Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial

Background Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0–10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003–0.000). Conclusion Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study.

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Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186601 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6601 ◽

Cited By ~ 2

Author(s):

Jacobo Rodríguez-Sanz ◽

Miguel Malo-Urriés ◽

Jaime Corral-de-Toro ◽

Carlos López-de-Celis ◽

María Orosia Lucha-López ◽

...

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Manual Therapy ◽

Exercise Program ◽

Chronic Neck Pain ◽

Exercise Group ◽

Home Exercise ◽

Upper Cervical Spine ◽

Upper Cervical ◽

Cervical Spine Dysfunction

Chronic neck pain is one of today’s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients’ associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short- and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise; 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3- and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short- and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short- to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction.

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Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.08.008 ◽

2017 ◽

Vol 14 (1) ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

Inge Ris ◽

Birgit Juul-Kristensen ◽

Eleanor Boyle ◽

Alice Kongsted ◽

Claus Manniche ◽

...

Keyword(s):

Quality Of Life ◽

Neck Pain ◽

Pain Threshold ◽

Neck Disability Index ◽

Pressure Pain Threshold ◽

Chronic Neck Pain ◽

Traumatic Group ◽

Neck Disability ◽

Pain Patients

AbstractBackground and aimsPatients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.MethodsThis cross-sectional study included 200 participants with chronic neck pain:120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure painthreshold.The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p < 0.01. Differences between groups for the continuous data were determined using either a Student’s, t-test or Mann Whitney U-test.ResultsIn both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs.138 months p = 0.001).Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p = 0.005, craniocervical flexion test p = 0.007, cervical extensor test p = 0.006) and cervical pressure pain threshold bilateral (p = 0.002/0.004), as well on self-reported function (Neck Disability Index p = 0.001 and Patient-Specific Functional Scale p = 0.007), mental quality of life (mental component summary of the Short Form Health Survey p = 0.004 and EuroQol-5D p = 0.001) and depression (Beck Depression Inventory-II p = 0.001).ConclusionsThis study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level.ImplicationsPressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profilingchronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.

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Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228334 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8334

Author(s):

Vanessa González-Rueda ◽

César Hidalgo-García ◽

Jacobo Rodríguez-Sanz ◽

Elena Bueno-Gracia ◽

Albert Pérez-Bellmunt ◽

...

Keyword(s):

Neck Pain ◽

Controlled Trial ◽

Neck Disability Index ◽

Chronic Neck Pain ◽

Control Group ◽

Upper Cervical Spine ◽

Rotation Test ◽

Upper Cervical ◽

Neck Disability ◽

Therapy Protocol

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion–rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion–rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion–rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion–rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion–rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.

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Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34412 ◽

2021 ◽

pp. 536-542

Author(s):

Divya Jain ◽

Swapna Jawade ◽

Neha Chitale

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Conventional Therapy ◽

Rating Scale ◽

Neck Disability Index ◽

Exercise Program ◽

Pain Rating ◽

Numerical Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

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Comparison of Sustained Natural Apophyseal Glides and Maitland Manual Therapy in Non-Specific Neck Pain on Numeric Pain Rating Scale and Neck Disability Index

Annals of King Edward Medical University ◽

10.21649/journal.akemu/2017/23.4.425.430 ◽

2017 ◽

Vol 23 (4) ◽

Author(s):

Fahad Tanveer ◽

Adnan Afzal ◽

Muhammad Adeel ◽

Sana Shahid ◽

Maham Masood

Keyword(s):

Neck Pain ◽

Manual Therapy ◽

Rating Scale ◽

Neck Disability Index ◽

Pain Rating ◽

Numeric Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

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Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial

Rehabilitation Research and Practice ◽

10.1155/2016/6480826 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Pavlos Bobos ◽

Evdokia Billis ◽

Dimitra-Tania Papanikolaou ◽

Constantinos Koutsojannis ◽

Joy C. MacDermid

Keyword(s):

Neck Pain ◽

Pain Threshold ◽

Controlled Trial ◽

Neck Disability Index ◽

Chronic Neck Pain ◽

Trigger Points ◽

Neck Muscle ◽

Myofascial Trigger Points ◽

Neck Disability ◽

Over Time

Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs). Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI) score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM) was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67) completed the study. Neck disability and neck pain were improved over time between and within groups (p<0.05). However, no differences were found within and between the therapeutic groups (p<0.05) in the tested muscles’ PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold.

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“Short- and mid-term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial.”

Clinical Rehabilitation ◽

10.1177/0269215520965054 ◽

2020 ◽

pp. 026921552096505

Author(s):

Vanessa González-Rueda ◽

Carlos López-de-Celis ◽

Elena Bueno-Gracia ◽

Jacobo Rodríguez-Sanz ◽

Albert Pérez-Bellmunt ◽

...

Keyword(s):

Neck Pain ◽

Rating Scale ◽

Controlled Trial ◽

Neck Disability Index ◽

Chronic Neck Pain ◽

Control Group ◽

Controlled Clinical Trial ◽

Primary Care Center ◽

Randomized Controlled ◽

Upper Cervical

Objective: To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. Design: Randomized controlled trial. Setting: Primary Care Center in Cornellà, Spain. Subjects: 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. Interventions: All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. Main measures: Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. Results: NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. Conclusions: Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. Trial registration: This study was registered in Clinicaltrials.gov (NCT02832232).

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