Effectiveness of osteopathic interventions in patients with non-specific neck pain: A systematic review and meta-analysis

Neck pain is a condition potentially leading to considerable pain and disability for patients, also affecting the healthcare system due to its consequent high costs. In 2017 it was estimated to have 288.7 million cases worldwide (95% CI: 254.7–323.5), with a higher prevalence among women [1,2]. Most of the cases are classified as “non-specific”, namely without any determined disease leading to symptoms [3]. It can last over time, thus being addressed as chronic neck pain, and its prevalence ranges between 30% and 50%, limiting the daily activities in 11.5% of the cases [4].

Physical therapies are one of the strategies used to face this burden, showing positive effects on both short- and long-term periods [5]; the guidelines for the management of non-specific neck pain (NS-NP) suggest a multidisciplinary approach consisting of thoracic and cervical manipulation and/or mobilization, physical exercise, and patients’ education [6].

Some of these manipulations are in common with the osteopathic manipulative treatment (OMT), a manual approach focusing on the diagnosis and treatment of somatic dysfunction (ME 93.0 in the ICD-11 coding tool). Its aim is the improvement of the physiological function together with the support of homeostasis [[7], [8], [9]]. It involves a wide range of manual techniques, such as soft tissue stretching, joint manipulation, resisted isometric ‘muscle energy’ stretching, myofascial release (MFR), craniosacral treatment (CST) and visceral manipulations. Each of these modalities can be applied alone or in combination, depending on the patients' clinical history. Actually, OMT is characterized by a whole-body approach, which can be applied to many body regions, sometimes far from the symptomatic area [10].

Previous reviews and meta-analyses assessed the effectiveness of manual therapies in patients with NS-NP, analyzing different kinds of manipulations alone or combined with exercise; the results showed an overall reduction in pain and disability levels [[11], [12], [13], [14]]. Furthermore, in 2015 Franke et al. investigated the effects of OMT in chronic neck pain, examining only three studies [15].

Therefore, the primary aim of this study was to verify if literature has increased over years, then summarizing evidence concerning the effectiveness of osteopathic interventions in patients with NS-NP for pain reduction and functional status improvement. Lastly, it was also evaluated which kind of osteopathic manipulation performed better than the others and if the improvements lasted over a medium- or a long-term period.

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