Effectiveness of the Osteopathic Treatment in Patients With Nonspecific Cervical Pain: Randomized Controlled Pragmatic Clinical Trial
Phase: NA
Conditions: Manual Therapies, Neck Pain
Sponsor: Escola D'osteopatia De Barcelona

Research Protocol 
 
"Effectiveness of osteopathic treatment in patients with nonspecific neck 
pain. Randomized controlled pragmatic clinical trial " 
 
 
 
Identifier: PR407 / 18 
 
Date: 20th November 2018 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
Research protocol 
 
1. Administrative information 
a. Title 
b. Trial registration 
c. Protocol Version 
d. Functions and responsibilities 
2. Introduction 
a. Justification 
b. Goals 
c. Design 
3. Methods: 
a. Scope of the study 
b. Selection criteria 
c. Interventions 
d. Procedures 
e. Variables 
f. Participating Schedule 
g. Sample 
h. Randomization 
i. Masking 
4. Ethics 
5. Appendices 
6. References 
 

 
 
1. Administrative Information 
 
 
 
 
 
 
 
 
a. Title 
Effectiveness of osteopathic treatment in patients with nonspecific neck pain. 
Randomized controlled pragmatic clinical trial. 
 
b. Trial registration 
Anticipated its registration in ClinicalTrials.gov after its acceptance by the Ethical 
Committee. 
Identifier: PR407 / 18 
 
c. Protocol version 
v. 04: 20/11/2018 
 
d. Functions and responsibilities 
Óscar Hernández CO (OH) – Physiotherapist Col. 3802 
Drafting the protocol, writing the final manuscript, performing the osteopathic 
intervention.  
oscarha@eobosteopatia.com / +34.649.360.771 
 
Edgar Segarra CO (ES) – Physiotherapist Col. 4363 
Drafting the protocol, writing the final manuscript, performing the osteopathic 
intervention.  
edbandini@gmail.com / +34.657.559.428 
 
David Puertas CO (DP) – Physiotherapist Col. 5753 
Drafting the protocol, writing the final manuscript, performing the osteopathic 
intervention.   
dpuertas81@gmail.com / +34.606.450.462 
Gerard Alvarez MSc DO (GA) – Physiotherapist Col. 2894 
Director of the Spain National Centre - Centre for Osteopathic Medicine Collaboration. 
Trial supervision 
gerardalv@gmail.com / +34.620.214.206 
 
 
 

 
 
2. Introduction 
 
 
 
 
 
 
 
 
a. Justification 
In Spain cervical pain affects practically 20% of the population annually1, while 
globally it is estimated that between 22% and 77% of the population will suffer 
cervical pain at some point in their life2. Prevalence increases with age, and is 
more common in women than in men (1.6: 1) 3. 
Although the natural evolution of cervical pain tends to improve, the rates of 
recurrence and chronicity are high2. And therefore it becomes an anatomical 
region of interest in relation to the assessment of the effectiveness and / or 
effectiveness of the osteopathic therapeutic approach. 
 
Different studies prove the efficacy of various manual therapy techniques 
applied on the cervical and / or upper dorsal region, suggesting significant 
positive changes in cervical pain and mobility levels in patients with nonspecific 
cervical pain. 
In this sense, Casanova-Méndez et al4 showed that the adjustment of high 
speed and low amplitude, also called "thrust", of the 4th thoracic vertebra (T4) 
improves mobility and mechanic-sensitivity of the cervical region as well as 
decreases pain in the same area. All of the improves appears in the short term. 
On the other hand, Salom et al5 concluded that dorsal manipulation using the 
same thrust technique is more effective than manipulation without thrust to 
reduce chronic mechanical neck pain of bilateral type. 

 
 
In relation to the study of interventions that include multiple treatment 
techniques, we can observe in a study by Saavedra et al6 that the combination 
of manipulative techniques at the dorsal and cervical level is more effective than 
the application of a single cervical technique in the improvement of cervical 
function. In addition, both approaches show a reduction in cervical pain and 
increase the range of vertebral movement. 
 
In the same line we find the article by Massarachio et al7, revealing positive 
changes in the short term in patients with cervical pain who underwent cervical 
and dorsal manipulation both in the index of cervical functionality, numerical 
scale of pain and overall rate of change. 
 
In a recent systematic review and meta-analysis of 2015 carried out by Franke 
et al8. it is suggested that BMT causes clinically relevant effects in pain 
reduction as well as in functionality in patients with non-specific chronic neck 
pain. 
 
Taking these studies as a starting point, it is necessary to bear in mind that the 
reality of the osteopathic approach to the patient is not limited to the use of a 
single technique, but that the treatment is formed from a set of them. The 
ultimate goal is to restore mobility and functionality to a specific region, 
especially taking into account the concepts of individuality and holism. 
 

 
 
For this, it is essential to base the treatment on a previous exploration, and there 
is evidence of a lack of clinical trials with a perspective based on the result of 
that previous exploration, taking into account again the individuality of the 
patient and also the clinical criterion of the therapist. This procedure is more 
realistic with the usual practice. 
 
On the other hand, it is also necessary to evaluate, as different studies 
conclude9,10, how the application of osteopathic treatment can be conditioned in 
the final result at different doses. 
In this sense, the latest revision of 2017 of the Clinical Practice Guideline for 
cervical pain2 indicates that the dose in terms of intensity, frequency and 
duration are variable and do not allow to transfer it to practice reliably. It adds as 
a method to find an adequate dose of treatment the combination of an original 
test of dose descriptions with clinical judgment, taking into account the principles 
of physical exercise, movement, pain science and patient preferences. 
 
Lastly, two Cochrane reviews show that both manual therapy11 and exercise 
therapy12 are effective in the treatment of patients with cervical pain. Although 
later a meta-analysis13 of Fredin et al. (2017) concluded that the combination of 
manual therapy and exercises does not seem to be more effective than the 
practice of physical exercise in isolation. 
 
 

 
 
b. Goals 
 
Main goal: 
The effectiveness of osteopathic treatment will be evaluated in 
comparison with an exercise plan in patients with nonspecific cervical pain. 
 
Secondary objective: 
The result of the treatment applied in different temporal frequencies will 
be compared. 
 
c. Trial Design 
Randomized, pragmatic, double-blind controlled clinical trial. 
 
 
 

 
 
3. Methods 
 
 
 
 
 
 
 
 
 
 
 
a. Scope of the study 
The participants will be recruited in the following osteopathy services, where the 
therapeutic intervention will be carried out: 
 
• Centre Integrosalus (c/ d’Anselm Clavé, 8 – 08348 – Cabrils. Barcelona) 
• Centre Axis (c/ de Castelló, 5 - 08770 - Sant Sadurní d'Anoia. Barcelona) 
• Clínica d’Osteopatia Horta (c/ Duero, 68 - 08031 – Horta. Barcelona) 
 
 
b. Selection criteria 
Inclusion criteria: 
The sample will be formed by patients between the ages of 18 and 75 years, 
who present cervical pain of any intensity and duration, and with a minimum 
score of 10 points on the Neck Disability Index (NDI)14,15. 
 
Exclusion criteria: 
Patients who present at the time of recruitment other pathologies or elements 
that may condition cervical pain, such as: acute shoulder tendinopathy, cervical 
radiculopathy, chronic diseases of general musculoskeletal involvement 
(Chronic Fatigue Syndrome and / or Fibromyalgia). Similarly, patients suffering 
from any type of vertiginous syndrome, who have suffered a whiplash in the last 
year or who are or have been under treatment for cervical pain in the last 3 
months will also be excluded. 

 
 
 
The taking of anti-inflammatories by the patient is not taken as a measure of 
exclusion. If the patient is under pharmacological treatment, it will be recorded 
and will be taken into account as a co-intervention. However, this treatment will 
not be modified under any circumstances nor will it be grounds for exclusion 
from the study. 
 
c. Interventions 
The test will be carried out with 3 branches (2 experimental + 1 control). 
 
• All groups (1, 2 and 3) will conduct a home-based pattern of combined 
exercises based on stretching, active anti-resisted exercises and joint 
mobility exercises focused on the cervico-dorsal and scapulo-thoracic 
regions. Whose clinical effectiveness has shown significant positive 
changes in pain levels and cervical functionality12,13,16. 
 
• The two experimental groups (group 1 and group 2) will also receive 
Osteopathic Manipulative Treatment (OMT) whose description is 
detailed below: (description based on the TIDier17 intervention report 
guide). 
 
The TMO is a 100% manual intervention that is applied individually with a direct 
contact between therapist and patient. 
 

 
 
• Groups 1 and 2 will receive 3 sessions of BMT. 
o Group 1 will receive 3 sessions with a weekly frequency (with + -2 
days of margin: between 5 and 9 days). 
o Group 2 will receive 3 sessions at the rate of one session every 3 
weeks (with + -2 days of margin: between 19-23 days). 
 
The clinical experience of the therapists participating in the intervention indicates 
that 3 sessions could be a sufficient number to achieve changes in the clinic of 
patients with nonspecific cervical pain and that these may be clinically 
significant, either immediately after the intervention and in the middle. term (1 
month post-intervention). 
 
From the same clinical experience it is considered that an interval of between 1 
and 3 weeks is the most common during the course of a treatment to a patient 
with nonspecific neck pain. 
 
Therefore, it is considered necessary to compare whether there may be 
differences applying a greater or lesser frequency within the most usual range of 
applied treatment. 
 
 
 
 
 

 
 
d. Procedures 
At the beginning of the 1st session, a battery of questions will be made as an 
anamnesis with the objective of evidencing possible risk factors at the 
therapeutic level (see Appendix 4. Patient data collection form). The presence 
of one or more risk factors will suppose the exclusion of the patient from the 
study. 
 
Next, a brief osteopathic musculoskeletal evaluation will be made to the patient. 
This exploration will follow a standardized protocol for all patients in the 
experimental groups (1 and 2). 
 
The tests to be carried out will be: 
• Observation (standing patient): 
o Assessment of the anterior projection of the head 
o Assessment of the variation in the physiological curves of the 
spine 
• Active test of the cervical spine with the patient in a sitting position. 
o Flexo-Extension / Rotations / Lateral inclinations 
• Segmental test of joint mobility of the cervical and dorsal spine (patient in 
sitting and supine position) 
• Passive mobility test of the cervical spine (patient in the supine position): 
o Flexo-Extension / Rotations / Lateral inclinations 
 
 

 
 
The combination of exercises scheduled at home for all groups is based on the 
conclusions of different studies12,13,16, and will consist of: 
o Self-resisted active exercise in flexion, rotations and inclinations 
of the cervical spine. 
o Active mobility in its maximum travel (without forcing pain) in 
flexion, rotations and inclinations of the cervical spine. 
o Stretching upper trapezius muscles and scalenes. 
o Active mobility in circumferential joints of the glenohoumeral joint, 
and in flexo-extension of the thoracic spine. 
 
Said guideline will be shown to the patient during the first visit, and will be 
accompanied by a visual support with the detail so that he remembers it and can 
do it at his home. 
The work schedule will be carried out for 7 weeks, at a rate of 5 sessions per 
week. 
It will be the patient himself who will keep a diary record of the activity carried 
out during the weeks that the trial lasts. The diary will be facilitated by the 
therapists, and in it the exercises to be performed will be indicated. 
 
For groups 1 and 2, a total of 3 techniques selected from a list of 7 available 
techniques common to all centers will be applied in each session. The choice of 
techniques will be based on the results of the examination performed, the 
particularities of the patient and the clinical experience of the osteopath. In each 

 
 
session the techniques can change under the criteria of the osteopath. However, 
they will always be 3 and always within the list of available techniques. 
 
The TMO techniques that may be applied will be the following: 
*See the full description of the type of techniques in Glossary Of Osteopathic Terminology, 201118 
 
1. Technique of Inhibition of the suboccipital muscles19 
Objectives: achieve a relaxation in the short muscle that joins the occipital bone 
with the C1 and C2 vertebrae and associated vascular and neurological 
structures, as well as alleviating the associated muscular tension through the 
insertion of the superior fibers of the trapezius muscle in the same region 
occipital. 
 
2. Functional technique for the middle and deep cervical fascia20 
Objectives: to relax the fascial and muscular tissues that make up the anterior 
muscular bundle of the neck that allows a better alignment of the cervical spine 
in the antero-posterior projection of the head with respect to the thorax. 
 
3. High-speed cervical spine technique (Cervical wheel C1-C6) 21 
4. High-speed technique in the cervico-dorsal junction (prone position) 21 
5. High speed technique in dorsal column (D1-D12) - (Dog Technique) 21 
Objectives for techniques 3, 4 and 5: recover mobility in specific vertebral 
segments that present somatic dysfunction, as well as influence primary afferent 

 
 
neurons in the para-spinal tissue, the motor control system and the pain 
processing22. 
The term Somatic dysfunction is part of the osteopathic terminology and is 
defined as "Alterations in the function of the components related to the somatic 
system: skeletal, articular and myofascial structures and their related vascular, 
neural and lymphatic elements" 18 
 
6. Muscle stretching technique of the diaphragm (supine decubitus) 23 
Objectives: to reduce muscle tension by allowing better mobility of the thoracic 
cage and a better balance of the pressures on the thoracic / abdominal cavity. In 
the same way, better mobility on the cervical spine. 
 
7. Thorax joint mobility technique (long lever) 21 
Objectives: to improve the mechanics of thoracic mobility, both at the level of the 
anterior thoracic cage and lateral and posterior, allowing an improvement in the 
cervical-thoracic mechanical function. 
 
 
 

 
 
e. Variables 
 
Main Variable: 
o Neck Disability Index (NDI). 
This index is the most used in cervical pain assessments14. It is a test of 10 
questions with 6 possible answers, which punctuate aspects such as the 
intensity of cervical pain or the degree of limitation in the main activities of daily 
life. 
The score covers the range of 0 to 50 points, the degree of involvement in 
cervical functionality being greater the higher the score obtained in the test. 
We establish the minimum change to be detected (minimum clinically relevant 
change) at 5 points. The Spanish version of the NDI will be used, validated by 
Andrade Ortega,JA et al.24 
 
Secondary Variable: 
o Degree of general quality of life, through the SF-36 health 
questionnaire25.  
 
 
The data will be reported in the form of a report by the patient himself, who will 
receive via e-mail (whenever possible) or in printed form the questionnaire to be 
completed and will deliver to the same centre in which the intervention has been 
carried out. 
 

 
 
Adverse effects: A record of any adverse effects that may be 
occur during the study, these being detailed in the same patient control sheet 
(see Appendix 4). 
 
Tracing: 
NDI: The measurements at the beginning of the study (baseline measures), 3 
days after the last intervention and after 1 month post-study. 
Quality of life (SF-36): The measurements in this case will be taken at the 
beginning of the study (baseline measures) and after 1 month post-study. 
 
 
 
 

 
 
f. Participants Schedule 
 
 

 
 
g. Sample 
The sample size has been calculated following the following parameters: 
Randomized clinical trial, with 3 branches of study, a minimum detectable 
change in the NDI of 5 points (10%), 80% statistical power and a standard 
deviation of 7. 
Accepting an alpha risk of 0.05 and a beta risk of less than 0.2 in a bilateral 
contrast will require 46 subjects in each group, that is, an n = 132. 
The value of estimated losses is 10% of the total. 
 
 
h. Randomization 
A pragmatic experimental comparative trial with three branches of study 
(osteopathic treatment with 2 different dosages versus active muscle exercise) 
is proposed. 
 
After obtaining informed consent (see Appendix 1. Information sheet and 
Informed Consent), patients who meet the inclusion criteria will be awarded to 
the study groups following a random sequence generated by computer and 
stratified by each centre. The assignment through the opaque envelope system 
will guarantee the concealment of said assignment. 
The generation of the sequence and the preparation of the opaque envelopes 
will be done by an external researcher not involved in the interventions. 
The recruitment of the participants, and their assignment to the study groups will 
be carried out by the same people in charge of carrying out the intervention.. 

 
 
 
 
i. Masking 
A double masking is proposed. 
Three active interventions are compared. 
The patients will be blinded in relation to the study group they belong to, 
ensuring the masking of the participants. 
The data that is intended to be obtained for its analysis are of a self-reported 
nature and will be collected and administered by an external investigator not 
linked to the interventions, ensuring the masking of the evaluator. 
Due to the nature of the interventions, masking of therapists is not possible. 

 
 
4. Ethics 
 
 
 
 
 
 
 
 
 
 
 
This protocol will be presented at the Escola d'Osteopatia de Barcelona, as part 
of the development of a research project to obtain the D.O. (diploma in 
osteopathy). Prior to the development of the trial, it will be presented to the 
Clinical Ethics Committee of Bellvitge Hospital for approval. 
 
The recruitment of participants will be done under the signature of the informed 
consent (see Appendix 1). 
The centres where the study will be carried out are of a private nature, and the 
development of the trial will not entail any cost for the patient in the interventions 
received. 
 
The people in charge of informing the study, obtaining the signature of the 
informed consents and carrying out the interventions will be the OH, ES and DP 
researchers. 
The patient may leave the study at any time, without prior notice and without 
specifying the reason. 
Participation in this clinical trial by patients does not imply any increase in risk in 
relation to usual clinical practice. Comparative interventions are common in 
osteopathic manual practice. 
 
Randomization, preparation of opaque envelopes and data monitoring will be 
carried out by GA. 
The clinical and personal data of the participants will be coded numerically, and 

 
 
this relationship is kept in the custody of the research team. Likewise, the 
processing of these data will be in accordance with the provisions of the LOPD 
15/1999 and the General Data Protection Regulation (EU) 2016/679. In no case 
will this information be disclosed to people outside the study. 
 
This clinical study will be carried out in accordance with the principles of the 
Declaration of Helsinki (Fortaleza, 2013). 
 
Declaration of conflicts of interest: No. 
 
 
 

 
 
5. Appendices  
 
 
 
 
 
 
 
 
 
 
 
a. Appendix 1 (Information Sheet and Informed Consent) 
 
“Effectiveness of the osteopathic treatment in patients with nonspecific cervical pain. 
Randomized controlled pragmatic clinical trial “ 
 
Principal Investigators: 
* Óscar Hernandez (IntegroSalus), Edgar Segarra (Osteopatia Horta Clinic), David Puertas (Center Axis) 
 
 
Informational page 
 
 
Dear Mr / Mrs: 
 
The study, in which we propose to participate, constitutes a scientific investigation in the field of 
cervical pain. This research is framed in the context of a final Master project. It is a study whose 
intervention does not generate any type of cost for the patient nor an increased risk in relation to the 
usual clinical practice, given that the interventions compared are common in osteopathic manual 
practice. The objective of this study is to compare the effect of 3 interventions. All of them have been 
shown to have positive effects in reducing cervical pain. Two of the interventions constitute different 
modalities of manual therapy, and the third is based on a specific exercise plan for cervical pain. If you 
agree to participate in this study, you will be required to complete two questionnaires related to cervical 
pain (50 questions) and quality of life (36 questions). The estimated time to complete the forms is 8 
minutes and must be completed in three moments of the study (start, end of treatment, 1 month post-
treatment). You will receive them by email again or you can fill them out electronically at any of the 
centers attached to the study 
Participation is VOLUNTARY. At any time you can leave the study without giving any explanation. All 
personal data obtained in this study will be treated confidentially in accordance with the Organic Law of 
Protection of Personal Data 15/99 and the Regulation (EU) 2016/679 General Data Protection. The 
information obtained will be used exclusively for the specific purposes of this study, and will be coded 
to maintain the anonymity of the participants at all times. 
Participants have the right to access, rectification, cancellation, opposition, to limit the processing of 
their data that are incorrect, to request a copy of them, or to transfer the data collected (portability) to a 
third party, and to exercise These rights must be communicated to the principal investigator. 
In case of transfer of data to third countries outside the EU or the European Economic Area (EEA), the 
researcher will establish the necessary measures to guarantee a level of data protection equivalent to 
that granted by European legislation. 
The research team will keep the records of this clinical study for a period of not less than 25 years. 
 
 
* This study project has been previously authorized by an independent Research Ethics Committee, 
which ensures respect for the rights, safety and well-being of people who participate in research 
projects. 
 
 

 
 
 
“Effectiveness of the osteopathic treatment in patients with nonspecific cervical pain. 
Randomized controlled pragmatic clinical trial “ 
 
Principal Investigators: 
* Óscar Hernandez (IntegroSalus), Edgar Segarra (Osteopatia Horta Clinic), David Puertas (Center Axis) 
 
 
 
Informed Consent 
 
 
We request your consent to participate in this study, which means that we can use the 
information obtained in the survey and record and analyse it later in the framework of this scientific 
research. Of course, if you do not participate in the study, in no case will this influence the 
professional care provided. 
 
 
 
 
 
PATIENT WRITTEN CONSENT 
 
 
 
I,..................................................................................................................., I read the sheet 
information that they have given me, I have been able to ask questions about the study, I have 
received enough information about it and I have been able to consult my doubts  
with Mr .............................................................. 
 
I understand that acceptance is voluntary and that I can leave the study whenever I want without 
giving explanations, so I agree to participate in the study. 
 
 
 
 
Signature of the patient                              Signature of the osteopath attending to him 
 
 
 

 
 
b. Appendix 2 (NDI – Neck Disability Index Questionnaire) 
SPANISH VERSION REFORMULATED OF “NECK DISABILITY INDEX” 
27 
 
Name:    ____________________________________                                Age:  _______ 
Date:        ________________________ 
Address: _________________________________________________ 
Profession:  ________________________ 
 
Please read the instructions carefully: 
This questionnaire has been designed to give your doctor information about how neck pain affects your daily life. 
Please fill in all possible questions and mark on each one ONLY THE ANSWER THAT APPROXES TO YOUR CASE. 
Although more than one answer may apply to your question, check only the one that best represents your problem. 
Question I: Neck pain intensity        
           
¨ I have no pain right now 
¨ The pain is very mild at this time 
¨ The pain is moderate right now 
¨ The pain is strong right now 
¨ The pain is very strong right now 
¨ At this time the pain is the worst one can imagine 
Question VI: Concentrate on something 
 
¨ I totally focus on something when I want without difficulty 
¨ I totally focus on something when I want with some difficulty 
¨ I have some difficulty concentrating when I want 
¨ I have enough difficulty concentrating when I want 
¨ I have a hard time concentrating when I want 
¨ I can never concentrate 
 
Question II: Personal care (washing, dressing, etc.) 
 
¨ I can take care of myself normally without increasing pain 
¨ I can take care of myself normally, but this increases my pain 
¨ Taking care of me hurts so I have to do it slowly and carefully 
¨ Although I need some help, I manage for almost all my care 
¨ Every day I need help for most of my care 
¨ I can't get dressed, I wash with difficulty and I stay in bed 
Question VII: Work and usual activities 
 
¨ I can work all I want 
¨ I can do my usual job, but no more 
¨ I can do almost all my usual work, but no more 
¨ I can't do my usual job 
¨ I can hardly do some kind of work 
¨ I can't work on anything 
 
Question III: Lifting weights 
 
¨ I can lift heavy objects without increasing pain 
¨ I can lift heavy objects, but the pain increases 
¨ Pain prevents me from lifting heavy objects from the ground, 
but I can do it if they are placed in an easy place, such as on 
a table 
¨ Pain prevents me from lifting heavy objects from the ground, 
but I can lift medium or light objects if they are placed in an 
easy place 
¨ I can only lift very light objects 
¨ I cannot lift or carry any weight 
 
Question VIII: Driving vehicles 
 
¨ I can drive without neck pain 
¨ I can drive everything I want, but with a slight neck pain 
¨ I can drive everything I want, but with moderate neck pain 
¨ I can't drive everything I want due to neck pain 
¨ I can barely drive due to intense neck pain 
¨ I can't drive anything because of neck pain 
 
Question IV: Reading 
 
¨ I can read everything I want without my neck hurting 
¨ I can read everything I want with a slight pain in the neck 
¨ I can read everything I want with moderate neck pain 
¨ I can't read everything I want due to moderate neck pain 
¨ I can barely read because of the great pain in my neck 
¨ I can't read anything at all 
 
 
Question IX: Dream 
 
¨ I have no problem sleeping 
¨ Neck pain makes me lose less than 1 hour of sleep every 
night 
¨ Neck pain makes me lose 1 to 2 hours of sleep every night 
¨ Neck pain makes me lose 2 to 3 hours of sleep every night 
¨ Neck pain makes me lose 3 to 5 hours of sleep every night 
¨ Neck pain makes me lose 5 to 7 hours of sleep every night 
 
 
Question V: Headache 
 
¨ I have no headache 
¨ Sometimes I have a small headache 
¨ Sometimes I have a moderate headache 
¨ I often have a moderate headache 
¨ I often have a severe headache 
¨ I have almost continuous headache 
 
 
 
 
Question X: Leisure Activities 
 
¨ 
I can do all my leisure activities without neck pain 
¨ 
I can do all my leisure activities with some neck pain 
¨ 
I can't do some of my leisure activities because of neck pain 
¨ 
I can only do a few leisure activities because of neck pain 
¨ 
I can barely do the things I like because of neck pain 
¨ I cannot do any leisure activity 
 
 

 
 
c. Appendix 3 (SF-36 v.2 Questionnaire) 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 

 
 
 
 
 

 
 
d. Appendix 4 (Patient data collection form) 
 
Patient’s Name: __________________________________________   Sex: ___________ 
Assigned Group:  ________               Identification: __________           Age: ___________ 
 
Anamnesis Exclusion 
¨ 
Discopathy diagnosed - Level: _________________ 
¨ 
Previous Radiculopathies: _____________________________ 
¨ 
Surgical interventions: ___________________________ 
¨ 
Osteosynthesis material carrier: ___________________ 
¨ 
Pacemaker carrier 
¨ 
Previous spine fractures - Level: _________________ 
¨ 
HTA (medicated / unmedicated) - Value: ______________ 
¨ 
Osteoporosis diagnosed 
¨ 
Rheumatic Diseases: ______________________ 
¨ 
Cancer history: _____________________________ 
¨ 
Current medication (corticosteroids) ____________________     -     - 
¨ 
Current medication (anticoagulants) ____________________     -     - 
¨ 
In current treatment or in anticipation of oral implants or orthodontics for the duration of the study. 
 
MEDICATION: ____________________     -     -           ____________________     -     - 
                               ____________________     -     -           ____________________     -     - 
 
Expl #1 
 
Obs: ____________________ 
 
Active T.: _________________ 
 
Passive T.: ________________ 
 
Segm T: _______________ 
 
Expl #2 
 
Obs: ____________________ 
 
Active T.: _________________ 
 
Passive T.: ________________ 
 
Segm T: _______________ 
 
Expl #3 
 
Obs: ____________________ 
 
Active T.: _________________ 
 
Passive T.: ________________ 
 
Segm T: _______________ 
 
TTm #1    __ / __ / __ 
 
¨ 
Suboccipital inhibition 
¨ 
Cervical fascia 
¨ 
High cervical speed (C1-C7) 
¨ 
High speed CT 
¨ 
High back speed (D1-D12) 
¨ 
Stretching diaphragm 
¨ 
Chest joint mobility 
 
TTm #2    __ / __ / __ 
 
¨ 
Suboccipital inhibition 
¨ 
Cervical fascia 
¨ 
High cervical speed (C1-C7) 
¨ 
High speed CT 
¨ 
High back speed (D1-D12) 
¨ 
Stretching diaphragm 
¨ 
Chest joint mobility 
 
TTm #3    __ / __ / __ 
 
¨ 
Suboccipital inhibition 
¨ 
Cervical fascia 
¨ 
High cervical speed (C1-C7) 
¨ 
High speed CT 
¨ 
High back speed (D1-D12) 
¨ 
Stretching diaphragm 
¨ 
Chest joint mobility 
 
Adverse Effects 
 
Adverse Effects 
 
Adverse Effects 

 
 
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