Effect of Manual Therapy on Non Specific Neck Pain

Effects of Upper Thoracic Mulligan Mobilization for Pain, Range of Motion and Function in Patients With Mechanical Neck Pain

The aim of this study is to investigate the effects of Mulligan concept Reverse Natural Apophysial Glide Technique (RNAGS)technique applied to the thoracic region on pain, limitation of movement, and functionality in individuals with mechanical neck pain.

Study Overview

• Status: Completed
• Conditions: Neck Pain
• Intervention / Treatment: Other: Mulligan Reverse Natural Apophysial Glide Technique (RNAGS); Other: Conventional physical therapy and sham manual therapy; Other: Conventional physical therapy

Detailed Description

When we look at the studies investigating the effectiveness of different treatment modalities in non-specific neck pain (NSNP), there is no method accepted as the gold standard for the treatment of NSNP. One of the preferred treatment options for NSNP is physiotherapy and rehabilitation. Physiotherapy and rehabilitation includes electrotherapy modalities, therapeutic exercises, joint mobilisation and manipulations, myofascial release. Among these treatments, manual therapy, which targets the harmony of structure and function, is one of the most preferred treatment methods by physiotherapists. Manual therapy provides improvement by orienting the body's biomechanics, circulation and body structure by directly affecting the joints, muscles and soft tissues. In the literature, there are studies on both cervical mobilisation and thoracic mobilisation for neck pain. Cervical mobilisation and manipulation in neck pain are controversial because they carry certain risks. It has been reported that mobilisation of the thoracic spine decreases pain in the cervical region and increases mobilisation in this region. When the literature was examined, there was no study examining the effect of the Mulligan concept natural apophyseal reversal technique applied to the thoracic region on NSNP. This study was planned to investigate the effect of natural apophyseal reversal on pain and mobility limitation in individuals diagnosed with NSNP.

• Study Type: Interventional
• Enrollment (Actual): 69
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Bolu, Turkey, 14300
    • Faculty of Health Sciences Bolu Abant Izzet Baysal University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Those between the ages of 18-65
• Those with neck pain lasting at least 3 months
• Individuals diagnosed with mechanical neck pain by a specialist physician

Exclusion Criteria:

• Those with a history of spinal surgery
• Those with a history of whiplash injury
• Those with a history of trauma in the cervical and thoracic region
• Pregnancy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan group (MG); Individuals underwent 11 sessions (every day for the first week, every other day for the next two weeks).Hot pack was applied to the neck and upper trapezius area for 20 minutes.2 channels and 4 electrodes in the neck area; Conventional transcutaneous electrical nerve stimulation (TENS) was applied to the patient for 20 minutes with current transition time: 50-100 microseconds, frequency: 60-120 Hz and mild tingling without causing discomfort.US application was performed at a frequency of 1.5 W/cm2 and 1 Mhz for 8 minutes.Stretching exercises were applied to the trapezius upper part and levator scapula muscles for 15-30 seconds with 10 repetitions under the supervision of a physiotherapist.In addition to physiotherapy applications in MG, Mulligan natural apophyseal reversal technique was applied to the upper thoracic segments. Mulligan mobilization was performed with 3 sets of 10 repetitions and 15-20 seconds of rest between sets.	Other: Mulligan Reverse Natural Apophysial Glide Technique (RNAGS); Mulligan mobilization techniques was applied to the upper thoracic segments with the RNAGS technique. The application was performed with one hand (thumb in extension, other fingers flexed) that was used to perform the pushing maneuver on the transverse processes, while the other arm was used to gently grasp the head of the patient and recline the neck against the body for stabilization. Conventional TENS was applied to the neck area with 2 channels and 4 electrodes for 20 min (current passage time: 50-100 microseconds, frequency: 0-120 Hz). Ultrasonography was performed for 8 minutes with an intensity of 1.5 w/cm2 and a frequency of 1 MHz. Stretching exercises were applied to the upper part of the trapezius and levator scapula muscles for 15-30 seconds for 10 repetitions by a physiotherapist.; Other Names: TENS; Stretching exercises; Hotpack; Utrasound
Sham Comparator: Sham (different in the direction and amplitude of mobilization) group; Individuals underwent 11 sessions (every day for the first week, every other day for the next two weeks).Hot pack was applied to the neck and upper trapezius area for 20 minutes.2 channels and 4 electrodes in the neck area; Conventional TENS was applied to the patient for 20 minutes with current transition time: 50-100 microseconds, frequency: 60-120 Hz and mild tingling without causing discomfort.US application was performed at a frequency of 1.5 W/cm2 and 1 Mhz for 8 minutes.Stretching exercises were applied to the trapezius upper part and levator scapula muscles for 15-30 seconds with 10 repetitions under the supervision of a physiotherapist.Sham mobilization was applied to the segments where Mulligan mobilization was carried out in Sham group, in which the direction of thrust and thrust were different.	Other: Conventional physical therapy and sham manual therapy; A sham Mulligan RNAGS technique with low pressure compression was applied to thoracic region. Conventional TENS was applied to the neck area with 2 channels and 4 electrodes for 20 min (current passage time: 50-100 microseconds, frequency: 0-120 Hz). Ultrasonography was performed for 8 minutes with an intensity of 1.5 w/cm2 and a frequency of 1 MHz. Stretching exercises were applied to the upper part of the trapezius and levator scapula muscles for 15-30 seconds for 10 repetitions by a physiotherapist.; Other Names: TENS; Stretching exercises; Hotpack; Utrasound
Other: Physiotherapy group; Individuals underwent 11 sessions (every day for the first week, every other day for the next two weeks).Hot pack was applied to the neck and upper trapezius area for 20 minutes.2 channels and 4 electrodes in the neck area; Conventional TENS was applied to the patient for 20 minutes with current transition time: 50-100 microseconds, frequency: 60-120 Hz and mild tingling without causing discomfort.US application was performed at a frequency of 1.5 W/cm2 and 1 Mhz for 8 minutes.Stretching exercises were applied to the trapezius upper part and levator scapula muscles for 15-30 seconds with 10 repetitions under the supervision of a physiotherapist.	Other: Conventional physical therapy; Conventional TENS was applied to the neck area with 2 channels and 4 electrodes for 20 min (current passage time: 50-100 microseconds, frequency: 0-120 Hz). Ultrasonography was performed for 8 minutes with an intensity of 1.5 w/cm2 and a frequency of 1 MHz. Stretching exercises were applied to the upper part of the trapezius and levator scapula muscles for 15-30 seconds for 10 repetitions by a physiotherapist; Other Names: TENS; Stretching exercises; Hotpack; Utrasound

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Joint Range of Motion Assessment (ROM)	Active flexion, extension, right/left lateral flexion and rotation of the cervical region were measured in the sitting position with a phone goniometer application.	3 weeks
Pain Assessment	Visual analogue scale (VAS) was used to assess the severity of mechanical neck pain. Individuals were asked to mark the pain they felt on a 10 cm long VAS scale ("0" indicates no pain and "10" indicates unbearable pain).	3 weeks
Neck Disability Status Assessment (NDI)	Evaluate neck disability status A questionnaire consisting of 10 items. Seven items are related to activities of daily living, two are related to pain intensity and one is related to concentration. The response to each item is scored between 0 (no limitation) and 5 (maximum limitation) and the final NDI score is obtained by summing each score	3 weeks

Collaborators and Investigators

• Sponsor: Abant Izzet Baysal University
• Investigators: Principal Investigator: Omer Osman PALA, PhD, Abant Izzet Baysal University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): May 30, 2021
• Study Completion (Actual): May 30, 2021

Study Registration Dates

• First Submitted: December 29, 2023
• First Submitted That Met QC Criteria: December 29, 2023
• First Posted (Actual): January 10, 2024

Study Record Updates

• Last Update Posted (Actual): January 10, 2024
• Last Update Submitted That Met QC Criteria: December 29, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: Mulligan; Range of Motion; Mechanical Neck Pain; Thoracic Mobilization
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: AIBU-FTR-ÖOP-07

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan for data sharing.

Drug and device information, study documents

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