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

Abstract

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.

“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.”

“…In the present study, improvement in neck disability in both manual therapy groups compared to the Control Group, reached the minimal clinically important difference. These results are comparable to those of previous studies using multimodal approaches including manual therapy and cervical exercises 28,29 and superior to studies which regional mobilization, manipulation or exercise were performed in isolation. 26,27,29,33…”

“…Multimodal approach associated with specific upper cervical mobilization seems to be superior in reducing pain 27 than the application of a multimodal approach but without specific mobilization or manipulation. 27,28 Conversely, Rodríguez-Sanz et al 29 showed that adding four 20-minutes sessions of upper cervical manual therapy to an exercise program was more effective in relieving neck pain at short- and mid-term in a similar sample as in our study. Therefore, more studies are needed to analyse the optimal dosage of the upper cervical manual therapy approach.…”

Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial

“…Forty-eight primary care subjects (12 men and 36 women) were included in the study. The inclusion criteria comprised: medical diagnosis of chronic neck pain with more than three months of evolution [ 35 ], a positive result in the flexion-rotation test (less than 33° or a difference of 10° or more between the two rotations) [ 6 , 8 , 9 ] and loss of mobility in C0-1 and/or C2-3 spine segments found through manual assessment according to Zito et al and Kaltenborn [ 36 , 37 ]. Subjects were also required to be over 18 years old and sign the informed consent.…”

“…Most rotational movement of the upper cervical spine occurs at the C1-2 segment [ 3 ]. The flexion-rotation test is the most used test to assess the range of movement (ROM) in the transverse plane of the upper cervical spine, and it is a valid and reliable test [ 4 , 5 , 6 , 7 ]. This test is an easily applied method of manual examination that localizes the presence of joint dysfunction at C1-2 level [ 8 ].…”

“…Therefore, the International Federation of Orthopedic Manual Physical Therapists (IFOMPT) recommended that end-range rotation and extension positions should be avoided during cervical spine mobilization and manipulation [ 22 ]. Alternative therapeutic strategies proposed in the literature to avoid the direct mobilization of C1-C2 are: thoracic spine thrust manipulation, exercise and patient education [ 23 , 24 , 25 ] and the mobilization of C0-C1 [ 1 , 3 ] and C2-C3 [ 6 ].…”