Objectives: To study the natural history of prolonged neck pain and the effectiveness of bone setting as its treatment. Methods: A randomized clinical trial with blinded outcome assessment and 1-year follow-up was completed. Forty-two working-aged patients with nonspecific neck pain for at least I month and no contraindications to manipulative therapies were recruited. They were randomly allocated into 5 weekly sessions of bone setting provided by 2 experienced folk healers (22 patients) or follow-up without therapy (20 patients). The primary outcomes were neck mobility after the 5-week therapy period and the Million scales modified for neck pain at 5 weeks, and 3, 6, and 12 months after baseline. Secondary outcomes included self-rated improvement and pain drawing at 5 weeks, and 3, 6, and 12 months after baseline, Beck depression scales at 5 weeks and 12 months after baseline, and sick leaves, additional therapies, and pain medication during I year after baseline. Results: At baseline, neck pain was reported constant or increasing by 51% and episodic by 49% of the patients with mean duration of symptoms of 4.3 years for the bone setting and 8.4 years for the control group. Seventy-eight percent of the patients participated in the clinical measurements at 5 weeks, and 90% returned the questionnaires after I year. The cervical mobility of the bone setting patients increased 29% in the frontal, 23% in the sagittal, and 16% in the horizontal plane, whereas the figures for the control group were - 1.4%, 1.0%, and 3.0%, respectively. The mean Million index of the bone setting group (50.6 mm at baseline) was 18.5 mm at 5 weeks, 21.2 mm at 3 months, 22.9 mm at 6 months, and 14.2 mm at 1 year. The figures for the control group were 53.2 mm at baseline, and 4.0, 6.2, 5.4, and 5.5 turn at the corresponding follow-up points. After I year, improvement was reported by 80% of the bone setting and 28% of the control patients. Conclusion: In this study, manual therapy had a measurable effect on the mobility of cervical spine at 5 weeks and an effect on pain that lasted for at least half a year.
