, G., Evans, R., Nelson, B., Aker, P. D., Goldsmith, C. H., & Vernon, H. (2001). A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine, 26(7), 788-797.
   • Cervicogenic Headache
9. Rolle, G., Tremolizzo, L., Somalvico, F., Ferrarese, C., & Bressan, L. C. (2014). Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache. The Journal of the American Osteopathic Association, 114(9), 678-685.
10. Tuchin, P. J., Pollard, H., & Bonello, R. (2000). A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of manipulative and physiological therapeutics, 23(2), 91-95.
11. Vernon, H., Borody, C., Harris, G., Muir, B., Goldin, J., & Dinulos, M. (2015). A randomized pragmatic clinical trial of chiropractic care for headaches with and without a self-acupressure pillow. Journal of manipulative and physiological therapeutics, 38(9), 637-643.
12. Heikkilä, H., Johansson, M., & Wenngren, B. I. (2000). Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Manual therapy, 5(3), 151-157.
13. Haas, M., Groupp, E., Aickin, M., Fairweather, A., Ganger, B., Attwood, M., … & Baffes, L. (2004). Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. Journal of manipulative and physiological therapeutics, 27(9), 547-553.
14. Bove, G., & Nilsson, N. (1998). Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. Jama, 280(18), 1576-1579.
15. Vernon, H., Jansz, G., Goldsmith, C. H., & McDermaid, C. (2009). A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. Journal of manipulative and physiological therapeutics, 32(5), 344-351.
    • Cervical Manipulation and Shoulder
16. Wassinger, C. A., Rich, D., Cameron, N., Clark, S., Davenport, S., Lingelbach, M., … & Davidson, J. (2016). Cervical & thoracic manipulations: acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain. Manual therapy, 21, 227-232.
17. Winters, J. C., Sobel, J. S., Groenier, K. H., Arendzen, H. J., & Meyboom-de Jong, B. (1997). Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study. Bmj, 314(7090), 1320.
18. de Camargo, V. M., Alburquerque-Sendín, F., Bérzin, F., Stefanelli, V. C., de Souza, D. P. R., & Fernández-de-las-Peñas, C. (2011). Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 34(4), 211-220.
19. Mintken, P. E., Cleland, J. A., Carpenter, K. J., Bieniek, M. L., Keirns, M., & Whitman, J. M. (2010). Some factors predict successful short-term outcomes in individuals with shoulder pain receiving cervicothoracic manipulation: a single-arm trial. Physical therapy, 90(1), 26-42.
    • Cervical Manipulation and Elbow
20. Fernández-Carnero, J., Fernández-de-las-Peñas, C., & Cleland, J. A. (2008). Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal of manipulative and physiological therapeutics, 31(9), 675-681.
21. Fernández-De-Las-Peñas, C., Pérez-De-Heredia, M., Brea-Rivero, M., & Miangolarra-Page, J. C. (2007). Immediate effects on pressure pain threshold following a single cervical spine manipulation in healthy subjects. Journal of Orthopaedic & Sports Physical Therapy, 37(6), 325-329.
22. Fernández-Carnero, J., Cleland, J. A., & Arbizu, R. L. T. (2011). Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial. Journal of manipulative and physiological therapeutics, 34(7), 432-440.
23. Vicenzino, B., Collins, D., Benson, H., & Wright, A. (1998). An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. Journal of manipulative and physiological therapeutics, 21(7), 448-453.
24. Vicenzino, B., Collins, D., & Wright, A. (1996). The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia. Pain, 68(1), 69-74.
25. Bautista-Aguirre, F., Oliva-Pascual-Vaca, A., Heredia-Rizo, A. M., Bosca-Gandia, J. J., Ricard, F., & Rodriguez-Blanco, C. (2017). Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial. European journal of physical and rehabilitation medicine, 53(3), 333-341.
26. Suter, E., & McMorland, G. (2002). Decrease in elbow flexor inhibition after cervical spine manipulation in patients with chronic neck pain. Clinical Biomechanics, 17(7), 541-544.
27. Haavik, H., & Murphy, B. (2011). Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of manipulative and physiological therapeutics, 34(2), 88-97.
28. Bracht, M. A., Coan, A. C. B., Yahya, A., & Santos, M. J. D. (2018). Effects of cervical manipulation on pain, grip force control, and upper extremity muscle activity: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 26(2), 78-88.
29. Berglund, K. M., Persson, B. H., & Denison, E. (2008). Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain. Manual therapy, 13(4), 295-299.
    • Cervical Manipulation and Jaw
30. Oliveira-Campelo, N. M., Rubens-Rebelatto, J., MartÍn-Vallejo, F. J., Alburquerque-SendÍn, F., & Fernández-de-las-Peñas, C. (2010). The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. Journal of orthopaedic & sports physical therapy, 40(5), 310-317.
31. Mansilla-Ferragut, P., Fernández-de-las Peñas, C., Alburquerque-Sendín, F., Cleland, J. A., & Boscá-Gandía, J. J. (2009). Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain. Journal of manipulative and physiological therapeutics, 32(2), 101-106.
32. Haavik, H., Özyurt, M., Niazi, I., Holt, K., Nedergaard, R., Yilmaz, G., & Türker, K. (2018). Chiropractic manipulation increases maximal bite force in healthy individuals. Brain sciences, 8(5), 76.
33. La Touche, R., París-Alemany, A., Mannheimer, J. S., Angulo-Díaz-Parreño, S., Bishop, M. D., Lopéz-Valverde-Centeno, A., … & Fernández-Carnero, J. (2013). Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain?: A randomized-controlled trial. The Clinical journal of pain, 29(3), 205-215.
34. Pedroni, C. R., Oliveira, A. S., & Bérzin, F. (2005). Immediate effect of cervical mobilization in temporomandibular disorder patients. Brazilian Journal of Oral Sciences, 4(15), 911-918.
35. Calixtre, L. B., Grüninger, B. L. D. S., Haik, M. N., Alburquerque-Sendín, F., & Oliveira, A. B. (2016). Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. Journal of Applied Oral Science, 24(3), 188-197.
36. Packer, A. C., Pires, P. F., Dibai-Filho, A. V., & Rodrigues-Bigaton, D. (2015). Effect of upper thoracic manipulation on mouth opening and electromyographic activity of masticatory muscles in women with temporomandibular disorder: a randomized clinical trial. Journal of manipulative and physiological therapeutics, 38(4), 253-261.
37. George, J. W., Fennema, J., Maddox, A., Nessler, M., & Skaggs, C. D. (2007). The effect of cervical spine manual therapy on normal mouth opening in asymptomatic subjects. Journal of chiropractic medicine, 6(4), 141-145.
    • Systemic Response (including 13, 20, 22, 25, 27, 28, )
38. Win, N. N., Jorgensen, A. M. S., Chen, Y. S., & Haneline, M. T. (2015). Effects of upper and lower cervical spinal manipulative therapy on blood pressure and heart rate variability in volunteers and patients with neck pain: a randomized controlled, cross-over, preliminary study. Journal of chiropractic medicine, 14(1), 1-9.
39. Goertz, C. M., Salsbury, S. A., Vining, R. D., Long, C. R., Pohlman, K. A., Weeks, W. B., & Lamas, G. A. (2016). Effect of spinal manipulation of upper cervical vertebrae on blood pressure: results of a pilot sham-controlled trial. Journal of manipulative and physiological therapeutics, 39(5), 369-380.
40. Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cleland, J. A., Rodríguez-Blanco, C., & Alburquerque-Sendín, F. (2008). Changes in pressure pain thresholds over C5-C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. Journal of manipulative and physiological therapeutics, 31(5), 332-337.
41. Ruiz-Sáez, M., Fernández-de-las-Peñas, C., Blanco, C. R., Martínez-Segura, R., & García-León, R. (2007). Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. Journal of manipulative and physiological therapeutics, 30(8), 578-583.
42. Srbely, J. Z., Vernon, H., Lee, D., & Polgar, M. (2013). Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Journal of manipulative and physiological therapeutics, 36(6), 333-341.
43. Coronado, R. A., Bialosky, J. E., Bishop, M. D., Riley 3rd, J. L., Robinson, M. E., Michener, L. A., & George, S. Z. (2015). The comparative effects of spinal and peripheral thrust manipulation and exercise on pain sensitivity and the relation to clinical outcome: a mechanistic trial using a shoulder pain model. journal of orthopaedic & sports physical therapy, 45(4), 252-264.
44. Dishman, J. D., & Burke, J. (2003). Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study. The spine journal, 3(3), 204-212.
45. Niazi, I. K., Türker, K. S., Flavel, S., Kinget, M., Duehr, J., & Haavik, H. (2015). Changes in H-reflex and V-waves following spinal manipulation. Experimental brain research, 233(4), 1165-1173.
46. Daligadu, J., Haavik, H., Yielder, P. C., Baarbe, J., & Murphy, B. (2013). Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. Journal of manipulative and physiological therapeutics, 36(8), 527-537.
47. Lelic, D., Niazi, I. K., Holt, K., Jochumsen, M., Dremstrup, K., Yielder, P., … & Haavik, H. (2016). Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: A brain source localization study. Neural plasticity, 2016.
48. Haavik-Taylor, H., & Murphy, B. (2007). Transient modulation of intracortical inhibition following spinal manipulation. Chiropractic Journal of Australia, 37(3), 106.
49. Haavik, H., Niazi, I., Jochumsen, M., Sherwin, D., Flavel, S., & Türker, K. (2017). Impact of spinal manipulation on cortical drive to upper and lower limb muscles. Brain sciences, 7(1), 2.
50. Christiansen, Thomas Lykke, Imran Khan Niazi, Kelly Holt, Rasmus Wiberg Nedergaard, Jens Duehr, Kathryn Allen, Paul Marshall, Kemal S. Türker, Jan Hartvigsen, and Heidi Haavik. "The effects of a single session of spinal manipulation on strength and cortical drive in athletes." European journal of applied physiology 118, no. 4 (2018): 737-749.
51. Humphries, K. M., Ward, J., Coats, J., Nobert, J., Amonette, W., & Dyess, S. (2013). Immediate effects of lower cervical spine manipulation on handgrip strength and free-throw accuracy of asymptomatic basketball players: a pilot study. Journal of chiropractic medicine, 12(3), 153-159.
52. Dunning, J., & Rushton, A. (2009). The effects of cervical high-velocity low-amplitude thrust manipulation on resting electromyographic activity of the biceps brachii muscle. Manual therapy, 14(5), 508-513.
53. Herzog, W., Scheele, D., & Conway, P. J. (1999). Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. Spine, 24(2), 146-152.
54. Pires, P. F., Packer, A. C., Dibai-Filho, A. V., & Rodrigues-Bigaton, D. (2015). Immediate and short-term effects of upper thoracic manipulation on myoelectric activity of sternocleidomastoid muscles in young women with chronic neck pain: A Randomized Blind Clinical Trial. Journal of manipulative and physiological therapeutics, 38(8), 555-563.
    • Cervical Manipulation versus Other Interventions
55. Escortell, E. M., Lebrijo, G. P., Pérez, Y. M., del Barco Asúnsolo, A., Riesgo, R. F., & Saa, C. R. (2008). Randomized clinical trial for primary care patients with neck pain: manual therapy versus electrical stimulation. Atencion primaria, 40(7), 337-343.
56. Hamilton, L., Boswell, C., & Fryer, G. (2007). The effects of high-velocity, low-amplitude manipulation and muscle energy technique on suboccipital tenderness. International journal of osteopathic medicine, 10(2-3), 42-49.
57. Lin, J. H., Shen, T., Chung, R. C. K., & Chiu, T. T. W. (2013). The effectiveness of Long's manipulation on patients with chronic mechanical neck pain: a randomized controlled trial. Manual therapy, 18(4), 308-315.
58. Saavedra-Hernández, M., Castro-Sánchez, A. M., Arroyo-Morales, M., Cleland, J. A., Lara-Palomo, I. C., & Fernandez-De-Las-Penas, C. (2012). Short-term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 42(8), 724-730.
59. Galindez-Ibarbengoetxea, X., Setuain, I., Ramírez-Velez, R., Andersen, L. L., González-Izal, M., Jauregi, A., & Izquierdo, M. (2017). Immediate Effects of Osteopathic Treatment Versus Therapeutic Exercise on Patients With Chronic Cervical Pain. Alternative Therapies in Health & Medicine, 23(7).
60. Moretti, B., Vetro, A., Garofalo, R., Moretti, L., Patella, S., Patella, V., & Simone, C. (2004). Manipulative therapy in the treatment of benign cervicobrachialgia of mechanical origin. La Chirurgia degli organi di movimento, 89(1), 81-86.
61. McReynolds, T. M., & Sheridan, B. J. (2005). Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. Journal of the American Osteopathic Association, 105(2), 57.
62. Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of internal medicine, 156(1_Part_1), 1-10.
63. Hoving, J. L., Koes, B. W., de Vet, H. C., van der Windt, D. A., Assendelft, W. J., van Mameren, H., … & Bouter, L. M. (2002). Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: a randomized, controlled trial. Annals of internal medicine, 136(10), 713-722.
64. Hoving, J. L., de Vet, H. C., Koes, B. W., van Mameren, H., Devillé, W. L., van der Windt, D. A., … & Bouter, L. M. (2006). Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. The Clinical journal of pain, 22(4), 370-377.
65. Korthals-de Bos, I. B., Müllner, M., Hoving, J. L., van Tulder, M. W., Rutten-van Mölken, M. P., Adèr, H. J., … & Bouter, L. M. (2003). Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trialCommentary: Bootstrapping simplifies appreciation of statistical inferences. Bmj, 326(7395), 911-914.
    • Cervical Manipulation and Other Interventions
66. FALLA, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. Eur J Phys Rehabil Med.
67. Antonia, G. C. (2014). Efficacy of manual and manipulative therapy in the perception of pain and cervical motion in patients with tension-type headache: a randomized, controlled clinical trial. Journal of chiropractic medicine, 13(1), 4-13.
68. Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., … & Richardson, C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 27(17), 1835-1843.
69. Akhter et al. demonstrated that both manual therapy and exercise improved pain and function related to non-specific neck pain, however, the best results were exhibited by the combined intervention group.
70. Evans, R., Bronfort, G., Nelson, B., & Goldsmith, C. H. (2002). Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine, 27(21), 2383-2389.
71. Moustafa, I. M., & Diab, A. A. (2015). The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatology international, 35(7), 1163-1174.
72. Evans, R., Bronfort, G., Schulz, C., Maiers, M., Bracha, Y., Svendsen, K., … & Transfeldt, E. (2012). Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine, 37(11), 903-914.
73. Maiers, M., Bronfort, G., Evans, R., Hartvigsen, J., Svendsen, K., Bracha, Y., … & Grimm, R. (2014). Spinal manipulative therapy and exercise for seniors with chronic neck pain. The Spine Journal, 14(9), 1879-1889.
74. Martel, J., Dugas, C., Dubois, J. D., & Descarreaux, M. (2011). A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain. BMC musculoskeletal disorders, 12(1), 41.
75. Boline, P. D., Kassak, K., Bronfort, G., Nelson, C., & Anderson, A. V. (1995). Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics, 18(3), 148-154.
76. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of manipulative and physiological therapeutics, 21(8), 511-519.
77. Saayman L, Hay C, Abrahamse H. Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study. J Manipulative Physiol Ther. 2011;34(3):153-63.
78. Li, C., Zhang, X. L., Ding, H., Tao, Y. Q., & Zhan, H. S. (2007). Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 5(4), 403-406.
79. Puentedura, E. J., Landers, M. R., Cleland, J. A., Mintken, P., Huijbregts, P., & Fernandez-De-Las-Peñas, C. (2011). Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 41(4), 208-220.
    • Risk of Adverse Effects
80. Magarey, M. E., Rebbeck, T., Coughlan, B., Grimmer, K., Rivett, D. A., & Refshauge, K. (2004). Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Manual Therapy, 9(2), 95-108.
81. Stevinson, C., Honan, W., Cooke, B., & Ernst, E. (2001). Neurological complications of cervical spine manipulation. Journal of the Royal Society of Medicine, 94(3), 107-110.
82. Haldeman, S., Carey, P., Townsend, M., & Papadopoulos, C. (2002). Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. The Spine Journal, 2(5), 334-342.
83. Dvořák, J., Loustalot, D., Baumgartner, H., & Antinnes, J. A. (1993). Frequency of complications of manipulation of the spine. European Spine Journal, 2(3), 136-139.
84. Thiel, H. W., Bolton, J. E., Docherty, S., & Portlock, J. C. (2007). Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine, 32(21), 2375-2378.
85. Rothwell, D. M., Bondy, S. J., & Williams, J. I. (2001). Chiropractic manipulation and stroke. Stroke, 32(5), 1054-1063.
86. Kranenburg, H. A., Schmitt, M. A., Puentedura, E. J., Luijckx, G. J., & Van der Schans, C. P. (2017). Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: a systematic review. Musculoskeletal science and practice, 28, 32-38.
87. Cagnie, B., Vinck, E., Beernaert, A., & Cambier, D. (2004). How common are side effects of spinal manipulation and can these side effects be predicted?. Manual therapy, 9(3), 151-156.
88. Paanalahti, K., Holm, L. W., Nordin, M., Asker, M., Lyander, J., & Skillgate, E. (2014). Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC musculoskeletal disorders, 15(1), 77.
89. Di Fabio, R. P. (1999). Manipulation of the cervical spine: risks and benefits. Physical Therapy, 79(1), 50-65.
90. Puentedura et al. analyzed 10 reported cases of injury following thoracic manipulation, noting that spinal cord injury and pneumothorax have occurred.
91. Smith, W. S., Johnston, S. C., Skalabrin, E. J., Weaver, M., Azari, P., Albers, G. W., & Gress, D. R. (2003). Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology, 60(9), 1424-1428.
92. Oppenheim, J. S., Spitzer, D. E., & Segal, D. H. (2005). Nonvascular complications following spinal manipulation. The Spine Journal, 5(6), 660-666.
93. Haneline, M. T., Croft, A. C., & Frishberg, B. M. (2003). Association of internal carotid artery dissection and chiropractic manipulation. The Neurologist, 9(1), 35-44.
94. Herzog, W., Tang, C., & Leonard, T. (2015). Internal carotid artery strains during high-speed, low-amplitude spinal manipulations of the neck. Journal of manipulative and physiological therapeutics, 38(9), 664-671.
95. Quesnele, J. J., Triano, J. J., Noseworthy, M. D., & Wells, G. D. (2014). Changes in vertebral artery blood flow following various head positions and cervical spine manipulation. Journal of manipulative and physiological therapeutics, 37(1), 22-31.
96. Licht, P. B., Christensen, H. W., Højgaard, P., & Marving, J. (1998). Vertebral artery flow and spinal manipulation: a randomized, controlled and observer-blinded study. Journal of manipulative and physiological therapeutics, 21(3), 141-144.
97. Qi, J., Ping, R., Zhang, S., Xu, Y., Wu, K., & Li, Y. (2019). Effects of Cervical Rotatory Manipulation (CRM) on Carotid Atherosclerosis Plaque in Vulnerability: A Histological and Immunohistochemical Study Using Animal Model. BioMed research international, 2019.
98. Guan, T., Zeng, Y., Qi, J., Qin, B., Fu, S., Wang, G., & Zhang, L. (2019). Effects of Cervical Rotatory Manipulation on Internal Carotid Artery in Hemodynamics Using an Animal Model of Carotid Atherosclerosis: A Safety Study. Medical science monitor: international medical journal of experimental and clinical research, 25, 2344.
99. Huang, X., Ye, L., Wu, Z., Liang, L., Wang, Q., Yu, W., … & Jiang, X. (2018). Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three-Dimensional Finite Element Analysis. Evidence-Based Complementary and Alternative Medicine, 2018.
100. Haldeman, S., Kohlbeck, F. J., & McGregor, M. (2002). Stroke, cerebral artery dissection, and cervical spine manipulation therapy. Journal of neurology, 249(8), 1098-1104.
101. Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based caseecontrol and case-crossover study. Spine 2008;33(4 Suppl):S176e83
102. Barker, S., Kesson, M., Ashmore, J., Turner, G., Conway, J., & Stevens, D. (2001). Guidance for pre-manipulative testing of the cervical spine. Physiotherapy, 87(6), 318-321.
103. Magarey, M. E., Rebbeck, T., Coughlan, B., Grimmer, K., Rivett, D. A., & Refshauge, K. (2004). Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Manual Therapy, 9(2), 95-108.
104. Uitvlugt, G., & Indenbaum, S. (1988). Clinical assessment of atlantoaxial instability using the sharp‐purser test. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 31(7), 918-922.
105. Cattrysse, E., Swinkels, R. A. H. M., Oostendorp, R. A. B., & Duquet, W. (1997). Upper cervical instability: are clinical tests reliable?. Manual Therapy, 2(2), 91-97.
106. Hutting, N., Scholten-Peeters, G. G., Vijverman, V., Keesenberg, M. D., & Verhagen, A. P. (2013). Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Physical therapy, 93(12), 1686-1695.
107. Forrester, G. A., & Barlas, P. (1999). Reliability and Validity of the Sharp-Purser Test in the Assessment of Atlanto-axial Instability in Patients with Rheumatoid Arthritis. Physiotherapy, 85(7), 376.
108. Kaale, B. R., Krakenes, J., Albrektsen, G., & Wester, K. (2008). Clinical assessment techniques for detecting ligament and membrane injuries in the upper cervical spine region—a comparison with MRI results. Manual therapy, 13(5), 397-403.
109. Cote, P., Kreitz, B. G., Cassidy, J. D., & Thiel, H. (1996). The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis. Journal of Manipulative and Physiological Therapeutics, 19(3), 159-164.
110. Kranenburg, H. A., Lakke, S. E., Schmitt, M. A., & Van der Schans, C. P. (2017). Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients. Journal of Manual & Manipulative Therapy, 25(5), 279-287.
111. Carnes, D., Mullinger, B., & Underwood, M. (2010). Defining adverse events in manual therapies: a modified Delphi consensus study. Manual therapy, 15(1), 2-6.
112. Kranenburg, R., Schmitt, M. A., Luijckx, G. J., Puentedura, E. J., & van der Schans, C. (2016, July). Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics: a systematic review. In International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) Conference 2016.
113. Chaibi, A., & Russell, M. B. (2019). A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Annals of medicine, 51(2), 118-127.
114. Haldeman, S., Kohlbeck, F. J., & McGregor, M. (2002). Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine, 27(1), 49-55.
115. Hurwitz, E. L., Morgenstern, H., Vassilaki, M., & Chiang, L. M. (2004). Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study. Journal of Manipulative and physiological Therapeutics, 27(1), 16-25.
116. Rubinstein, S. M., Leboeuf-Yde, C., Knol, D. L., de Koekkoek, T. E., Pfeifle, C. E., & van Tulder, M. W. (2007). The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. Journal of Manipulative and Physiological Therapeutics, 30(6), 408-418.
117. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66–99. Spine, 40(4), 264.
118. Dabbs, V., & Lauretti, W. J. (1995). A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics, 18(8), 530-536.
     • Mobilization versus Manipulation
119. Martínez-Segura, R., Fernández-de-las-Peñas, C., Ruiz-Sáez, M., López-Jiménez, C., & Rodríguez-Blanco, C. (2006). Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 29(7), 511-517.
120. Waqas, S., Ahmad, A., Ahmad, S., Shafi, T., & Shahid, H. A. (2016). Comparison of Maitland Thoracic Spine Manipulation Versus Maitland Cervical Spine Mobilization in Chronic Unilateral C6 –C7 Cervical Radiculopathy. Annals of King Edward Medical University, 22(2)
121. Cassidy, J. D., Lopes, A. A., & Yong-Hing, K. (1992). The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 15(9), 570-575.
122. Dunning, J. R., Cleland, J. A., Waldrop, M. A., Arnot, C., Young, I., Turner, M., & Sigurdsson, G. (2012). Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. journal of orthopaedic & sports physical therapy, 42(1), 5-18.
123. El-Sodany, A. M., Alayat, M. S. M., & Zafer, A. M. I. (2014). Sustained natural apophyseal glides mobilization versus manipulation in the treatment of cervical spine disorders: a randomized controlled trial. Int J Adv Res, 2(6), 274-280.
124. Lopez-Lopez, A., et al. "Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial." Eur J Phys Rehabil Med 51.2 (2015): 121-32.
125. Leaver, A. M., Maher, C. G., Herbert, R. D., Latimer, J., McAuley, J. H., Jull, G., & Refshauge, K. M. (2010). A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Archives of physical medicine and rehabilitation, 91(9), 1313-1318.
126. Pérez, H. I., Perez, J. L. A., Martinez, A. G., La Touche, R., Lerma-Lara, S., Gonzalez, N. C., … & Fernández-Carnero, J. (2014). Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain. Manual therapy, 19(3), 215-221.
127. Griswold, D., Learman, K., O'Halloran, B., & Cleland, J. (2015). A preliminary study comparing the use of cervical/upper thoracic mobilization and manipulation for individuals with mechanical neck pain. Journal of Manual & Manipulative Therapy, 23(2), 75-83.
128. Griswold, D., Learman, K., Kolber, M. J., O'Halloran, B., & Cleland, J. A. (2018). Pragmatically applied cervical and thoracic nonthrust manipulation versus thrust manipulation for patients with mechanical neck pain: a multicenter randomized clinical trial. journal of orthopaedic & sports physical therapy, 48(3), 137-145.
129. Hurwitz, E. L., Morgenstern, H., Harber, P., Kominski, G. F., Yu, F., & Adams, A. H. (2002). A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. American Journal of Public Health, 92(10), 1634-1641.
130. Parker, G. B., Tupling, H., & Pryor, D. S. (1978). A controlled trial of cervical manipulation for migraine. Australian and New Zealand journal of medicine, 8(6), 589-593.
131. Dunning, J. R., Butts, R., Mourad, F., Young, I., Fernandez-de-las Peñas, C., Hagins, M., … & Cleland, J. A. (2016). Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC musculoskeletal disorders, 17(1), 64
     • Additional Research
132. Allan, M., Brantingham, J. W., & Menezes, A. (2003). Stretching as an adjunct to chiropractic manipulation of chronic neck pain-before, after or not at all? A prospective randomized controlled clinical trial. European Journal of Chiropractic, 50(2), 41-52.
133. Peterson, C. K., Schmid, C., Leemann, S., Anklin, B., & Humphreys, B. K. (2013). Outcomes from magnetic resonance imaging–confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up. Journal of manipulative and physiological therapeutics, 36(8), 461-467.
134. Fisher, A. R., Bacon, C. J., & Mannion, J. V. (2015). The effect of cervical spine manipulation on postural sway in patients with nonspecific neck pain. Journal of Manipulative and physiological therapeutics, 38(1), 65-73.
135. Shilton, M., Branney, J., de Vries, B. P., & Breen, A. C. (2015). Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropractic & manual therapies, 23(1), 33.
136. Karas, S., Olson Hunt, M. J., Temes, B., Thiel, M., Swoverland, T., & Windsor, B. (2018). The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 26(1), 3-10.
137. Ssavedra-Hernández, M., Castro-Sánchez, A. M., Fernández-de-las-Peñas, C., Cleland, J. A., Ortega-Santiago, R., & Arroyo-Morales, M. (2011). Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine. Journal of manipulative and physiological therapeutics, 34(3), 144-152.