After low back pain, neck pain is one of the most common reasons patients seek out chiropractic care. In the absence of red flags like suspected cancer, infection, severe neurological loss, or a sudden headache, among others, guidelines for the management of neck pain support the use of manual therapies as an initial treatment approach, often in combination with other therapies to optimize outcomes for the patient. But which types of manual therapy are best for managing neck pain?

While there are a several manual therapies available to a chiropractor, for this discussion, we’ll divide them into thrust and non-thrust. The term high-velocity low-amplitude (HVLA) or “thrust” specifically describes a form of manual therapy accompanied by a cracking noise that results from joint cavitation. This is the type of treatment most commonly associated with chiropractic adjustments and may also be called spinal manipulative therapy or spinal manipulation. On the other hand, low-velocity low-amplitude (LVLA) manual therapies are known as the non-thrust variety as joint cavitation does not usually occur.  These manual therapies are often referred to as mobilization therapy.

A systematic review and meta-analysis of data from six clinical trials identified no differences between thrust- and non-thrust manual therapies applied to either the neck or upper back with respect to improvements in neck pain, disability, or range of motion. Why was the upper back included in a paper regarding managing neck pain? The muscles at the back of the neck that help keep the head upright connect to the upper back area and often, patients with neck pain have a forward head posture, which places added strain on these muscles and contributes to neck pain.

The good news is that doctors of chiropractic are trained to provide both forms of manual therapy, and the treatment used can depend on the patient’s preferences and also their chiropractor’s clinical experience and physical examination findings. In some cases, the decision may not be made until treatment is delivered. Why’s that? If a patient has difficulty relaxing, it is VERY challenging to achieve joint cavitation (cracking) using thrust manipulation as muscle splinting or guarding decreases the ability of the thrust to effectively move the joint. For these patients, the chiropractor will opt for mobilization instead.

Bottom line: TALK to your chiropractor about manual therapy preferences (if there is one) and most likely, you will be accommodated. Further, if you are not satisfied with the results that you’re experiencing, discuss alternate methods of manual therapy and remember there are MANY other effective approaches offered by your chiropractor such as the use of modalities, exercise training, home/office traction, trigger point therapy, and much more.