Efficacy of Oxygen-ozone Therapy and Cervical Rehabilitation

March 31, 2026 updated by: De Sire Alessandro, University of Catanzaro

Efficacy of Oxygen-ozone Therapy and Cervical Rehabilitation on Functioning in Patients Affected by Nec

Neck pain represents one of the most prevalent and disabling musculoskeletal conditions worldwide, significantly affecting functional capacity, work productivity, and quality of life. Despite the availability of multiple conservative treatment strategies, there is still no clear consensus on the most effective rehabilitation approach, particularly when combining interventional and exercise-based therapies. In recent years, oxygen-ozone (O₂O₃) therapy has emerged as a promising minimally invasive treatment for musculoskeletal pain, due to its potential anti-inflammatory, analgesic, and microcirculatory effects. However, evidence regarding its integration with structured rehabilitation programs for neck pain remains limited.

The purpose of this prospective double-arm study was to evaluate the effectiveness of a combined therapeutic approach based on O₂O₃ paravertebral injections followed by cervical rehabilitation exercises. Specifically, the study aimed to compare two commonly used rehabilitation strategies-McKenzie-based therapy and Back School exercises-in order to determine which approach provides greater benefits when associated with O₂O₃ treatment.

The primary research question addressed whether the combination of O₂O₃ injections with McKenzie exercises leads to superior improvements in disability, compared to O₂O₃ combined with Back School. Secondary questions explored whether this combined approach is effective in reducing pain intensity and improving health-related quality of life in patients with chronic neck pain.

To answer these questions, patients with clinically significant neck pain were treated with a standardized O₂O₃ injection protocol and subsequently allocated to one of the two rehabilitation programs. Outcomes related to disability, pain, and quality of life were assessed across multiple time points to evaluate both short-term and follow-up effects.

Overall, this study seeks to clarify the added value of integrating interventional therapies with specific rehabilitation strategies and to identify the most effective combination for optimizing functional recovery in patients with neck pain.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

46

Phase

  • Phase 2
  • Phase 1

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

  • Italy
    • CZ
      • Catanzaro, CZ, Italy, 88100
        • University "Magna Graecia "of Catanzaro

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults aged 18 years or older
  • Diagnosis of neck pain lasting at least 12 weeks
  • Moderate to severe pain (score ≥ 4 on a 0-10 pain scale)
  • Presence of muscle pain (trigger points) in the neck region
  • Willingness to stop pain medications or other treatments that could interfere with the study
  • Ability to understand the study and provide informed consent

Exclusion Criteria:

  • Cognitive impairment or inability to provide informed consent
  • Current use of anti-inflammatory drugs, opioids, or ongoing rehabilitation treatments
  • Neck pain caused by nerve damage, infections, tumors, or systemic diseases
  • History of recent neck trauma or surgery
  • Presence of serious medical conditions such as cancer, rheumatoid arthritis, fibromyalgia, thyroid disorders, or diabetes
  • Active infections
  • Pregnancy

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Study group

Intramuscular paravertebral O₂O₃ therapy was administered by a physician specialized in Physical and Rehabilitation Medicine with expertise in ozone injections. All participants received 8 weekly cervical paravertebral injections of an O₂O₃ gas mixture (10 μg/mL, total volume 10 mL), delivered using a 27-gauge needle. Each session consisted of five symmetrical injections of 2 mL into the paravertebral cervical muscles.

Following the injection cycle, patients underwent a structured rehabilitation program based on the McKenzie method.
Drug: Combined O₂O₃ Injection and McKenzie-Based Rehabilitation Program

Intramuscular paravertebral oxygen-ozone (O₂O₃) therapy was administered using a gas mixture at a concentration of 10 μg/mL, with a total volume of 10 mL per session. The treatment was delivered through five bilateral paravertebral cervical injections (2 mL per site) using a 27-gauge needle. Sessions were performed once weekly for 8 consecutive weeks.

Following the injection phase, participants underwent a structured rehabilitation program based on the McKenzie method, consisting of 10 supervised sessions over a 2-week period, focused on repeated cervical movements, postural correction, and patient-directed exercises.
Active Comparator: Control group

Intramuscular paravertebral O₂O₃ therapy was administered by a physician specialized in Physical and Rehabilitation Medicine with expertise in ozone injections. All participants received 8 weekly cervical paravertebral injections of an O₂O₃ gas mixture (10 μg/mL, total volume 10 mL), delivered using a 27-gauge needle. Each session consisted of five symmetrical injections of 2 mL into the paravertebral cervical muscles.

Following the injection cycle, patients underwent a structured rehabilitation program based on the Back School method.
Drug: Combined O₂O₃ Injection and back school Rehabilitation Program

Intramuscular paravertebral oxygen-ozone (O₂O₃) therapy was administered using a gas mixture at a concentration of 10 μg/mL, with a total volume of 10 mL per session. The treatment was delivered through five bilateral paravertebral cervical injections (2 mL per site) using a 27-gauge needle. Sessions were performed once weekly for 8 consecutive weeks.

Following the injection phase, participants underwent a structured rehabilitation program based on the back school, consisting of 10 supervised sessions over a 2-week period, focused on repeated cervical movements, postural correction, and patient-directed exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Disability Index (NDI)
Time Frame: From enrollment to the end of treatment at 24 weeks
The Neck Disability Index (NDI) is a validated, self-reported questionnaire used to assess disability related to neck pain. It consists of 10 items evaluating pain intensity and its impact on daily activities, including personal care, lifting, reading, work, driving, sleeping, and recreation. Each item is scored from 0 (no disability) to 5 (maximum disability), with a total score ranging from 0 to 50. The final score is typically expressed as a percentage, with higher scores indicating greater disability.
From enrollment to the end of treatment at 24 weeks

Collaborators and Investigators

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

Sponsor

University of Catanzaro

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)

March 1, 2024

Primary Completion (Actual)

November 1, 2024

Study Completion (Actual)

November 30, 2024

Study Registration Dates

First Submitted

March 19, 2026

First Submitted That Met QC Criteria

March 25, 2026

First Posted (Actual)

March 31, 2026

Study Record Updates

Last Update Posted (Actual)

April 6, 2026

Last Update Submitted That Met QC Criteria

March 31, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 78/2024

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

product manufactured in and exported from the U.S.

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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