Spinal Mobilization Most Cost Effective Option for Neck Pain

New research showed that chiropractic led to significant improvements for 94% of neck-pain patients, but how do chiropractic techniques compare to other conservative treatments in the management of neck pain?

To answer that question, it's helpful to look back at an important study from 2003 published in the British Medical Journal. The study compared various conservative treatments and concluded that manual therapy was the most cost-effective option for neck pain.

Researchers from the Netherlands were interested in evaluating not only the costs associated with manual therapy but how efficiently manual therapy delivered relief compared to other treatments.

They randomly assigned 183 patients with acute neck pain to receive care from manual therapists (MT), physiotherapists (PT), or general practitioners (GP). For the purposes of this study, manual therapy consisted of spinal mobilization applied to the neck without spinal adjustments.

Patients receiving manual therapy had the fastest recovery rate. After seven weeks of care, 68% of the MT group had recovered, compared to 51% of the PT group and 36% of the GP group. These differences in recovery rates were still statistically significant after 26 weeks but not after 52 weeks.

To calculate costs of treatments, the researchers considered direct costs such as visits to the healthcare provider and the costs of prescription drugs, in addition to indirect costs like work absenteeism and travel time. The manual therapy group had significantly lower costs, with patients spending only a third of the costs spent by patients in the PT and GP groups. On average manual therapy patients had approximately $611 in costs compared to $1773 in the physiotherapy group and $1885 in the general practitioner group (or $447, $1297, and $1379, respectively). Only nine patients in the MT group reported missed work due to neck pain, compared to 12 in the PT group and 15 in the GP group.

The reduced cost likely stemmed from the fact that MT patients were using significantly less prescription drugs and required fewer treatment interventions due to quicker recovery rates. The authors concluded that manual therapy, specifically spinal mobilization, is less costly and more effective for alleviating neck pain than physiotherapy or care from a general practitioner.


Korthals-de Bos IB, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner. British Medical Journal 2003. doi: http://dx.doi.org/10.1136/bmj.326.7395.911.