Clinical trial NCT06960525: Joint Mobilization vs. Strengthening Exercises on Cervical Proprioception for Nonspecific Neck Pain
Official title: Comparison of Joint Mobilization vs. Strengthening Exercises for Improving Cervical Proprioception in Individuals With Nonspecific Neck Pain: A Randomized Clinical Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Chronic Neck Pain
Nonspecific Neck Pain
Keywords: chronic neck pain
Nonspecific neck pain
cervical proprioception
cervical mobilization
cervical strengthening exercises
neck
cervical
proprioception
mobilization
manual
strengthening
pain
Lead sponsor: Imam Abdulrahman Bin Faisal University
Sponsor class: OTHER
Collaborators: name: Al Hada Military Hospital
First posted: 2025-05-07
Enrollment: 26
Sex: ALL
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This is a double-blinded randomized clinical trial with a parallel-group design.
Primary purpose: TREATMENT

Brief summary: This clinical trial aims to compare the effects of cervical joint mobilization versus cervical strengthening exercises in patients with chronic neck pain. The study will assess neck proprioception, pain intensity, cervical muscle strength, range of motion, and neck disability.

The main question it aims to answer is:

Which treatment is superior, or do they have equal effects after the first session and after the 12th session?

Participants will:

Receive either cervical joint mobilization or cervical strengthening exercises for 12 sessions.

Do not perform any physical therapy treatment outside the trial. Visit the clinic three times per week for treatment.

Detailed description: Neck pain refers to a type of generalized neck discomfort characterized by mechanical features. This condition is a widespread issue, causing significant levels of pain, disability, and can lead to economical strain. Patients suffering from neck pain often experience functional impairments, including weak neck muscles and impaired proprioception. Strengthening exercises and cervical joint mobilization offer effective relief of pain and improve disability. Exploring the superiority of these techniques in improving cervical proprioception to prevent recurrence is still a vague topic. Therefore, this study will investigate the effect of Maitland joint mobilization versus cervical strengthening exercises in patients with nonspecific chronic neck pain on neck proprioception, pain intensity, cervical muscles strength, range of motion and neck disability. This is a double-blinded randomized clinical trial with a parallel-group design. Twenty-six participants will be allocated randomly to one of two groups. Group one (Mobilization) will have cervical joint mobilization according to Maitland approach. Group two (Exercises) will perform craniocervical, cervical and axioscapular muscles strengthening exercises. Treatment will be provided for 12 sessions. Both groups will receive standardized care, including patient education and transcutaneous electrical nerve stimulation.

Eligibility criteria: Inclusion Criteria:

* 18 to 50 years
* Pain ≥ 3 months
* Neck pain on VAS ≥ 3/10
* NDI ≥ 5/50 points
* ZZ Errors ≥ 9 or the time to complete the task ≥ 28s

Exclusion Criteria:

* Unilateral headache aggravated by neck movement.
* Upper extremity symptoms beyond the elbow.
* Any history of neck trauma including whiplash
* Recent fractures (last 8 weeks)
* Cervical surgery (last 3 months)
* Current neck-related dizziness
* Known or suspected ves3bular pathology
* Internal fixation of the cervical spine
* Physical therapy for the neck (last 3 months)

Primary outcomes:
measure: Active cervical movement sense
timeFrame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
measure: Visual Analogue Scale
timeFrame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
measure: Neck Disability Index
timeFrame: Three points: 1) baseline, 2) week 4
Secondary outcomes:
measure: Cervical joint position error
timeFrame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
measure: Cervical muscles strength
timeFrame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
measure: Cervical range of motion
timeFrame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Other outcomes:
Locations:
city: Taif
country: Saudi Arabia
facility: Armed Forces Hospital - Al Hada
state: Makkah
Study officials:
affiliation: Imam Abdulrahman Bin Faisal University
name: Ali M Alshami, Phd
role: STUDY_DIRECTOR
References:
citation: Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017 Jul;47(7):A1-A83. doi: 10.2519/jospt.2017.0302.
citation: de Zoete RMJ. Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management. J Clin Med. 2023 Nov 15;12(22):7108. doi: 10.3390/jcm12227108.
citation: de Zoete RM, Armfield NR, McAuley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Br J Sports Med. 2020 Nov 2:bjsports-2020-102664. doi: 10.1136/bjsports-2020-102664. Online ahead of print.
citation: Ernst MJ, Williams L, Werner IM, Crawford RJ, Treleaven J. Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals. Musculoskelet Sci Pract. 2019 Oct;43:64-69. doi: 10.1016/j.msksp.2019.06.006. Epub 2019 Jul 2.