Background & Aims
Background: Nonspecific neck pain is one of the most common causes of neck disorder, which leads to increased postural sway with cervical proprioceptive deficit.
Purpose: This study aimed to determine the effect of cervical mobilization on static/dynamic balance and cervical proprioception in patients with nonspecific neck pain (NSNP), which may lead to a lack of postural control and joint position sense.
Methods
Study Design: A two-armed, double-blind, parallel-group, randomized clinical trial with a 3-week treatment protocol was carried out for the study.
Methods: Sixty-six patients were randomly allocated into two groups. Both groups received conventional physiotherapy (hot pack-TENS); however, the mobilization group received mobilization and the placebo-control group received placebo mobilization twice a week for 3 weeks. Static/dynamic balance, joint position sense, mobility and pain were evaluated with Kinesthetic Skill Training System 3000 device, joint position error test, CROM (Cervical Range-of-Motion Instrument), and Visual Analogue Scale, respectively.
Results
Results: Following treatment, there were significant improvements in both dynamic balance (p<0.001) and proprioception in the direction of left rotation in the mobilization group (p=0.003), and these changes were more than those in placebo-controls statistically (p<0.001/p=0.003). Although there was a significant decrease in the deficits of static balance (p=0.044) and proprioception in the direction of right rotation (p=0.011) after mobilization, these changes were not more than those in pacebo-controls (p=0.192/p=0.154).
Conclusions
Cervical mobilization had a significant effect on dynamic balance, a limited effect on the sense of cervical proprioception and no effect on static balance in patients with NSNP. This study contributes valuable insights into the therapeutic potential of cervical mobilization for addressing postural control and joint position sense in individuals with NSNP. Future research may delve into refining treatment protocols or exploring additional outcome measures to further enhance our understanding of the nuanced effects of cervical mobilization on different aspects of neck pain and associated impairments.
References
1.Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Europa medicophysica. 2007;43(1):79-89.
2.Kulkarni V, Chandy M, Babu K. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurology India. 2001;49(4):355.
3.Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29(19):2108-2114.
4.Sahrmann S, Azevedo DC, Van Dillen L. Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy. 2017;21(6):391-399.
5.Duray M, ?im?ek ?, Altu? F, Cavlak U. Effect of proprioceptive training on balance in patients with chronic neck pain. 2018;
6.Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy. 2008;13(1):2-11.
7.Ruhe A, Fejer R, Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder-A systematic review of the literature. Chiropractic & manual therapies. 2011;19(1):1-11.
8.Humphreys BK. Cervical outcome measures: testing for postural stability and balance. Journal of manipulative and physiological therapeutics. 2008;31(7):540-546.
9.Grace Gaerlan M, Alpert PT, Cross C, Louis M, Kowalski S. Postural balance in young adults: the role of visual, vestibular and somatosensory systems. Journal of the American Academy of Nurse Practitioners. 2012;24(6):375-381.
10.Corneil BD, Olivier E, Munoz DP. Neck muscle responses to stimulation of monkey superior colliculus. I. Topography and manipulation of stimulation parameters. Journal of Neurophysiology. 2002;88(4):1980-1999.
11.Wannaprom N, Treleaven J, Jull G, Uthaikhup S. Neck muscle vibration produces diverse responses in balance and gait speed between individuals with and without neck pain. Musculoskeletal Science and Practice. 2018;35:25-29.
12.Capra NF, Ro JY. Experimental muscle pain produces central modulation of proprioceptive signals arising from jaw muscle spindles. Pain. 2000;86(1-2):151-162.
13.Voogt L, de Vries J, Meeus M, Struyf F, Meuffels D, Nijs J. Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review. Manual therapy. 2015;20(2):250-256.
14.Jun P, Pagé I, Vette A, Kawchuk G. Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review. Chiropractic & manual therapies. 2020;28(1):1-13.
15.Lee K-S, Lee J-H. Effect of Maitland mobilization in cervical and thoracic spine and therapeutic exercise on functional impairment in individuals with chronic neck pain. Journal of physical therapy science. 2017;29(3):531-535.
16.Fisher AR, Bacon CJ, Mannion JV. The effect of cervical spine manipulation on postural sway in patients with nonspecific neck pain. Journal of Manipulative and physiological therapeutics. 2015;38(1):65-73.
17.Romero del Rey R, Saavedra Hernandez M, Rodriguez Blanco C, Palomeque del Cerro L, Alarcon Rodriguez R. Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: A randomized controlled trial. Disability and Rehabilitation. 2022;44(8):1227-1233.
18.Gómez F, Escribá P, Oliva-Pascual-Vaca J, Méndez-Sánchez R, Puente-González AS. Immediate and short-term effects of upper cervical high-velocity, low-amplitude manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain: a randomized controlled trial. Journal of Clinical Medicine. 2020;9(8):2580.
19.Beinert K, Lutz B, Zieglgänsberger W, Diers M. Seeing the site of treatment improves habitual pain but not cervical joint position sense immediately after manual therapy in chronic neck pain patients. European Journal of Pain. 2019;23(1):117-123.
20.Palmgren PJ, Sandström PJ, Lundqvist FJ, Heikkilä H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. Journal of Manipulative and Physiological Therapeutics. 2006;29(2):100-106.
21.Heikkilä H, Johansson M, Wenngren B-I. Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Manual therapy. 2000;5(3):151-157.
22.Miranda IF, Facchini D, Manfio EF. Influence of Cervical Spine Manipulation on Neck Joint Position Sense error in patients with chronic neck pain. Manual Therapy, Posturology & Rehabilitation Journal. 2016:1-8.
23.Rehab NI, Saleh MSM, Abdelmageed SM, Elkafrawy N. Effect of different therapeutic modalities on cervical joint position sense, neck pain and dizziness in patients with cervical spondylosis: A randomized controlled trial.
24.Quek JMT, Pua Y-H, Bryant AL, Clark RA. The influence of cervical spine flexion-rotation range-of-motion asymmetry on postural stability in older adults. Spine. 2013;38(19):1648-1655.
25.Moher D. hopewell S, schulz KF, montori V, gøtzsche PC, devereaux PJ, elbourne D, egger M, altman DG, for the CONSORT group. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trial. BMJ. 2010;340:c869.
26.Kaltenborn FM. Manual Mobilization of the Joints. vol Volume 2:The Spine. Norlis Bokhandel; 2018.
27.Reddy RS, Tedla JS, Dixit S, Abohashrh M. Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis. BMC musculoskeletal disorders. 2019;20(1):1-7.
28.Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. European journal of physical and rehabilitation medicine. 2010;46(2):239.
29.Law EYH, Chiu TT-W. Measurement of cervical range of motion (CROM) by electronic CROM goniometer: a test of reliability and validity. Journal of back and musculoskeletal rehabilitation. 2013;26(2):141-148.
30.Huskisson E, JONES J, SCOTT PJ. Application of visual-analogue scales to the measurement of functional capacity. Rheumatology. 1976;15(3):185-187.
31.Yang J, Lee B, Kim C. Changes in proprioception and pain in patients with neck pain after upper thoracic manipulation. Journal of physical therapy science. 2015;27(3):795-798.
32.Alahmari K, Reddy RS, Silvian P, Ahmad I, Nagaraj V, Mahtab M. Intra-and inter-rater reliability of neutral head position and target head position tests in patients with and without neck pain. Brazilian journal of physical therapy. 2017;21(4):259-267.
Presenting Author
Nagihan Acet
Poster Authors
Nagihan Acet
Assist. Prof.
At?l?m University
Lead Author
Nagihan Acet
Atilim University
Lead Author
NEV?N ATALAY GÜZEL
PROFESOR
Gazi University, Department of Physiotherapy and Rehabilitation
Lead Author
ZAFER GÜNEND?
Gazi University, Department of Physical Medicine and Rehabilitation
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neck Pain