Effects of C0-C1 Mobilization in the Neutral Position in Subjects With Upper Cervical Rotational Hypomobility

Study Overview
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Brief Summary
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C1-C2 is the most mobile segment of the spine and its dysfunction is frequently associated to cervical pain and headache. However, serious neurovascular adverse effects have been documented through direct treatment of C1-C2 segment. Although indirect treatment via adjacent segments and avoidance of end range of rotation and extension have been recommended for a safer and effective cervical treatment, there is no scientific evidence of the effectiveness of the indirect treatment approach in the cervical neutral position for C1-C2 hypomobility. Due to that, the investigators designed a randomized controlled trial to compare the short-term effects in the Flexion Rotation Test (FRT) of a translatoric mobilization of C0-C1, a translatoric mobilization of C7-T1 and a control group in subjects with C1-C2 hypomobility.The primary hypothesis is that C0-C1 dorsal glide mobilization applied in the neutral cervical position can recover the C1-C2 rotational range of movement in subjects with upper cervical hypomobility.

Conditions
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Upper Cervical Spine Rotational Hypomobility

Intervention / Treatment
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* Other: C0-C1 dorsal glide manual mobilization
* Other: C7-T1 ventral cranial glide manual mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: FRT with less than 32º or asymmetry of 10º between right and left, whenever one of the sides does not exceed physiological C1-C2 ROM (45º) Indication of grade III mobilization in C0-C1 and C7-T1 segments Aged 18-66 Signed informed consent Exclusion Criteria: Contraindication to manual therapy and red flags according to Rushton et al. (2012) Pain presence at the beginning or during the study Cervical treatment during the last three months Inability to tolerate FRT Involvement in litigation or compensation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 66 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Intervention group<br>C0-C1 dorsal glide mobilization in the cervical neutral position. | Other: C0-C1 dorsal glide manual mobilization<br> <br> |
| Experimental: Intervention group 2<br>C7-T1 ventral cranial glide mobilization in the cervical neutral position | Other: C7-T1 ventral cranial glide manual mobilization<br> <br> |
| No Intervention: Control group<br>Not receiving any intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in baseline in Range of movement in Upper Cervical Spine | Flexion-rotation test measured by CROM device | 1 hour after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cervical range of movement in cardinal planes | Active cervical range of movement in sagittal, frontal and transversal planes measured by CROM device. | 1 hour after intervention | 
| Upper cervical flexion and extension range of movement | Active upper cervical flexion and extension range of movement measured with CROM device | 1 hour after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cervical, manual therapy, range of movement