Manual Therapy Combined with Exercise for Neck Pain: A Scoping Review of Randomized Controlled Trials

Salsabila Malikatul Jannah; Taufik Eko Susilo

doi:10.24843/

Authors

Salsabila Malikatul Jannah Physiotherapy Study Program, Faculty of Health Sciences, Muhammadiyah University of Surakarta, Surakarta, Indonesia Author
Taufik Eko Susilo Physiotherapy Study Program, Faculty of Health Sciences, Muhammadiyah University of Surakarta, Surakarta, Indonesia Author

DOI:

https://doi.org/10.24843/

Keywords:

Neck Pain, Manual Therapy, Exercise Therapy, Spinal Manipulation, Physical Therapy Modalitie, Randomized Controlled Trials as Topic

Abstract

Background: Neck pain is one of the leading causes of disability worldwide and substantially affects quality of life and work productivity. Manual therapy and exercise are among the most commonly used physiotherapy interventions, yet evidence regarding their combined application remains heterogeneous.

Objective: To map the existing evidence on neck pain types, pain assessment instruments, and combinations of manual therapy and exercise used in randomized controlled trials (RCTs).

Methods: A scoping review was conducted according to PRISMA-ScR guidelines. Electronic searches were performed in PEDro, PubMed, and ScienceDirect for RCTs published between January 2016 and August 2025. Eligible studies included adults with non-pathological neck pain receiving combined manual therapy and exercise. Data were extracted and synthesized narratively.

Results: Twenty RCTs involving sample sizes ranging from 18 to 619 participants were included. Chronic non-specific neck pain and mechanical neck pain were the most frequently investigated conditions. High-velocity low-amplitude manipulation combined with craniocervical flexion or stabilization exercises was the most common intervention. Sixteen of 20 studies reported significant pain reduction following combined interventions (p<0.05). Notable findings included greater improvements in pain, disability, and cervical mobility compared with exercise alone, with effect sizes reaching d=2.21 for cervical rotation and d=1.33 for disability outcomes. The Visual Analogue Scale was the most frequently used pain assessment tool (12 studies).

Conclusion: Combined manual therapy and exercise generally demonstrate favorable effects on pain and function in adults with neck pain. However, substantial heterogeneity in intervention protocols and outcome measures highlights the need for standardized approaches and further high-quality research.