OBJECTIVE: To determine whether neck manipulation is more effective for neck pain than mobilization. DESIGN: Randomized controlled trial with blind assessment of outcome. SETTING: Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia. PARTICIPANTS: Patients (N = 182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner. INTERVENTIONS: Participants were randomly assigned to receive treatment with neck manipulation (n = 91) or mobilization (n = 91). Patients in both groups received 4 treatments over 2 weeks. MAIN OUTCOME MEASURE: The number of days taken to recover from the episode of neck pain. RESULTS: The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio 0.98; 95% confidence interval 0.66 to 1.46). CONCLUSIONS: Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

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