Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial

Vanessa González-Rueda, César Hidalgo-García, Jacobo Rodríguez-Sanz, Elena Bueno-Gracia, Albert Pérez-Bellmunt, Pere Ramón Rodríguez-Rubio, Carlos López-de-Celis, Vanessa González-Rueda, César Hidalgo-García, Jacobo Rodríguez-Sanz, Elena Bueno-Gracia, Albert Pérez-Bellmunt, Pere Ramón Rodríguez-Rubio, Carlos López-de-Celis

Abstract

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion-rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion-rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion-rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion-rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion-rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.

Keywords: craniocervical; neck pain; physical therapy; range of motion; spinal manipulation.

Conflict of interest statement

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. This work was supported by the IDIAP Jordi Gol i l’Institut Català de la Salut [n 7Z17/004] and PERIS 2018 [n 7Z18/003] for this study.

Figures

Figure 1
Figure 1
Conventional physical therapy treatment. (A) Stretching of the upper trapezius muscle; (B) stretching of the elevator scapula muscle; (C) stretching of the pectoralis major muscle; (D) cervical spine auto-traction; (E) thoracic spine auto-mobilization.
Figure 2
Figure 2
(A) Pressure inhibition technique application. (B,C) lateral and cranial view of the upper cervical translatoric mobilization (UCTM) application.
Figure 3
Figure 3
Flow chart.

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