Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness of a Manual Specific Approach to the Suboccipital Area on Pain, Range of Motion, Disability and Clinical Significance of Changes on Patients With Chronic Mechanical Neck Pain and Rotation Deficit of the Upper Cervical Spine
Brief Summary: There are different inhibition suboccipital techniques, usually adjuvant of physiotherapy, for treatment of patients with chronic neck pain. In our clinical practice, a favorable effect is observed on patients with chronic neck pain, but there are no published studies evaluating the results of this techniques on pain, mobility and disability.

The objective of this trial is to evaluate if the suboccipital manual techniques, provides further improvement in pain intensity, neck disability, range of motion, on patients with chronic mechanical neck pain and rotation deficit of the upper cervical spine, being treated with physiotherapy. For this purpose, investigators conduct a double-blind (patient and evaluator) randomized controlled trial, in a Public Primary Care Center.

Seventy four subjects will be randomized (computer application) into three groups: Mobilization Group, Maintained pressure Group and Control Group. All the three groups receive the same protocolized physiotherapeutic treatment during three weeks and, additionally, the Mobilization Group receives six sessions (two sessions in a week during three weeks) of translational dorsal glide mobilization technique grade III of the atlanto-occipital joint and the Maintained pressure Group receives six sessions (two sessions in a week during three weeks) of pressure maintained suboccipital Inhibition technique. The Control Group receives the protocolized physiotherapeutic treatment only.

Pain intensity (VAS), Neck Disability Index (NDI), Range of motion (CROM), will be measured at baseline, after treatment period, and three months after discharge from treatment. After discharge for treatment the patient subjective opinion about their evolution will be collected through a Global Rating of Change (GROC) scale, and evaluation of headache disability (HIT-6).


Options:
A: Inclusion Criteria:

* 18 to 65 years of age,
* having neck pain for more than 3 months, and
* being volunteer

Exclusion Criteria:

* Stenosis,
* traumatic injury history,
* previous surgery related to cervical spine,
* hypermobility,
* cancer,
* having inflammatory rheumatologic,
* severe psychological disorders,
* being pregnant, and
* intervention including exercise or physical therapy in the last 3 months
B: Inclusion Criteria:

* Diagnosis of chronic mechanical neck pain.
* Flexion-rotation test positive (less of 32 degrees or 10 degrees difference between the two sides)
* Sign the informed consent form.

Exclusion Criteria:

* Presenting one or more positive safety cervical test .
* Carriers of pacemaker or defibrillators.
* Previous history of severe trauma to the cervical region of the spine.
* Inflammatory arthritis.
* Inability to maintain supine position.
* Inability to tolerate flexion-rotation test
* Poor Language and communication skills making difficult to understand the informed consent.
* Pending litigation or legal claim.
C: Inclusion Criteria:

* mean neck pain intensity 45mm
* neck pain for at least 3 months
* age 18-75
* partner or friend for the application of the massage

Exclusion Criteria:

* specific neck pain due to trauma, neurological disorder, prolapse, operation, cancer
* severe deformity of the spine
* skin disease, allergy on the neck area
* hemophilia, anticoagulation, antiplatelet disorder
* severe psychiatric disorder
* severe comorbidity
* regular intake of opiates and corticosteroids \>10mg prednisolon
* pregnancy
* participation in other clinical trials
D: Inclusion Criteria:

* chronic cervicogenic headache
* threshold pain level
* threshold headache frequency
* independently ambulatory
* English literate
* candidate for spinal manipulation

Exclusion Criteria:

* contraindication to thrust spinal manipulation or massage
* most other headache types
* Recent manual/exercise therapy from licensed provider for head/neck
* threshold pain medication use
* pregnancy
* involvement with another pain study
* suspicion of unmanaged depression
* most cancers
* hypertension (at least stage II)
* complicating neurological/spinal conditions
* pre-randomization noncompliance or cannot/will not comply with protocols
* health-related litigation, claims, or disability compensation

Answer: B