Effectiveness of a specific manual approach to the suboccipital region in patients with chronic mechanical neck pain and rotation deficit in the upper cervical spine: study protocol for a randomized controlled trial

Vanessa González Rueda, Carlos López de Celis, Martín Eusebio Barra López, Andoni Carrasco Uribarren, Sara Castillo Tomás, Cesar Hidalgo García, Vanessa González Rueda, Carlos López de Celis, Martín Eusebio Barra López, Andoni Carrasco Uribarren, Sara Castillo Tomás, Cesar Hidalgo García

Abstract

Background: Mechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual techniques have been recommended for restoring cervical mobility, but their effectiveness in these patients is unknown. The aim of the present study is to compare the effectiveness of two types of specific techniques of the upper neck region: the pressure maintained suboccipital inhibition technique (PMSIT) and the translatory dorsal glide mobilization (TDGM) C0-C1 technique, as adjuncts to a protocolized physiotherapy treatment of the neck region in subjects with chronic mechanical neck pain and rotation deficit in the upper cervical spine.

Methods: A randomized, prospective, double-blind (patient and evaluator) clinical trial. The participants (n = 78) will be randomly distributed into three groups. The Control Group will receive a protocolized treatment for 3 weeks, the Mobilization Group will receive the same protocolized treatment and 6 sessions (2 per week) of the TDGM C0-C1 technique, and the Pressure Group will receive the same protocolized treatment and 6 sessions (2 per week) of the PMSIT technique. The intensity of pain (VAS), neck disability (NDI), the cervical range of motion (CROM), headache intensity (HIT-6) and the rating of clinical change (GROC scale) will be measured. The measurements will be performed at baseline, post-treatment and 3 months after the end of treatment, by the same physiotherapist blinded to the group assigned to the subject.

Discussion: We believe that an approach including manual treatment to upper cervical dysfunction will be more effective in these patients. Furthermore, the PMSIT technique acts mostly on the musculature, while the TDGM technique acts on the joint. We expect to clarify which component is more effective in improving the upper cervical mobility.

Trial registration: ClinicalTrials.gov NCT02832232 . Registered on July 13th, 2016.

Keywords: Atlantoaxial joint; Cervical vertebrae; Range of motion; Suboccipital muscle inhibition.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol has been approved by the Clinical Research Ethics Committee (CREC) of the Jordi Gol Institute of Research in Primary Healthcare (reference number P16/068) on May 25th, 2016 and has been registered at Consent for publication

Consent was provided for images of the techniques to be included and published.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort Diagram: Flow of the participants throughout the study
Fig. 2
Fig. 2
Suboccipital translatory dorsal glide mobilization (TDGM) C0-C1 technique
Fig. 3
Fig. 3
Pressure maintained suboccipital inhibition technique (PMSIT)

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