The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial.

Only 28 women were analysed, with 13 in the manipulation group and 15 in the sham group, so the study was small. The sham group received touch and positioning without the thrust, so the study cannot separate the thrust from the handling or preload. There was no control group with no touch contact. Baseline age differed between groups (37.1 versus 30.1 years), which may reflect chance in a small sample. Participants had relatively low resting pain, including sham scores as low as 1/10 and manipulation scores as low as 2/10, so they may not match typical patients seeking therapy. The study only measured immediate blood changes within about 90 seconds and did not follow patients over time. Cortisol may have been missed because the final blood draw was too early for cortisol, whose half-life is 60 to 90 minutes and whose secretion is not immediate. Venipuncture itself can increase perceived stress and cortisol. Only women were studied, so results may not generalise to men.

Funding was provided by Loma Linda University. The supplied text does not include an author conflict of interest declaration.

Do not read the rises in oxytocin, neurotensin and orexin A after manipulation as proof that manipulation beats sham. The main comparison between manipulation and sham did not show a difference, and the reported outcomes were blood markers, not patient pain or disability.