Table 3.

Intervention description and outcomes

Citation	Pre-intervention assessment/testing	Intervention	Length of intervention	Longitudinal follow-up	Clinical outcomes	Patient satisfaction
Casagrande et al. [34]	Not reported	After 4-weeks of rest the patient started a rehabilitation program 2-weeks of Tecar Therapy sessions, manual passive physical therapy, deltoid muscle electrostimulation After 2-weeks, 2 × /week of hydrokinesis sessions, hydrobike, walking, water walking, running After 8-weeks restart working directly on soccer field	8-weeks	Playing professional soccer (“Serie B”) 5-years post-operative	Return to sport (work) after less than 4-months	Not reported
Cole et al. [49]	10 mg hydrocodone, 3–4 × daily Average NRS 6/10 Best NRS 4/10 Worst NRS 10/10 BBQ 48/70	7 visits: Myofascial release to thoracic and lumbar musculature HVLA SMT to cervicothoracic junction and thoracic spine Table-assisted drop SMT to sacroiliac joints Table-assisted flexion distraction SMT Home care consisting of stretching, foam rolling, end range loading	Undetermined (at least 3 months duration)	1-week, 2-month follow ups, undetermined thereafter	Opioid therapy discontinued NRS 3/10 BBQ 30/70	Not reported
Cooper and Golberg [35]	Not reported	Patient presented 9 × just over 1-month with 6 SMT, 2 of which were cervical Cervical SMT consisted of consecutive T1, T2 prone toggle table assisted thrust; C5 instrument assisted thrust using 25 pounds of force	~ 1-month	Not reported	Patient reported “significant” pain reduction	Not reported
Harrison et al. [36]	Patient reported condition interfered with work duties Right-sided weakness in grip strength NRS 6/10 NDI 18% disability ROM: 32◦ Ext 48◦ Flex 23◦ L Rot 69◦ R Rot 31◦ L LF 27◦ R LF	10 visits over ~ 1-month: Manual and instrument assisted SMT to non-fused cervical and upper thoracic spine Cervical rotational stretching Cervical and thoracic myofascial therapy Cervical and thoracic region cryotherapy 11 visits over ~ 1-month: “Mirror image postural” SMT Manual and instrument assisted SMT to cervical and thoracic spine Mirror image exercise Mirror image cervical spine extension traction 8 visits over 4-months: Combination of above treatments 30 visits over 26-months: Combination of above treatments 59 total visits	~ 32-months	1, 2, 6, 21, 32-month follow ups	1-month follow up: Decreased C5–C6 dermatome sensation Right-sided weakness in grip strength NRS 2/10 NDI 22% disability ROM: 32◦ Ext 50◦ Flex 27◦ L Rot 59◦ R Rot 27◦ L LF 23◦ R LF 2-month follow up: NRS 1/10 NDI 12% disability ROM: 44◦ Ext 50◦ Flex 23◦ L Rot 63◦ R Rot 28◦ L LF 34◦ R LF 6-month follow up: NRS 1/10 NDI 10% disability 21-month follow up: Normal C5-C6 dermatome sensation Patient reported perceived increased grip strength Patient returned to work 32-month follow up: NRS 2/10 NDI 8% disability	Not reported
Murphy and Morris [37]	Motor strength was + 5/5 bilaterally throughout DTRs were absent with the exception of ankle jerks (1 + bilaterally and symmetric) ROM of cervical spine was restricted and painful in all directions	Initial recommendation to apply ice to cervical spine and maintain mobility Patient returned the following day: Administered C2-C3 SMT using lateral flexion muscle energy technique with patient in supine posture with instruction to continue ice application at home Patient returned the next day reporting inability to lift left arm and a “buzzing” sensation throughout the thoracic, lumbar regions MRI was performed the following day	2 days	Not Applicable	Patient died of heart failure while receiving MRI MRI revealed epidural abscess extending from C2-C4 within right posterior epidural space	Not reported
Polkinghorn and Colloca [38]	Unable to demonstrate cervical ROM due to pain Psychologically distraught	Instrument assisted cervical SMT	Total of 30 treatments over 8-months; initially 3x/week with progressive decrease in treatment frequency	1-week, 1-month, 2-month, 2-year follows ups	End of week 1, acute exacerbation resolved After 1 month almost all previous chronic neck pain resolved After 2 months patient was pain-free and observable cervical range of motion had improved to near normal; Patient resumed strenuous physical activity (skiing, jogging, and vigorous exercise) At 2-years chronic neck problem completely resolved	Patient reported satisfaction
Salvatori et al. [39]	NPRS neck: 10 NPRS headache: 3 NDI: 46 Cervical ROM: 30◦ Ext 18◦ Flex 25◦ L Rot 10◦ R Rot 10◦ L LF 15◦ R LF Grip strength (kg): Left 22.7 Right 22.2 DNF Endurance Test: 3	ROM—therapeutic exercise interventions included active cervical rotation, Flex and Ext self-mobilization techniques for thoracic spine Strength was addressed using a gradual progression from cervical isometric exercises, supine DNF exercises, to isotonic cervical exercises and a combination of cervical and thoracic spine postural strengthening during functional positions Therapeutic exercises were progressed from an emphasis on increasing mobility, followed by exercises dosed for endurance and strength At the 2nd visit, thoracic spine thrust SMT was initiated	12 physical therapy sessions over 6 weeks	6 weeks	NPRS neck: 0 NPRS headache: 0 NDI: 16 Cervical ROM: 62◦ Ext 65◦ Flex 70◦ L Rot 75◦ R Rot 35◦ L LF 33◦ R LF Grip strength (kg): Left 29.5 Right 35.4 DNF Endurance Test: > 90	Not reported
Tibbles [42]	Decreased ROM and pain with cervical ext and r rot Decreased C6 dermatome to light touch on right  + 4/5 strength right biceps 1 cm wasting in right biceps	Gentle cervical SMT at C5-C6 level on painful side	1.5 weeks	1.5 weeks, 4.5 weeks	Felt 80% better after 1.5 weeks of treatment—only slight neck pain, occasional numbness in arm 4.5 weeks after beginning treatment—pain free with slight right wrist extensor muscle weakness (4 + /5)	Not reported
Bloink and Blum [43]	Unable to run/walk > 1/2 mile Strength:  + 4/5 right supraspinatus,  + 4/5 right infraspinatus,  + 4/5 right subscapularis,  + 4/5 right teres minor,  + 4/5 right triceps,  + 4/5 bilateral deltoids NRS 8–9/10 Cervical ROM: Bilateral Rotation 10 degrees with pain Cervical Flexion, Extension, Bilateral Lateral Flexion produced neck pain Strength:  + 4/5 bilateral supraspinatus,  + 4/5 bilateral infraspinatus,  + 4/5 bilateral deltoids  + 4/5 right subscapularis,  + 4/5 right teres minor,  + 4/5 right triceps,  + 4/5 right biceps	12 visits over ~ 2 months: Category 1 SOT blocking, intra-oral cranial adjustments, sphenomaxillary cranial treatment Immediate co-management with dental office 10 visits over ~ 5 weeks consisting of category 1 SOT blocking, intra-oral cranial adjustments, sphenomaxillary cranial treatment; 3 of these visits included immediate co-management with dental office 14 visits over ~ 16 weeks consisting of treatment of the thoracic, lumbar, sacroiliac regions	~ 2-months  ~ 21-weeks	~ 2-month  ~ 5, 21-week follow-ups	Hiked 10 miles which he reported he had not been able to for 2 1/2 years Ran one mile without experiencing any symptoms Cervical spine and arm pain abolished with occasional right periscapular pain Cervical spine ROM returned to normal in all directions  ~ 5-week follow up: NRS 3/10 during provocative activities Significantly reduced right upper extremity pain Left arm symptoms resolved 5 + upper extremity strength throughout  ~ 21-week follow up: Occasional pain in right shoulder and bicep occurring after participating in strenuous activities	Not Reported Not Reported
Malone et al. [40]	Not reported Not reported	Series of neck SMT of unknown quantity or duration Cervical SMT	Not reported Not reported	Not reported Not reported	Not reported Not reported	Not reported Not reported
Peolsson et al. [32]	VAS neck (0–100 mm) VAS arm (0–100 mm) NDI Neck ROM Hand strength NME Manual Dexterity Arm Elevation	Group 1: ACDF with postoperative PT (n = 31) Post-operative advice including ROM, posture, ergonomics, and avoiding static workload 6-weeks post-operative PT same as group 2 Group 2: PT alone (n = 32) Structured program with gradual progression through defined set of exercises integrated with cognitive-behavioral approach Medical exercise therapy focused on neck stabilization and endurance, strengthening of scapular muscles, stretching neck and shoulder muscles, thoracic mobilization Program was performed 2x/week for 14 weeks Education in pain management was conducted 1/week for 14 weeks 18 patients who experienced dizziness were also instructed in vestibular rehabilitation	14 weeks	6, 12, 24-month follow ups	No significant differences in any reported outcome measures between groups	Not reported
Ren et al. [33]	Neck pain VAS NDI Self-Rating Anxiety Scale QUALEFFO-41	Group 1: Routine Care and Foot Massage (n = 43) Routine care (undefined) and 10-min foot massage every other day for 4 weeks, starting 2-days post-operative Group 2: Routine Care Only (n = 43) Routine care undefined	4 weeks	4 week follow up	No significant difference between groups for neck pain VAS and NDI Intervention demonstrate significant improvement in Self Rating Anxiety Scale compared to pre-test and to control group The pain subscale of the quality of life scale was significantly improved for pain compared to control and only the intervention group showed significant improvement in mental function	Not reported

BBQ back beliefs questionnaire, SMT spinal manipulative therapy, NRS numeric [pain] rating scale, NDI neck disability index, ROM ranges of motion, Ext extension, Flex flexion, L Rot left rotation, R Rot right rotation, L LF left lateral flexion, R LF right lateral flexion, DTRs deep tendon reflexes, BP blood pressure, bpm beats per minute, MRI magnetic resonance imaging, NPRS numerical pain rating scale, kg Kilograms, DNF deep neck flexors, cm centimeters, UE upper extremity, HNP herniated nucleus pulposus, VAS visual analogue scale, NDI neck disability index, NME neck muscle endurance, ACDF anterior cervical discectomy and fusion, PT physical therapy, QUALEFFO-41 quality of life questionnaire for patients with osteoporosis vertebral fractures