Skip to main content
Top
Published in: Trials 1/2020

Open Access 01-12-2020 | Exercise Therapy | Research

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

Authors: Carlos Bernal-Utrera, Juan Jose Gonzalez-Gerez, Ernesto Anarte-Lazo, Cleofas Rodriguez-Blanco

Published in: Trials | Issue 1/2020

Login to get access

Abstract

Background

Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment modalities described for its management, the most common approach is based on manual therapy and specific therapeutic exercise, which have shown a moderate effect on subjects with chronic non-specific neck pain. However, the effect times of these treatments have not been accurately detailed. Our study aims to break down and compare the effects of two experimental treatments based on manual therapy and therapeutic exercise.

Methods

The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain were studied. The sample was randomized divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of our research, we studied (a) pain, based on the visual analog scale and the pressure pain threshold, and (b) cervical disability, through the Neck Disability Index (NDI). Outcomes were registered on week 1, week 4, and week 12. The findings were analyzed statistically considering a 5% significance level (P ≤ 0.05).

Results

No statistically significant differences (P 0.05) were obtained between the experimental groups, if they exist against the control group. Nonetheless, we found that manual therapy improved perceived pain before than therapeutic exercise, while therapeutic exercise reduced cervical disability before than manual therapy. Effect size (R2) shows medium and large effects for both experimental treatments.

Conclusion

There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy. Clinical improvement could potentially be influenced by central processes.

Trial registration

Brazilian Clinical Trial Registry, RBR-2vj7sw. Registered on 28 November 2018.
Literature
1.
go back to reference 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 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.
go back to reference Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc England. 2015;90(2):284–99.CrossRef Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc England. 2015;90(2):284–99.CrossRef
3.
go back to reference 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 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.
go back to reference Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ (Clinical research ed). 2020;368:m791. https://doi.org/10.1136/bmj.m791.CrossRef Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ (Clinical research ed). 2020;368:m791. https://​doi.​org/​10.​1136/​bmj.​m791.CrossRef
5.
go back to reference Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008;13(1):2–11.PubMedCrossRef Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008;13(1):2–11.PubMedCrossRef
6.
go back to reference Ortego G, Villafañe JH, Doménech-García V, Berjano P, Bertozzi L, Herrero P, et al. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res. 2016;90(3–4):70–81.PubMedCrossRef Ortego G, Villafañe JH, Doménech-García V, Berjano P, Bertozzi L, Herrero P, et al. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res. 2016;90(3–4):70–81.PubMedCrossRef
7.
go back to reference 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. 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.
9.
go back to reference Fredin K, Lorås H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;31:62–71.PubMedCrossRef Fredin K, Lorås H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;31:62–71.PubMedCrossRef
10.
go back to reference Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5(6):455–64.PubMedPubMedCentralCrossRef Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5(6):455–64.PubMedPubMedCentralCrossRef
11.
go back to reference Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696–701.PubMedCrossRef Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696–701.PubMedCrossRef
12.
go back to reference 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 England. 2013;27(6):504–12.CrossRef 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 England. 2013;27(6):504–12.CrossRef
13.
go back to reference 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 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
14.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
15.
go back to reference 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 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
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
17.
go back to reference Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. Man Ther. 2013;18(5):360–6.PubMedCrossRef Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. Man Ther. 2013;18(5):360–6.PubMedCrossRef
18.
go back to reference Elliot JM, O’Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects. Arch Phys Med Rehabil. 2010;91(9):1418–22.CrossRef Elliot JM, O’Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects. Arch Phys Med Rehabil. 2010;91(9):1418–22.CrossRef
19.
go back to reference Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and constructo validity of the neck disability index and patient specific functional scale in patients with cervical radiculopathy. Spine. 2006;31:598–602.PubMedCrossRef Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and constructo validity of the neck disability index and patient specific functional scale in patients with cervical radiculopathy. Spine. 2006;31:598–602.PubMedCrossRef
21.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
22.
go back to reference Fischer AA. Algometry in diagnosis of musculoskeletal pain and evaluation of treatment outcome: an update. J Muscoskel Pain. 1998;6:5–32.CrossRef Fischer AA. Algometry in diagnosis of musculoskeletal pain and evaluation of treatment outcome: an update. J Muscoskel Pain. 1998;6:5–32.CrossRef
23.
go back to reference 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 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
24.
go back to reference Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomas M, Cano A, Muriel A, Zamora J, DelReal MT, Gestoso M, Mufraggi N. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008;9:43.PubMedPubMedCentralCrossRef Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomas M, Cano A, Muriel A, Zamora J, DelReal MT, Gestoso M, Mufraggi N. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008;9:43.PubMedPubMedCentralCrossRef
25.
go back to reference Lluch E, Schomacher J, Gizzi L, Petzke F, Seegar D, Falla D. Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test. Man Ther. 2014;19(1):25–31.PubMedCrossRef Lluch E, Schomacher J, Gizzi L, Petzke F, Seegar D, Falla D. Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test. Man Ther. 2014;19(1):25–31.PubMedCrossRef
27.
go back to reference Nijs J, Loggia ML, Polli A, Moens M, Huysmans E, Goudman L, et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients? Expert Opin Ther Targets. 2017;21(8):817–26.PubMedCrossRef Nijs J, Loggia ML, Polli A, Moens M, Huysmans E, Goudman L, et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients? Expert Opin Ther Targets. 2017;21(8):817–26.PubMedCrossRef
28.
go back to reference Nijs J, Goubert D, Ickmans K. Recognition and treatment of central sensitization in chronic pain patients: not limited to specialized care. J Orthop Sports Phys Ther. 2016;46(12):1024–8.PubMedCrossRef Nijs J, Goubert D, Ickmans K. Recognition and treatment of central sensitization in chronic pain patients: not limited to specialized care. J Orthop Sports Phys Ther. 2016;46(12):1024–8.PubMedCrossRef
29.
go back to reference Lluch Girbes E, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. Man Ther. 2015;20(2):349–52.PubMedCrossRef Lluch Girbes E, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. Man Ther. 2015;20(2):349–52.PubMedCrossRef
30.
go back to reference Beltran-Alacreu H, Lopez-de-Uralde-Villanueva I, Fernandez-Carnero J, La Touche R. Manual therapy, therapeutic patient education, and therapeutic exercise, an effective multimodal treatment of nonspecific chronic neck pain: a randomized controlled trial. Am J Phys Med Rehabil. 2015;94(10 Suppl 1):887–97.PubMedCrossRef Beltran-Alacreu H, Lopez-de-Uralde-Villanueva I, Fernandez-Carnero J, La Touche R. Manual therapy, therapeutic patient education, and therapeutic exercise, an effective multimodal treatment of nonspecific chronic neck pain: a randomized controlled trial. Am J Phys Med Rehabil. 2015;94(10 Suppl 1):887–97.PubMedCrossRef
Metadata
Title
Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial
Authors
Carlos Bernal-Utrera
Juan Jose Gonzalez-Gerez
Ernesto Anarte-Lazo
Cleofas Rodriguez-Blanco
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-020-04610-w

Other articles of this Issue 1/2020

Trials 1/2020 Go to the issue