Mechanical Neck Pain Manual Therapy and Prescriptive Exercise by Osteopaths

Mechanical Neck Pain

Mechanical Neck Pain is the general term that refers to any type of pain caused by placing abnormal stress and strain on muscles of the vertebral column. Typically, mechanical pain results from bad habits, such as poor posture, poorly-designed seating, and incorrect bending and lifting motions.


What Manual Therapy Techniques do Osteopaths use to Treat Mechanical Neck Pain?

Osteopaths use spinal manipulation, spinal mobilisation / mobilization, spinal distraction, massage, myofascial, muscle energy techniques and strain /counterstrain techniques to treat mechanical neck pain.

Spinal Manipulation

There are different variations of manipulative techniques that can applied to neck and mid back to treat mechanical neck pain. Where a single cervical manipulation is capable of producing both immediate and short-term benefits for mechanical neck pain (Gorrell et al. 2016).

Also not all manipulative techniques have the same effect as the spinal manipulative tecnhiques have dfferent biomechanical characteristics that may be responsible for varying clinical effects (Gorrell et al. 2016).

So essentially the reduction in neck pain is dependent how the technique was applied, the biomechanics of the patients neck and which technique was applied.


Manual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region (neck) producing repeating cycles while the person lies on their back. The traction force of the technique reduces neck pain intensity and neck-related disability (Gudavalli et al. 2015).


Regular massage over a 4 week period can significantly reduce (chronic) neck pain and dysfunction (Cook et al. 2015).

Myofascial Release

Myofascial release is a technique used to the connective tissues over the musculature, usually by pinching the skin and moving the tissue in a rolling motion. The technique has been shown to reduce neck pain disability in the short and long terms (De Meulemeester et al. 2017).

Which Manual Therapy Techniques are the Most Effective for Mechanical Neck Pain?

When you compare the effectiveness of manual therapy techniques applied as a treatment for mechanical neck pain.  It has been shown that the effect of manual therapy including spinal manipulation, mobilization, stretching and massage for patients seeking care for neck  pain in clinic is similar regardless if spinal manipulation or stretching is left out as a treatment option (Paanalahti et al. 2016).

So the osteopath will decide what is the most appropriate technique to apply on a case by case basis and no technique is superior to the other.

Are There Any Adverse Events following Manual Therapy?

Most reports of neck pain started after a manipulation and/or mobilisation, of which 53.4% lasted less than 24 hours, 38.1% more than 24 h but more than 3 months where 13.7% still experienced neck pain to date. Though mild to moderate adverse effects occur follwoing manual therapy are commonly reported and usually resolve within 24 hours (Thoomes-de Graaf et al. 2017).

Consequently, the benefits of reducing the severity of neck pain often outweigh the risks of treatment.  Furthermore, the Osteopath should be careful in their choice and application of manual therapy techniques for treating mechanical neck pain.

How Long Will It Take To Reduce The Severity of Mechanical Neck Pain Following Manual Therapy and Prescribed Exercise?

It can take anywhere between 48-96 hours. As one study showed that Improvements in neck disability and pain do not differ, for at least a 96-hour period, between patients performing general exercises and those performing an Augmented Exercise Programme following Manual Therapy (Petersen et al. 2015). Furthermore exercise  does have some preventive properties by reducing neck pain intensity and improved sensitivity (Murray et al. 2017).

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Reference List

Cook AJ, Wellman RD, Cherkin DC, Kahn JR, Sherman KJ. (2015). Randomized clinical trial assessing whether additional massage treatments for chronic neck painimprove 12- and 26-week outcomes. Spine J. Oct 1;15(10):2206-15

De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. Manipulative Physiol Ther. Jan;40(1):11-20

Gorrell LM, Beath K, Engel RM  (2016). Manual and Instrument Applied Cervical Manipulation for Mechanical Neck Pain: A Randomized Controlled Trial. Manipulative Physiol Ther. Jun;39(5):319-29.

Gudavalli MR, Salsbury SA, Vining RD, Long CR, Corber L, Patwardhan AG, Goertz CM (2015). Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck painTrials. 2015 Jun 5;16:259

Murray M, Lange B, Nørnberg BR, Søgaard K, Sjøgaard G (2017). Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial. BMC Musculoskelet Disord. Apr 7;18(1):147

Paanalahti K, Holm LW, Nordin M, Höijer J, Lyander J, Asker M, Skillgate E (2016). Three combinations of manual therapy techniques within naprapathy in the treatment of neckand/or back pain: a randomized controlled trial. BMC Musculoskelet Disord. Apr 23;17:176.

Petersen SB, Cook C, Donaldson M, Hassen A, Ellis A, Learman K (2015). The effect of manual therapy with augmentative exercises for neck pain: a randomised clinical trial. J Man Manip Ther. Dec;23(5):264-75

Thoomes-de Graaf M, Thoomes E, Carlesso L, Kerry R, Rushton A (2017). Adverse effects as a consequence of being the subject of orthopaedic manual therapy training, a worldwide retrospective survey. Musculoskelet Sci Pract. Jun;29:20-27

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