The objective of the present study was to evaluate stretching as an adjunct to chiropractic manipulation in order to determine the possible effect on chronic neck pain. Three groups of chronic neck pain patients were compared in a prospective randomized controlled trial without long-term follow up. The study was conducted at an outpatient university teaching clinic. Sixteen patients suffering from chronic mechanical neck pain were studied: five subjects (mean age 42 years) received chiropractic manipulation alone; five subjects (mean age 45 years) received muscle stretching before chiropractic manipulation; and six patients (mean age 39 years) received muscle stretching after chiropractic manipulation. Clinically, all subjects were diagnosed with chronic mechanical neck pain encompassing a triad of point tenderness, loss of motion and hypertonicity of musculature in the cervical spine. All subjects had suffered from chronic neck pain for a minimum of 12 weeks. There were no significant differences between the three groups with respect to age, sex, history, pain intensity or disability. The subjects had never previously received manipulation or stretching as treatment for their neck pain. Treatment group I received high-velocity, low-amplitude chiropractic manipulation to the cervical spine in the supine position. Treatment group 2 received a series of static stretches to the neck musculature followed by high-velocity, low-amplitude chiropractic manipulation of the cervical spine. Treatment group 3 received high-velocity, low-amplitude chiropractic manipulation of the cervical spine followed by a series of static stretches of the neck musculature. All subjects received a total of eight treatments, given twice a week for 4 weeks consecutively. Level of disability was measured before the study, mid-study and at the end of the study using the Neck Disability Index. Pain intensity was rated before the study, mid-study and at the end of the study on the Numerical Rating Scale 101. Prior to and immediately after each treatment, cervical-spine range of motion (RoM) was recorded in three planes using the Norotrack 360 Motion Analyser. Intra-group results showed that all subjects experienced an increase in RoM, but manipulation with adjunctive pre- or post-stretch had a significantly greater effect on the level of disability and pain intensity. A 58% improvement in pain intensity was seen in the manipulation alone group, while the pre-stretch group saw a significant 88% improvement and the post-stretch group saw a significant 84% improvement in pain intensity. Improvement in disability was three times greater in the pre-stretch group and two times greater in the post-stretch group compared with the manipulation alone. However, inter-group analysis failed to differentiate which treatment was the most effective with regard to RoM, pain and disability (p = 0.05). This pilot study demonstrates that stretching as an adjunct to manipulation may be more effective than manipulation alone in decreasing intra-group pain and intra-group disability in patients with chronic mechanical neck pain. Manipulation alone may create the same improvements to intra-group RoM as does manipulation and stretching. Therefore, stretching may have no additional effect on RoM. The timing of the adjunctive stretch, be it before or after the manipulation, may be of no significance. Since inter-group findings for RoM, pain and disability were not statistically significant, the impact of the intra-group findings may be lessened. Nevertheless, combining manipulation with stretch in this study significantly decreased intra-group pain and disability, and may be considered possibly useful in the management of chronic mechanical neck pain. Further studies are required to determine immediate and long-term benefits of stretching and manipulation for chronic mechanical neck pain.

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