Comparison of the Efficiency of Manual Therapy and Exercise in People With Mechanical Neck Pain

Mechanical neck pain (MNP) is defined as neck pain that becomes evident with the posture of the cervical region, movement or palpation of the cervical region muscles, felt in the cervical, occipital or posterior scapular region without spreading to the upper extremity, and without any trauma or specific pathology underlying the complaints. Most of the MNP cases are due to muscular or paraspinal soft tissue problems and show improvement in the first 6 weeks with conservative treatment methods. Various manual therapy techniques and various exercises are reported to have positive effects on neck pain. However, the isolated effects of these techniques in people with MNP are not fully known. Therefore, the aim of this study is to determine the effects of two different treatment programs in which the manual therapy technique and the exercise program are applied in individuals with MNP. In addition, comparing the effect of the treatment program in which manual therapy and exercise program are applied together with the isolated effects of these techniques is another aim.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Mobility Limitation
• Intervention / Treatment: Other: Exercise Program; Other: Manual Therapy

Detailed Description

Mechanical neck pain (MNP) is defined as neck pain that becomes evident with the posture of the cervical region, movement or palpation of the cervical region muscles, felt in the cervical, occipital or posterior scapular region without spreading to the upper extremity, and without any trauma or specific pathology underlying the complaints. MNP causes symptoms such as pain in the cervical region, increased sensitivity to pressure, decrease in active range of motion (ROM) of the cervical region, drowsiness, and dizziness. Most of the MNP cases are due to muscular or paraspinal soft tissue problems and show improvement in the first 6 weeks with conservative treatment methods. When the current treatment recommendations are examined according to the duration of neck pain accompanied by limitation of movement, an exercise program that includes thoracic region mobilization, cervical ROM exercises, and strengthening and stretching exercises for the scapulothoracic region and upper extremity muscles is recommended for acute neck pain. In addition, various manual therapy techniques can be applied to the cervical region.

In subacute neck pain, an exercise program is applied to increase the endurance of the neck and upper extremity muscles. During this period, various manual therapy methods can be applied to the thoracic and cervical region. In chronic neck pain, combined treatment applications including various exercises, mobilization and manipulation techniques, dry needling, laser and intermittent manual/mechanical traction are recommended. It is stated that the high-velocity low-amplitude technique, which is among the manual therapy techniques and used in many musculoskeletal problems, can increase the ROM, decrease the pain and improve the function.

Various manual therapy techniques and various exercises are reported to have positive effects on neck pain. However, the isolated effects of these techniques in people with MNP are not fully known. Therefore, the aim of this study is to determine the effects of two different treatment programs in which the manual therapy technique and the exercise program are applied in individuals with MNP. In addition, comparing the effect of the treatment program in which manual therapy and exercise program are applied together with the isolated effects of these techniques is another aim.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Buyukcekmece
    • Istanbul, Buyukcekmece, Turkey, 34500
      • Istanbul University-Cerrahpasa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with MNP
• Decrease in cervical region ROM
• Ability to adapt to verbal, written and visual instructions

Exclusion Criteria:

• Spine surgery history
• Neurological neck pain in the cervical region
• Presence of tumor in the cervical region
• Blood coagulation disorders
• Vertebrobasilar artery insufficiency
• Cervical region trauma history
• Communicative/mental problems that prevent participation in treatment
• Inflammatory rheumatological diseases affecting the cervical region
• Physiotherapy and rehabilitation treatments for neck pain in the last 3 months

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Exercise Group; Exercise Program only	Other: Exercise Program; Exercise program
Active Comparator: Manual Therapy Group; Manual Therapy only	Other: Manual Therapy; Manual Therapy: High velocity-low amplitude technique
Active Comparator: Manual Therapy and Exercise Group; Manual Therapy + exercise program	Other: Exercise Program; Exercise program; Other: Manual Therapy; Manual Therapy: High velocity-low amplitude technique

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability Index	The neck function of the patients will be evaluated with the Neck Disability Index. The disability levels of the participants due to neck pain will be evaluated with the 'Neck Disability Index' . This scale consists of 10 items including pain intensity, personal care, lifting, reading, headache, concentration, work, driving, sleep status and leisure activities. Each item was scored from 0 (no disability) to 5 (complete disability).	6 weeks
Pain intensity	Pain intensity of the patients at rest, during activity and at night was assessed using the Visual Analog Scale (VAS). In this evaluation, individuals were told that the number "0" on the 10 cm long horizontal line expresses "no pain", and the number "10" indicates "unbearable pain" and that individuals should mark their intensity of pain on this line.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Range of Motion (ROM)	Active neck flexion-extension, right-left lateral flexion and right-left rotation ROM of the participants will be evaluated with cervical goniometer.	6 weeks
Pain Pressure Threshold (PPT)	Participants' PPTs will be evaluated with a pressure algometer (Baseline Push-Pull Force Gauge®, Fabrication Enterprises, Inc.) that can measure pressure in kilograms and pounds, with a 1 cm diameter circular rubber tip attached to the piston of the pressure gauge	6 weeks l
36-Item Short Form Survey (SF-36)	Patients' quality of life will be evaluated with SF-36. This scale is a general health questionnaire that evaluates the person's perception of quality of life in the last four weeks under 8 sub-headings and 36 items. The sub-headings it includes; physical functions, physical roles, pain, social functions, mental health, emotional roles, energy and general health perception.	6 weeks
Patient satisfaction level	Patient Satisfaction will be assessed with the Global Rating of Change (GRC) scale. The scale to be used consists of 5 points (-2: I am much worse. -1: I am worse, 0: I am the same, +1: I am better, +2: I am much better).	At the end of 6-weeks

Collaborators and Investigators

• Sponsor: Tuğba Akgüller
• Investigators: Study Director: Yıldız Analay Akbaba, PhD, Istabul University-Cerrahpasa

Study record dates

Study Major Dates

• Study Start (Actual): December 13, 2021
• Primary Completion (Actual): April 19, 2022
• Study Completion (Actual): April 19, 2022

Study Registration Dates

• First Submitted: November 13, 2021
• First Submitted That Met QC Criteria: December 7, 2021
• First Posted (Actual): December 13, 2021

Study Record Updates

• Last Update Posted (Actual): May 26, 2023
• Last Update Submitted That Met QC Criteria: May 24, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: exercise; neck pain; manual therapy; mechanical neck pain
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain; Mobility Limitation
• Other Study ID Numbers: Istanbul University Cerrahpasa (Other Identifier: Istanbul University Cerrahpasa)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No