Head-to-Head Comparison of Muscle Energy Technique and Joint Mobilization on Pain Improvement in Mechanical Neck Pain and Related Outcomes: A Systematic Review and Meta-Analysis

Background: Mechanical neck pain (MNP) stems from muscular or articular dysfunction. Muscle energy technique (MET) and joint mobilization (JM) address these mechanical causes; however, comparative evidence remains limited. This systematic review and meta-analysis compared the effect of MET and JM in patients with MNP. Methods: Electronic databases (PubMed, Cochrane Library, EMBASE) were searched up to 12 September 2025. Randomized controlled trials (RCTs) directly comparing MET and JM were included following PRISMA 2020 guidelines. Pain intensity was prespecified as the primary outcome, while functional disability and cervical range of motion (ROM) were secondary outcomes. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Random-effects meta-analyses were conducted, with subgroup analyses stratified by JM technique and treatment duration. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Six RCTs encompassing 381 randomized participants were included. Of these, 301 participants contributed to the pain and disability analyses, and 250 contributed to the flexion and extension ROM analyses. Risk-of-bias assessment indicated that all included studies were judged to have “some concerns,” primarily owing to bias in outcome measurement. Overall pooled analyses showed no significant difference between MET and JM in pain reduction (MD = 1.15; 95% CI −0.26 to 2.57) or disability improvement, despite considerable heterogeneity (I2 > 90%). In an exploratory subgroup analysis of two trials, point estimates favored JM in studies using a 4-week Mulligan mobilization protocol. Conclusions: The pooled analyses found no statistically significant differences between MET and JM in pain, disability, or cervical flexion ROM, whereas extension ROM favored JM. Findings from the two trials of 4-week Mulligan mobilization remain exploratory and do not establish superiority or an optimal treatment duration. Protocol registration: PROSPERO CRD420251166998.