For physiotherapists and manual therapists, the management of acute and subacute neck pain often involves a decision between conservative manual interventions and pharmacological referrals. Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, are a standard line of defense, yet they come with systemic side effect profiles that many patients wish to avoid. A recent multicenter randomized clinical trial, published in the Journal of Traditional Chinese Medicine (December 2025), provides compelling evidence supporting the use of Shi’s cervical manipulation as a superior alternative to diclofenac for both pain relief and functional restoration.
Study Methodology and Scope
The study, titled “Efficacy and safety of Shi’s cervical manipulation versus diclofenac for patients with acute and subacute neck pain,” was a robust, positive-controlled, randomized clinical trial involving 240 patients. Participants were randomly assigned to either the trial group (receiving Shi’s manipulation) or the control group (receiving diclofenac) over a 12-week intervention period.
To ensure a comprehensive analysis of efficacy, the researchers collected data at multiple intervals: immediately post-treatment, followed by assessments at days 1 and 3, and weeks 1, 2, 4, 8, and 12. Uniquely, the study maintained a long-term follow-up protocol, reassessing patients at 26 and 52 weeks post-treatment. This extended timeline allows clinicians to evaluate not just the acute analgesic effects of manipulation, but also its role in preventing recurrence and maintaining long-term spinal health.
Clinical Outcomes: Manipulation vs. Medication
The primary outcome measure was neck pain severity evaluated via the Numerical Rating Scale (NRS). Secondary outcomes included the Neck Disability Index (NDI), cervical range of motion (ROM) measured via mobile instrumentation, patient satisfaction, and safety indices.
The results heavily favored the manual therapy intervention. Immediately following the intervention, the manipulation group demonstrated statistically significant improvements in NRS, NDI, and cervical ROM compared to the diclofenac group (P < 0.01). This superiority was consistent at the 3-day mark and continued through the early weeks of the trial. By weeks 8 and 12, significant differences remained, particularly regarding disability scores and specific ROM vectors such as lateral bending and axial rotation.
Long-Term Efficacy and Safety Profile
Perhaps the most significant finding for clinical practice is the long-term data. At the 26-week and 52-week follow-ups, the manipulation group maintained significantly better scores in both NDI and NRS compared to the medication group (P < 0.01). This suggests that Shi's manipulation facilitates lasting functional correction rather than merely masking symptoms.
Furthermore, the safety profile of the manual intervention was superior. The incidence of adverse reactions in the trial group was significantly lower than that of the control group (P < 0.05). Consequently, patient satisfaction was markedly higher among those receiving manual therapy.
Implications for Manual Therapists
This study reinforces the validity of specific cervical manipulation techniques as a primary intervention for acute and subacute neck pain. By outperforming a standard NSAID in both immediate pain reduction and long-term functional recovery—with fewer adverse events—Shi’s manipulation presents a highly viable, evidence-based treatment option for orthopaedic clinicians.
References
Mingcai, Z., Xun, L., Guoqing, D., Congying, L., Weian, Y., Wei, L., … & Yufeng, W. (2025). Efficacy and safety of Shi’s cervical manipulation versus diclofenac for patients with acute and subacute neck pain: a multicenter clinical randomized trial. Journal of Traditional Chinese Medicine. https://pubmed.ncbi.nlm.nih.gov/41376230/
