Mobilisation

Rating

Category: Allied Health Options

Injury Type: Acute

What is it?

Mobilisation is defined as low-grade/velocity, small or large amplitude passive movement techniques or 'neuro-muscular' technique within the patient's range of neck motion and control. They are gentle, controlled movements of the joints affected and differ from manipulation, with the aim of increasing movement and relieving pain. They are used by physiotherapists to treat joints that have become stiff from lack of movement, and/or are causing pain, such as neck pain resulting from stiff/inflamed joints of the cervical spine.

How does it work?

There has been a systematic review on the effectiveness of mobilisation for mechanical neck disorders (including but not exclusively, whiplash related disorder). Mobilisation was no better at improving pain or function than cold packs, collar, TENS (transcutaneous electrical nerve stimulation), acupuncture and ultrasound in the short or long term. Mobilisation, in conjunction with manipulation showed some potential as being better than no treatment for people with chronic neck disorders and headaches. However, most of the evidence suggests that adding mobilisation to manipulation or other soft tissue techniques does not make much difference to outcomes.

Another recent synthesis of evidence on mechanical neck disorders (not specific to whiplash related disorder) found that mobilisation was more effective than soft collars and general advice. It must be noted that this synthesis was not peer reviewed, as per routine process, and hence its findings should be considered with some caution. It should be noted that none of the research compared mobilisation on its own to no treatment, thus it is not possible to say that mobilisation is not effective. Recently published clinical guidelines for the Physiotherapy management of whiplash associated disorder based on a systematic review of literature found moderately strong evidence for mobilisations in the acute stage (0-2 weeks after injury) but not for the chronic stage.

Is it effective?

There has been a systematic review on the effectiveness of mobilisation for mechanical neck disorders (including but not exclusively, whiplash related disorder). Mobilisation was no better at improving pain or function than cold packs, collar, TENS (transcutaneous electrical nerve stimulation), acupuncture and ultrasound in the short or long term. Mobilisation, in conjunction with manipulation showed some potential as being better than no treatment for people with chronic neck disorders and headaches. However, most of the evidence suggests that adding mobilisation to manipulation or other soft tissue techniques does not make much difference to outcomes.

Another recent synthesis of evidence on mechanical neck disorders (not specific to whiplash related disorder) found that mobilisation was more effective than soft collars and general advice. It must be noted that this synthesis was not peer reviewed, as per routine process, and hence its findings should be considered with some caution. It should be noted that none of the research compared mobilisation on its own to no treatment, thus it is not possible to say that mobilisation is not effective. Recently published clinical guidelines for the Physiotherapy management of whiplash associated disorder based on a systematic review of literature found moderately strong evidence for mobilisations in the acute stage (0-2 weeks after injury) but not for the chronic stage.

Are there any disadvantages?

The systematic review reported benign, transient side effects (related to either/both mobilisation and manipulation) such as headache, radicular pain, thoracic pain, increased neck pain, distal paraesthesia, dizziness, and ear symptoms. Serious side effects were not reported, however, mobilisation is generally regarded as being safe. You may experience some discomfort/soreness during the treatment and over the following day or so, however this should not be severe and should settle quickly.

Where do you get it?

Spinal mobilisation is commonly provided by physiotherapists, and other health professionals such as chiropractors and osteopaths. Treatment should be provided by a qualified professional.

Recommendations

Spinal mobilisation may be useful as an adjunct to other treatments (see multimodal care), however its use as an isolated treatment is not warranted based on the current research evidence.

Key References

  • Dehner, C, Elbel, M, Strobel, P, Scheich, M, Schneider, F, Krischak, G & Kramer, M 2009, 'Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?', Patient Safety in Surgery , vol. 3, no. 2, doi: 10.1186/1754-9493-3-2.
  • Gross, AR, Hoving, JL, Haines, TA, Goldsmith, CH, Kay, T, Aker, P, Bronfort, G, Cervical overview group, 'Manipulation and mobilization for mechanical neck disorders', Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004249. DOI:10.1002/14651858.CD004249.pub2.
  • Guzman, J, Haldeman, S, Carroll, LJ, Carragee, EJ, Hurwitz, EL, Peloso, P, Nordin, M, Cassidy, JD, Holm, LW, Côté, P, Velde, G & Hogg-Johnson, S 2009, 'Task force on neck pain and its associated disorders', Journal of Manipulative and Physiological Therapeutics, vol. 32, pp. 227-243.
  • Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, 'Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders', European Spine Journal, vol. 17, no. 1, pp. 123-152.
  • Leaver, AM, Refshauge, KM, Maher, CG & McAuley, JH 2010, 'Conservative interventions provide short-term relief for non-specific neck pain: a systematic review', Journal of Physiotherapy, vol. 56, pp. 73-85.
  • Mercer, C, Jackson, A & Moore, A 2007, 'Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)', International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.
  • Miller, J, Gross, A, D'Sylva, J, Burnie, SJ, Goldsmith, CH, Graham, N, Haines, T, Brønfort, G & Hoving, JL 2010, 'Manual therapy and exercise for neck pain: A systematic review', Manual Therapy, vol. 15, pp. 334-354.
  • Poorbaugh, K, Brismée, J, Phelps, V & Sizer, P 2008, 'Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management', Pain Practice, vol. 8, no. 1, pp. 65-89.
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