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Lascurain-Aguirrebeña I1,2, Newham DJ3, Casado-Zumeta X4, Lertxundi A5, Critchley DJ2
1University of the Basque Country (UPV/EHU), Physiology, Leioa, Spain, 2Kings College London, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, London, United Kingdom, 3Kings College London, Centre of Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, London, United Kingdom, 4Atlas Fisioterapia, Donostia, Spain, 5University of the Basque Country, Leioa, Spain
Background: Cervical mobilisations are frequently used to treat neck pain but their effectiveness has been questioned by several systematic reviews. Evidence suggests better outcomes are achieved when applied to specific patient subgroups. A criteria for patients suitable for neck mobilisations has been proposed but effects on this subgroup has not been tested.
Purpose: To assess the effectiveness of cervical mobilisations applied to patients with neck pain who fulfil specific criteria and also to assess if further clinical characteristics may be associated with their effectiveness.
Methods: In a double-blind randomised controlled trial, 40 patients with neck pain (19-80 years; 24 female; 28 chronic) attending a Physiotherapy clinic were recruited. Criteria for inclusion were: primary complaint of neck pain, non-traumatic, mechanical, limited and painful range of movement (ROM), positive local provocation tests, no signs of central hyperexcitability or neurological deficit. They were randomised to a single session of 10 minutes of either cervical mobilisations (segments that reproduced symptoms and/or were identified as hypomobile) or motionless placebo (same head position and hand contact but no oscillation). Patients were classified as responders or non-responders according to symptomatic improvement using the Global Rating of Change scale. Presence of movement associated pain, ROM and movement velocity during neck flexion, extension, side flexion and rotation were also assessed with a Vicon 3D motion capture system. The association between symptomatic improvement and the following baseline clinical characteristics was assessed: presence of ROM and movement velocity restriction, number of painful movements, symptom duration (acute/subacute or chronic), neck disability index (NDI), maximum and average pain over last 24 hours and body mass index (BMI).
Results: Patients in the mobilisation group were more likely to be classified as responders (odds ratio (OR): 11.7; p=0.003). Having maximum pain >7/10 (OR:20.5), average pain >5/10 (OR:9.4), a normal BMI (OR:40.5) and >4 painful movements (OR:22.9) increased the odds (p 0.05) of successful outcome. Patients who responded to mobilisations had a higher NDI than non-responders (mean difference: 14.54; p=0.014). Symptom duration had no effect on treatment outcome. Mobilisations produced a significant increase in ROM in side flexion (p=0.006) and rotation (p=0.044) when compared with placebo, but only in patients with pre-intervention ROM restriction in those movements. 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant (p 0.05) increase in movement velocity, but only in those who had a velocity restriction pre-intervention.
Conclusion(s): Cervical mobilisations are effective in improving symptoms, increasing ROM and movement velocity when applied to patients with neck pain who fulfill specific criteria. Effectiveness of mobilisations is increased in patients with higher pain intensity and disability, greater number of painful movements and normal BMI. Duration of symptoms has no effect on effectiveness.
Implications: This study provides evidence for the use of mobilisations in the treatment of neck pain in patients that fulfill the criteria used in this study. Further clinical criteria are identified to guide the physiotherapist in clinical practice. Information gained may help with subgrouping.
Keywords: neck pain, mobilisations, range of movement
Funding acknowledgements: None.
Purpose: To assess the effectiveness of cervical mobilisations applied to patients with neck pain who fulfil specific criteria and also to assess if further clinical characteristics may be associated with their effectiveness.
Methods: In a double-blind randomised controlled trial, 40 patients with neck pain (19-80 years; 24 female; 28 chronic) attending a Physiotherapy clinic were recruited. Criteria for inclusion were: primary complaint of neck pain, non-traumatic, mechanical, limited and painful range of movement (ROM), positive local provocation tests, no signs of central hyperexcitability or neurological deficit. They were randomised to a single session of 10 minutes of either cervical mobilisations (segments that reproduced symptoms and/or were identified as hypomobile) or motionless placebo (same head position and hand contact but no oscillation). Patients were classified as responders or non-responders according to symptomatic improvement using the Global Rating of Change scale. Presence of movement associated pain, ROM and movement velocity during neck flexion, extension, side flexion and rotation were also assessed with a Vicon 3D motion capture system. The association between symptomatic improvement and the following baseline clinical characteristics was assessed: presence of ROM and movement velocity restriction, number of painful movements, symptom duration (acute/subacute or chronic), neck disability index (NDI), maximum and average pain over last 24 hours and body mass index (BMI).
Results: Patients in the mobilisation group were more likely to be classified as responders (odds ratio (OR): 11.7; p=0.003). Having maximum pain >7/10 (OR:20.5), average pain >5/10 (OR:9.4), a normal BMI (OR:40.5) and >4 painful movements (OR:22.9) increased the odds (p 0.05) of successful outcome. Patients who responded to mobilisations had a higher NDI than non-responders (mean difference: 14.54; p=0.014). Symptom duration had no effect on treatment outcome. Mobilisations produced a significant increase in ROM in side flexion (p=0.006) and rotation (p=0.044) when compared with placebo, but only in patients with pre-intervention ROM restriction in those movements. 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant (p 0.05) increase in movement velocity, but only in those who had a velocity restriction pre-intervention.
Conclusion(s): Cervical mobilisations are effective in improving symptoms, increasing ROM and movement velocity when applied to patients with neck pain who fulfill specific criteria. Effectiveness of mobilisations is increased in patients with higher pain intensity and disability, greater number of painful movements and normal BMI. Duration of symptoms has no effect on effectiveness.
Implications: This study provides evidence for the use of mobilisations in the treatment of neck pain in patients that fulfill the criteria used in this study. Further clinical criteria are identified to guide the physiotherapist in clinical practice. Information gained may help with subgrouping.
Keywords: neck pain, mobilisations, range of movement
Funding acknowledgements: None.
Topic: Musculoskeletal: spine; Musculoskeletal
Ethics approval required: Yes
Institution: Univerisity of the Basque Country
Ethics committee: CEISH
Ethics number: M10_2016_095
All authors, affiliations and abstracts have been published as submitted.
