Additional Effect of Cranial Base Release on Cervical Range and Proprioception in Patients With Mechanical Neck Pain

Study Overview
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Brief Summary
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Mechanical Neck pain is the second most commonly occurring musculoskeletal disorder worldwide, ranking 4th in overall disability. It is referred to as Nonspecific generalized neck pain with mechanical characteristics with a primary location between the supranuchal line and the first thoracic spinous process, includingpatients suffering from mechanical neck pain are reported to have several impairments, including pain, reduced cervical ROM, neck disability, and proprioceptive dysfunction. The treatment indicated involves the use of electrotherapy and thermal modalities. In addition, the use of different manual therapy techniques is advocated; however, the most effective management is still debatable. Evidence suggests that Natural Apophyseal glides have a significant positive effect on mechanical neck pain patients. So the study will identify the additional effect of cranial base release with natural apophyseal glides in alleviating pain and its effects on proprioception.

Official Title
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Additional Effect of Cranial Base Release on Cervical Range and Proprioception in Patients With Mechanical Neck Pain

Conditions
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Neck Pain

Intervention / Treatment
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* Procedure: Conventional Physical Therapy
* Procedure: Natural Apophyseal glides
* Procedure: Cranial Base Release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed with mechanical neck pain having reproducible non-specific neck pain with a primary location between the supranuchal line and the first thoracic spinous process Male and Female Age 18-40 years Pain severity on NPRS >3 Neck Disability score of 20% or above Problem not older than 2 months Exclusion Criteria: Patients with history of Recent significant trauma (including whiplash) Radiculopathy Cervical fracture Neck surgery Dizziness, vertigo Myelopathy, Malignancy Metabolic disease Diagnosed Osteoporosis, Rheumatoid arthritis Long-term corticosteroid and/or painkiller drug use

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 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
Interventional Model Description: This is a randomized controlled trial having two groups. One group will receive conventional physical therapy along with Natural apophyseal glides and the second will receive Natural Apophyseal Glides in addition to cranial base release with conventional physical therapy. Both groups will be recruited concurrently.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control Group<br>Participants of this group will receive the conventional physical therapy protocol mentioned above. In addition to this, they will receive Natural apophyseal glides 3 sets of 10 repetitions. Frequency: 3 times a week for 2 weeks. 6 sessions in total. Mobilizations will be performed in Grade 1 initially and then progressed to Grade 2 and 3 depending on the patients pain status and compliance. | Procedure: Conventional Physical Therapy<br>* 15 mins of TENS (frequency 100 Hz, phase duration 50 μs) with moist heat over the area of pain Isomeric Stretching of neck muscles followed by neck isometrics<br>Procedure: Natural Apophyseal glides<br>* -Will be applied in sitting position Therapist right hand would cradle the head such that the little finger would rest on the spinous process of the vertebra that is to be mobilized. The other hands thumb would be used to apply over pressure. Direction of force will be parallel to highly irritable-grossly restricted cervical facet joints. Intervention would involve 3 sets of 20 repetitions in 15minutes, 3 days a week for 2 weeks comprising of total 6 session.<br>|
| Experimental: Experimental Group<br>Participants of this Group will receive the conventional physical therapy protocol mentioned above. In addition to this, they will receive Natural apophyseal glides and cranial base release. Frequency: 3 times a week for 2 weeks. 6 sessions in total. Cranial base release would be given for around 1-4minutes until the tissues relax and would be given once daily | Procedure: Conventional Physical Therapy<br>* 15 mins of TENS (frequency 100 Hz, phase duration 50 μs) with moist heat over the area of pain Isomeric Stretching of neck muscles followed by neck isometrics<br>Procedure: Natural Apophyseal glides<br>* -Will be applied in sitting position Therapist right hand would cradle the head such that the little finger would rest on the spinous process of the vertebra that is to be mobilized. The other hands thumb would be used to apply over pressure. Direction of force will be parallel to highly irritable-grossly restricted cervical facet joints. Intervention would involve 3 sets of 20 repetitions in 15minutes, 3 days a week for 2 weeks comprising of total 6 session.<br>Procedure: Cranial Base Release<br>* Will be performed in lying position. therapist fingers will contact the sub occipital muscles and upward pressure would be given until the tissues and muscles relax. it will be given once daily for 3 days a week and will continue for 2 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pain | Pain will be measured on Numeric Pain Rating Scale. | 2 weeks | 
| Change in ROM | Cervical rotation will be measured through CROM device | 2 weeks | 
| Change in Cervical Proprioception | Will be measured from Laser Pointer Method | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Range of Motion, Proprioception