Cyriax Manipulation in Cervical Discogenic Pain

May 16, 2019 updated by: Riphah International University

Effects of Cyriax Manipulation in Cervical Discogenic Pain

The aim of this research is to find and compare the effect of traditional physical therapy and Cyriax manipulation on pain, range of motion and disability in patients with cervical discogenic pain. Randomized controlled trials done at Benazir Bhutto hospital, Rawalpindi . The sample size was 40. The subjects were divided in two groups, 20 subjects in traditional physical therapy group and 20 in Cyriax manipulation group. Study duration was of 6 months. Sampling technique applied was purposive non probability sampling technique. Only 25-45 years individual with cervical discogenic pain were included. Tools used in the study are Numeric pain rating scale (NPRS) and neck disablity index (NDI). Data was be analyzed through SPSS 21.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Cervical disc displacement is a significant cause of neck and arm pain and disability in majority of individuals. It causes a great burden on physical, social and emotional quality of life of patients. The cervical disc herniation is characterized by prolapsed nucleus pulposus material through the annulus into the spinal canal. The local mechanical or chemical irritation of neural structures typically leads to symptoms of radiculopathy, head and neck pain or myelopathy. The disc bulge may be postero-central to compress the dura matter, causing multi segmental pain and affect the scapular area. It can also be postero-lateral causing the root signs, that have dermatomal behavior and affect the upper limb in specific pattern. Postero-central bulge can also shift to postero-lateral with symptoms shifting from centralization to radiculopathy.

The State of U.S. Health: Burden of Diseases, Injuries and Risk Factors describes cervical pain among 5 most contributing factor in causing years lived in disability. the ratio tremendously increases after 40 years. Studies describing impact of chronic neck pain on general health care reveals 14% of patients reports grade II to grade IV neck pain with high pain intensity and disability.

Disc displacement disorders are included among the mechanical causes of neck pain. Symptomatic disc displacements can occur at any age but have different clinical features depending on the age group. In young adults nucleus pulposus can involve which is rare in old age. Diagnoses can be established on clinical findings along with patient's history and the functional examination. Disc displacement can occur in postero-central and Postero- lateral displacement. Movement of the disc posteriorly causes stress on the posterior longitudinal ligament and also on the anterior part of the Dura mater. As a result of this the pain travels in more than one segment with dural reference. Pain occurs in trapezius and scapular area. This typical poster central displacement causes the pain symptoms centrally and bilaterally. Poster lateral movement of disc tissue inserts force on the nerve root, which causes a Segmental pain or root pain and Segmental paraesthesia. Disc displacement may be primary or secondary. Secondary poster lateral displacement is more common type of displacement. Patient previously having pain in different segments like neck, trapezius and scapular region now feels pain in the upper limb area. It occurs due to the lateral shifting of disc tissues.

The goal of treatment in discogenic problems is to stop the conflict between the displaced disc material and affecting sensitive structure. Disc fragment may affect the Dura matter, nerve roots and intervertebral joints. Manipulations and traction brings back the disc material to its place. The choice depends on the displacement. Nuclear displacements are treated by traction while annular ones are by manipulations. Injection usually is done to help pain less spontaneous recovery. If there is too much postero-central displacement that it compresses the spinal cord then surgery usually is done.

Physiotherapy Treatment protocol for cervical discogenic pain include muscle strengthening and to relieve stress on muscles. Cyriax manipulation is a systematic technique of manipulation for the disc prolapse. this study hypothesize that there is a difference between the effects of traditional physical therapy and cyriax manipulation for the discogenic problems. The objecvtive of this study is to find the effects of cyriax manipulation and to compare it with traditional physical therapy treatment in patients with cervical discogenic pain.

Literature review A systematic and evidence based search of relevant literature was performed by utilizing PubMed and Google Scholar as search engines. Search term for the initial literature review was discogenic pain, prevalence of neck pain, financial burden of discogenic pain, causes of neck pain, pathophysiology of discogenic pain, treatment options for discogenic pain, manipulation, cyriax manipulation, short term effects of manipulation. The search was limited to papers in English preferably published since 2000 with full text available. Different studies were available regarding cervical manipulation and its effects but limited data was available regarding cyriax manipulation in recent years.

In 2004, previously concluded 33 high quality RCTs in a Cochrane review on mobilization and manipulation of mechanical neck pain. There was strong evidence that mobilization or manipulations when combined with exercises are beneficial for acute or chronic neck pain with or without headache. 3 -11 sessions were compared against placebo.

In literature June 2004, worked to find best evidence in a systematic review on efficacy of spinal manipulation and mobilization for low back pain and neck pain. They showed that there is moderate evidence that spinal manipulative therapy for chronic neck pain is superior when compared to physical therapy and family physician care.

Another randomized controlled trial to correlate the results of manual therapy, physiotherapy, general practitioner care, placebo in treatment of persistent neck and back pain. They took the patients well defined in sub-groups. Physiotherapy included exercises, massage and modalities (heat, ultra-sound, short-wave diathermy). Manual therapy included spine mobilization and manipulation. General practitioner provided analgesics, posture correction, home exercises and bed rest. Placebo consisted of detuned shortwave diathermy and ultra-sound for 10 mines.).Changes in severity of chief complain and functional limitation was main outcome measured by blinded research assistant. Results shows that manual therapy is significantly better than other sub-groups in chronic conditions younger than 40 years of age.

In 2015, in a Cochrane systematic review on mobilization and manipulation on neck pain showed immediate effects of a single manipulation on sub-acute to chronic neck pain. Multiple sessions of cervical manipulations on acute and chronic neck pain produce immediate and long term effects on the pain, function and quality of life.

Howe et al suggested that Manipulation produced a significant immediate improvement in symptoms in those with pain or stiffness in the neck, and pain/paraesthesia in the shoulder, and a nearly significant improvement in those with pain/paraesthesia in the arm/hand.

Study on the non-surgical treatment of cervical radiculopathy suggest manipulation to be very effective and safe in reducing pain, hypo-mobility and disability.

Randomized clinical trial suggest in their current randomized clinical trial that cervical and thoracic thrust manipulation induce similar changes in Pressure Pain Threshold,(PPT) neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain.

The combination of manual therapy and manipulation provide better results than manual therapy alone.

Compared intensive training, physiotherapy and manipulation for patients with chronic neck pain after 6 months and 1 year follow up. They found that there was no significant difference between the three treatments. They suggested that as it is not clear whether it is the result of treatment or effect of time. Future studies are necessary to find out the exact treatment.

Study Type

Interventional

Enrollment (Actual)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Federal
      • Islamabad, Federal, Pakistan, 44000
        • Riphah International University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years to 41 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Diagnosed and confirmed cases of cervical disco genic pain by Weiner's criteria and Cyriax clinical assessment,
  • Discogenic cases with pain either in cervico-scapular area, radiating to arm without any neurological symptoms were the main objects of study.

Exclusion Criteria:

  • Patients have vertebrobasilar insufficiency (tested by VBI tests),
  • Altanto axial instability (tested by sharp purser test),
  • Osteoporosis, Rheumatoid arthritis,
  • Neuropathies,
  • Recent surgeries and neuropathies were excluded from study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Traditional physical therapy
Cervical isometrics and Muscle Stretching
Other: Traditional physical therapy

Cervical isometrics 10 repetitions×1 set, 4 days/week and targeted muscle strechings (trapezius, scalenes and sternocleidomastoid) 10 repetitions×1 set, 4 days/week.

Total of 4 sessions were given each consisting of 40 mins.
Experimental: Cyriax manipulation
Experimental group was given cyriax manipulation protocol along with the cervical isometrics and muscle stretching.
Other: Cyriax manipulation

Experimental group was given cyriax manipulation protocol along with the cervical isometrics and muscle strechings.

Traction with rotation was not given in cases of bilateral arm pain. cervical isometrics 10 repetitions×1 set, 4 days/week and targeted muscle strechings (trapezius, scalenes and sternocleidomastoid) 10 repetitions×1 set, 4 days/week.

Total of 4 sessions were given each consisting of 40 mins.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck disability index
Time Frame: 4th Day
Changes from base line Northwick disability index was developed first in Northwick Park hospital, England. It was designed to measure the neck pain and disability over time. It consists of 10, five parts sections. At the end, score is calculated by dividing the obtained score by total (50) multiplied by 100. As the driving section was missing in all the female patients, total score was considered as 45 instead of 50.
4th Day

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
NPRS
Time Frame: 4th Day
Changes from base Line Numeric Pain rating scale is a scale for pain starting from 0-10. where 0 indicate no pain and 10 indicate severe pain.
4th Day
ROM Cervical Spine ( Flexion)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine flexion was taken with the Help of Goniometer
4th Day
ROM Cervical Spine ( extension)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine extension was taken with the Help of Goniometer
4th Day
ROM Cervical Spine ( Right side flexion)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine right side flexion was taken with the Help of Goniometer
4th Day
ROM Cervical Spine ( left side Flexion)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine left side flexion was taken with the Help of Goniometer
4th Day
ROM Cervical Spine ( right rotation)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine right rotation was taken with the Help of Goniometer
4th Day
ROM Cervical Spine ( left rotation)
Time Frame: 4th Day
Changes from the Baseline ROM range of Motion of Cervical spine left rotation was taken with the Help of Goniometer
4th Day

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 15, 2018

Primary Completion (Actual)

June 20, 2018

Study Completion (Actual)

June 30, 2018

Study Registration Dates

First Submitted

January 27, 2019

First Submitted That Met QC Criteria

January 31, 2019

First Posted (Actual)

February 1, 2019

Study Record Updates

Last Update Posted (Actual)

May 20, 2019

Last Update Submitted That Met QC Criteria

May 16, 2019

Last Verified

May 1, 2019

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • RiphahIU Aisha Razzaq

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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