Effects of Pain, Disability and Cervicokinesthesia After Cervical Manipulation

Study Overview
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Brief Summary
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Cervical spine manipulation has been found to be effective in patients with mechanical neck pain. Discrepancies exist on the side of manipulation and the placebo effect of this manual intervention. In addition, some authors have proposed that spinal manipulation can alter proprioception of the cervical spine. The aim of this study will be to investigate the effects of cervical spine manipulation on pain, disability, widespread pressure pain sensitivity, and cervicokinethesia in patients with mechanical neck pain.

Detailed Description
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Cervical spine manipulation has been found to be effective in patients with mechanical neck pain. Discrepancies exist on the side of manipulation and the placebo effect of this manual intervention. In addition, some authors have proposed that spinal manipulation can alter proprioception of the cervical spine. The aim of this study will be to investigate the effects of cervical spine manipulation on pain, disability and cervicokinethesia in patients with mechanical neck pain. Patients will receive cervical spine manipulation in either right or left side of the neck and will be assessed on pain intensity, neck-related disability, widespread pressure pain sensitivity, and cervicokinethesia by an assessor blinded to the allocation group.

Official Title
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Effects of Pain, Disability, Widespread Pressure Pain Sensitivity, and Cervicokinesthesia After Cervical Manipulation in Patients With Mechanical Neck Pain

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Right Cervical Manipulation
* Other: Left Cervical Manipulation
* Other: Sham Cervical Manipulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Generalized neck-shoulder pain with symptoms provoked by neck postures, neck movement, or palpation of the cervical musculature. Exclusion Criteria: any contraindication to manipulation, e.g., positive extension-rotation test; whiplash injury; previous cervical surgery; cervical radiculopathy or myelopathy; diagnosis of fibromyalgia syndrome; having undergone spinal manipulative therapy in the previous 6 months; less than 18 or greater than 65 years of age.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Right Cervical Manipulation<br>Patients assigned to this group will receive a cervical spine manipulation targeting the C3/C4 segment on the right side. | Other: Right Cervical Manipulation<br>* We will use a high-velocity, mid-range, left rotational force to the right articular pillar of C3, on the right articular pillar of C4 with the patient in supine, with left rotation and right side-bending.<br>|
| Experimental: Left Cervical Manipulation<br>Patients assigned to this group will receive a cervical spine manipulation targeting the C3/C4 segment on the left side. | Other: Left Cervical Manipulation<br>* We will use a high-velocity, mid-range, left rotational force to the left articular pillar of C3, on the left articular pillar of C4 with the patient in supine, with right rotation and left side-bending.<br>|
| Active Comparator: Sham Cervical Manipulation<br>Patients assigned to this group will receive a sham cervical spine manipulation targeting the C3/C4 segment on both sides. No therapeuthic thrust will be applied. | Other: Sham Cervical Manipulation<br>* The sham procedure will simulate C3/C4 manipulation in both sides without any therapeutic thrust<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in cervical kinesthetic sense before and after the intervention | The joint position sense error (JPSE) will be calculated to determine cervicokinethesia | Baseline and 15 minutes after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in disability before and after the intervention | The Neck Disability Index (NDI) will be used to determine neck-related disability | Baseline and one week after the intervention | 
| Changes in neck pain intensity before and after the intervention | An 11 points numerical pain rate scale (NPRS, 0-10) will be used to assess the intensity of neck pain | Baseline and one week after the intervention | 
| Changes in widespread pressure pain sensitivity before and after the intervention | Pressure pain thresholds will be assessed over C5/C6 zygapophyseal joints and the tibialis anterior muscle | Baseline and 15 minutes after the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cervical spine, Spinal manipulation