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Published in: Trials 1/2019

Open Access 01-12-2019 | Exercise Therapy | Study protocol

Manual therapy versus therapeutic exercise in non-specific chronic neck pain: study protocol for a randomized controlled trial

Authors: Carlos Bernal-Utrera, Juan José González-Gerez, Manuel Saavedra-Hernandez, Miguel Ángel Lérida-Ortega, Cleofás Rodríguez-Blanco

Published in: Trials | Issue 1/2019

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Abstract

Background

The underlying mechanisms of non-specific chronic neck pain relapses are not clear, but they could be associated with a deficit and alteration of neck muscles propioception that play a decisive role in cervical joint position, motor control of the head, and postural stability. Numerous treatments for non-specific chronic neck pain have been described in the scientific literature. However, few studies analyze its influence on postural stability, since these alterations are not fully described, and various theories emerge about the reasons that cause it. Our primary aim is to analyze the differences in postural stability, pain, cervical disability, and the relation between them produced by a treatment based on manual therapy and another based on therapeutic exercise.

Methods

The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain will be studied. The sample will be randomly divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of the study, we will take (1) Overall Balance Index, measured through a dynamic stabilometric platform; (2) pain, based on the visual analog scale and the Pressure Pain Threshold; (3) cervical disability, through the neck disability index. The findings will be analyzed statistically considering a 5% significance level (p ≤ 0.05).

Discussion

Our study aims to provide knowledge about postural stability and its relationship with pain in subjects with non-specific chronic neck pain. Analyzing the results produced by different types of therapy will allow us to draw conclusions about the mechanisms, structural or central, that may elicit these alterations.

Trial registration

Brazilian Clinical Trials Registry, RBR-2vj7sw. Registered on 28 November 2018.
Appendix
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Literature
1.
Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):1e34.CrossRef
2.
Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284–99 England.CrossRef
3.
Daffner SD, Hilibrand AS, Hanscom BS, Brislin BT, Vaccaro AR, Albert TJ. Impact of neck and arm pain on overall health status. Spine (Phila Pa 1976). 2003;28(17):2030–5.CrossRef
4.
Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008;13(1):2–11.CrossRef
5.
Grande-Alonso M, Moral Saiz B, Mínguez Zuazo A, Lerma Lara S, La Touche R. Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study. Neurol (English Ed). 2018;33(2):98–106.CrossRef
6.
Cuenca-Martínez F, Bartrina-Rodríguez I, Suso-Martí L, La R, Ferrer-Peña R, Bartrina-Rodríguez I, et al. Association between somatosensory, motor and psychological variables by levels of disability in patients with cervicogenic dizziness. Somatosens Mot Res. 2018;0(0):1–6.
7.
Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003;35(1):36–43.CrossRef
8.
Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sport Phys Ther. 2009;39(5):364–77.CrossRef
9.
L’Heureux-Lebeau B, Godbout A, Berbiche D, Saliba I. Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness. Otol Neurotol. 2014;35(10):1858–65.CrossRef
10.
Vincent K, Maigne J, Fischhoff C, Lanlo O, Dagenais S. Systematic review of manual therapies for nonspecific neck pain. Joint Bone Spine. 2013;80(5):508–15.CrossRef
11.
Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, et al. Exercises for mechanical neck disorders: a Cochrane review update. Man Ther. 2016;24:25–45.CrossRef
12.
Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15(4):334–54.CrossRef
13.
Holt KR, Haavik H, Elley CR. The effects of manual therapy on balance and falls: a systematic review. J Manip Physiol Ther. 2012;35(3):227–34.CrossRef
14.
Boyd L, Briggs C, et al. Muscle spindle distribution, morphology, and density in the longis colli and multifidus muscles of the cervical spine. Spine. 2002;27(7):694–701.CrossRef
15.
Bolton PS, Kerman IA, et al. Influences of neck afferents on sympathetic and respiratory nerve activity. Brain Res Bull. 1998;47(5):413–9.CrossRef
16.
Selbie WS, Thomson DB, et al. Suboccipital muscles in the cat neck: morphometry and histochemistry of the rectus capitis muscle complex. J Morphol. 1993;216(1):47–63.CrossRef
17.
Hellstrom F, Roatta S, et al. Responses of muscle spindles in feline dorsal neck muscles to electrical stimulation of the cervical sympathetic nerve. Exp Brain Res. 2005;165(3):328–42.CrossRef
18.
Corneil BD, Olivier E, et al. Neck muscle responses to stimulation of monkey superior colliculus. I. Topography and manipulation of stimulation parameters. J Neurophysiol. 2002;88(4):1980–99.CrossRef
19.
Peterson BW. Current approaches and future directions to understanding control of head movement. Prog Brain Res. 2004;143:369–81.PubMed
20.
Mergner T, Schweigart G, et al. Eye movements evoked by proprioceptive stimulation along the body axis in humans. Exp Brain Res. 1998;120(4):450–60.CrossRef
21.
Yamagata Y, Yates BJ, et al. Participation of Ia reciprocal inhibitory neurons in the spinal circuitry of the tonic neck reflex. Exp Brain Res. 1991;84(2):461–4.CrossRef
22.
Pera D, Graven-Nielsen T, et al. Inhibition of motor system excitability at cortical and spinal level by tonic muscle pain. Clin Neurophysiol. 2001;112(9):1633–41.CrossRef
23.
Flor H. Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehab Med. 2003;35:66–72.CrossRef
24.
Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther. 2004;9(3):125–33.CrossRef
25.
Pool JJM, Ostelo RWJG, Knol D, Bouter LM, de Vet HCW. Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther. 2010;15(1):111–6.CrossRef
26.
Sarig Bahat H, Weiss PL, Sprecher E, Krasovsky A, Laufer Y. Do neck kinematics correlate with pain intensity, neck disability or with fear of motion? Man Ther. 2014;19(3):252–8.CrossRef
27.
Uhlig Y, Weber BR, et al. Fiber composition and fiber transformation in neck muscles of patients with dysfunction of the cervical spine. J Orthop Res. 1995;13:240–9.CrossRef
28.
McPartland JM, Brodeur RR, et al. Chronic neck pain, standing balance, and suboccipital muscle atrophy—a pilot study. J Manip Physiol Ther. 1997;20(1):24–9.
29.
Field S, Treleaven J, et al. Standing balance: a comparison between idiopathic and whiplash induced neck pain. Man Ther. 2007;13(3):183–91.CrossRef
30.
Reneker JC, Moughiman MC, Cook CE. The diagnostic utility of clinical tests for differentiating between cervicogenic and other causes of dizziness after a sports-related concussion: an international Delphi study. J Sci Med Sport. 2015;18(4):366–72.CrossRef
31.
Saavedra-Hernandez M, Arroyo-Morales M, Cantarero-Villanueva I, Fernandez-Lao C, Castro-Sanchez AM, Puentedura EJ, et al. Short-term effects of spinal thrust joint manipulation in patients with chronic neck pain: a randomized clinical trial. Clin Rehabil. 2013;27(6):504–12 England.CrossRef
32.
Lopez-Lopez A, Alonso Perez JL, Gonzalez Gutierez JL, La Touche R, Lerma Lara S, Izquierdo H, et al. Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med. 2015;51(2):121–32.PubMed
33.
Jeong E-D, Kim C-Y, Kim S-M, Lee S-J, Kim H-D. Short-term effects of the suboccipital muscle inhibition technique and cranio-cervical flexion exercise on hamstring flexibility, cranio-vertebral angle, and range of motion of the cervical spine in subjects with neck pain: a randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(6):1025–34.CrossRef
34.
Heredia-Rizo AM, Pascual-Vaca AO, Cabello MA, et al. Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial. J Manip Physiol Ther. 2012;35:446–53.CrossRef
35.
Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy. Spine. 2006;31:598–602.CrossRef
36.
Kovacs FM, Bagó J, Royuela A, Seco J, Giménez S, Muriel A, et al. Psychometric characteristics of the Spanish version of instruments to measure neck pain disability. BMC Musculoskelet Disord. 2008;9:42.CrossRef
37.
Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45–56.CrossRef
38.
Fischer AA. Algometry in diagnosis of musculoskeletal pain and evaluation of treatment outcome: an update. J Muscoskel Pain. 1998;6:5–32.CrossRef
39.
Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007;23(9):760e6.CrossRef
40.
Parraca JA, Olivares PR, Carbonell-Baeza A, Aparicio VA, Adsuar JC, Gusi N. Test-retest reliability of biodex balance SD on physically active old people. J Hum Sport Exerc. 2011;6(2):444–51.CrossRef
41.
Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system. J Athl Train. 1998;33(4):323–7.PubMedPubMedCentral
42.
Salavati M, Akhbari B, Takamjani IE, Bagheri H, Ezzati K, Kahlaee AH. Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain. J Bodyw Mov Ther. 2016;20(2):441–8.CrossRef
Metadata
Title
Manual therapy versus therapeutic exercise in non-specific chronic neck pain: study protocol for a randomized controlled trial
Authors
Carlos Bernal-Utrera
Juan José González-Gerez
Manuel Saavedra-Hernandez
Miguel Ángel Lérida-Ortega
Cleofás Rodríguez-Blanco
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3598-7

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