Adding Two Different Types of Manual Techniques to an Exercise Program for the Management of Chronic Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Neck pain is one of the most common and costly musculoskeletal disorders in western societies
      with a high rate of recurrence and chronicity. In chronic neck pain, the persistence of
      symptoms is highly associated with changes in the biomechanics of the neck region that are
      related to the muscular imbalance between the neck muscles and specifically between the deep
      and superficial neck flexors. Manual techniques are special techniques applied by hand from
      the therapist that focus on reducing symptoms and improving disability. Both spinal
      manipulation and soft tissue mobilization techniques have a positive effect in individuals
      with chronic neck pain, especially when they are combined with the appropriate therapeutic
      exercise programme. However, it has not been determined which of the above-mentioned
      combinations is more effective in patients with chronic neck pain.

      The aim of this study is to compare the efficacy of two different kinds of manual technique,
      when they combine with the same therapeutic exercise program in the management of patients
      with chronic neck pain.

      An assessor-blind randomized control trial with a duration of ten weeks and a 6-month follow
      up will be performed in 80 women with chronic neck pain. The participants will be allocated
      into four groups of 20 persons each (three intervention groups and one control group). The
      first three groups will follow the same exercise program. Only exercise will be applied to
      the first group. The second group will apply a combination of soft tissue mobilization
      techniques and exercise. The third group will follow a combination of spinal manipulation and
      exercise, while the fourth group will not receive any treatment. The neck pain will be
      evaluated with the visual analogue scale, the disability related to neck pain with the neck
      disability index, the pressure pain threshold of the neck muscles with pressure algometry,
      the active range of motion with a bubble inclinometer, the maximum isometric strength of the
      neck muscles with a hand dynamometer, the muscular fatigue of the flexors of the neck with
      the craniocervical flexion test and the quality of life with the sf-36 questionnaire before,
      during and after the intervention, while follow-ups will take place six months later.
    

Detailed description: 
      Background Neck pain is one of the most common and costly musculoskeletal disorders in
      western societies with a high rate of recurrence and chronicity. In chronic neck pain, the
      persistence of symptoms is highly associated with changes in the biomechanics of the neck
      region that are related to the muscular imbalance between the neck muscles and specifically
      between the deep and superficial neck flexors. Manual techniques are special techniques
      applied by hand from the therapist that focus on reducing symptoms and improving disability.
      Both spinal manipulation and soft tissue mobilization techniques have a positive effect in
      individuals with chronic neck pain, especially when they are combined with the appropriate
      therapeutic exercise programme. However, it has not been determined which of the
      above-mentioned combinations is more effective in patients with chronic neck pain.

      Aim The aim of this study is to compare the efficacy of two different kinds of manual
      technique, when they combine with the same therapeutic exercise program in the management of
      patients with chronic neck pain.

      Method An assessor-blind randomized control trial with a duration of ten weeks and a 6-month
      follow up will be performed in 80 women with chronic neck pain. The participants will be
      allocated into four groups of 20 persons each (three intervention groups and one control
      group). The first three groups will follow the same exercise program. Only exercise will be
      applied to the first group. The second group will apply a combination of soft tissue
      mobilization techniques and exercise. The third group will follow a combination of spinal
      manipulation and exercise, while the fourth group will not receive any treatment. The neck
      pain will be evaluated with the visual analogue scale, the disability related to neck pain
      with the neck disability index, the pressure pain threshold of the neck muscles with pressure
      algometry, the active range of motion with a bubble inclinometer, the maximum isometric
      strength of the neck muscles with a hand dynamometer, the muscular fatigue of the flexors of
      the neck with the craniocervical flexion test and the quality of life with the sf-36
      questionnaire before, during and after the intervention, while follow-ups will take place six
      months later.
    

Intervention name(s): Intervention 1 Exercise; Intervention 2 Exercise and INIT; Intervention 3 Exercise and SMT; Control
Intervention type(s): Other; Other; Other; Other
Intervention description(s): • Exercise programme Endurance and Resistant training exercise program (Duration: 45 minutes) • Muscle retraining of longus colli and endurance training of the deep cervical flexors. • Resistant exercises for the muscles involved in neck flexion, extension, side bending and rotation of the neck region. Isometric contractions exercises (20-70% of MVC) and resistant exercises (12-15RM). • Active ROM exercises for the neck muscles • Upper limbs exercises with resistant bands • Stretching exercises for the neck and upper limbs muscles; Exercise programme same as Intervention Group 1 and
Integrated Neuromuscular Inhibition Technique application. Integrated Neuromuscular Inhibition Technique application. (Duration: 15min) The protocol was applied to the following muscles: • Upper border of the trapezius muscle • sternocleidomastoid • levator scapulae muscle • splenius capitis muscle Integrated Neuromuscular Inhibition Technique includes the combination of the following technique: • Ischemic compression • Muscle energy technique • Straincounterstrain technique; Exercise programme same as Intervention Group 1 and
Manipulation Care. Participants allocated to this group received Spinal Manipulation Therapy after the therapeutic exercise programme. Treatment was delivered by 1 chiropractor with a minimum 5-year experience of clinical practice. Pain provocation and static/motion palpation findings were used to determine areas of treatment in the cervical spine. The Manipulation Therapy technique included joint motion using a diversified thrust technique, and mobilization, a low-velocity type of joint oscillation. The type and the force of the applied spinal manipulation were individualized according to the age and physical condition of each participant. Soft passive stretching, light massage and hot packs were applied to the cervical and upper thoracic area before manipulation in order to prepare each participant.; Participants allocated to this group received general consulting istructions and a home based general exercise sheet
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: An assessor-blind randomized control trial with a duration of ten weeks and a 6-month follow up will be performed in 80 women with chronic neck pain. The participants will be allocated into four groups of 20 persons each (three intervention groups and one control group). The first three groups will follow the same exercise program. Only exercise will be applied to the first group. The second group will apply a combination of soft tissue mobilization techniques and exercise. The third group will follow a combination of spinal manipulation and exercise, while the fourth group will not receive any treatment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chronic Neck Pain; Exercise; Manual techniques; Spinal manipulation; Integrated neuromuscular inhibition technique; Rehabilitation