Effects of Cervicothoracic Self-Mobilization Along with Conservative Treatment in Subacute Neck Pain: Randomized Controlled Trial

Objectives: This study aims to investigate the effectiveness of mesotherapy in patients with acute or subacute neck pain compared to oral medications with the same active ingredients. Patients and methods: In this randomized, single-blind study, 44 patients with acute to subacute neck pain (6 males, 38 females; mean age: 46.8±11.1 years; range, 23 to 65 years) were included between October 30, 2023, and June 30, 2024. These patients were randomly assigned to two groups. The first group received two sessions of mesotherapy solution, administered at seven‑day intervals. The second group received oral meloxicam 15 mg once daily and thiocolchicoside 8 mg twice daily for seven days. Visual Analog Scale (VAS), Neck Disability Index (NDI), and cervical range of motion were evaluated before treatment and on the seventh and 14th days. Results: There was no significant difference in demographic data, initial VAS scores, range of motion, and NDI scores between the two groups (p>0.05). Significant improvements in the VAS (p<0.001 and p<0.03, respectively) and NDI scores (p<0.001 and p=0.016, respectively) were observed within both groups. However, there was no significant difference between the groups (p>0.05). No significant difference was found within or between the groups in range of motion (p>0.05). In the first group, VAS scores significantly improved 30 mins after both sessions (p=0.009 and p=0.038, respectively). Conclusion: We found mesotherapy to be as effective as oral combination therapy. Mesotherapy can be preferred as it allows the use of low-dose medication to relieve acute and subacute neck pain.

This study aims to investigate the effects of myofascial release therapy (MRT) added to standard physical therapy and rehabilitation practices on neck pain, trigger point (TP) numbers, pressure pain threshold (PPT), cervical joint range of motion (ROM), neck disability and quality of life in patients with cervical myofascial pain syndrome (MPS). This prospective, randomized-controlled trial included a total of 60 patients (8 males, 52 females; mean age: 41.6±12.5 years; range, 20 to 65 years) aged between 18 and 65 years who reported neck pain persisting for over one month and satisfied the Travell and Simons criteria for MPS diagnosis between December 2021 and September 2022. The patients in Group 1 (n=30) underwent a standard physical therapy program. Patients in Group 2 (n=30) additionally underwent MRT three days a week. Before and on Day 15 after treatment, patients' pain was evaluated by Visual Analog Scale (VAS), TP numbers by palpation, PPTs by pressure algometer, cervical ROM by goniometer, disability by Neck Disability Index (NDI), quality of life by Nottingham Health Profile (NHP). The VAS scores, TP numbers, PPTs, cervical ROM values, NDI, and NHP scores exhibited a significant improvement posttreatment compared to pretreatment in both groups (p<0.001). Considering the changes after treatment, in Group 2, the changes of VAS-movement, VAS-rest, TP numbers, PPTs, cervical ROMs, NDI, NHP scores were significantly higher than Group 1 (p≤0.05 for all). In patients with neck pain due to cervical MPS, MRT provides positive effects on pain, TP numbers, PPT measurements, cervical ROM, neck disability, and quality of life. The MRT appears to be an effective treatment for cervical MPS as it is non-invasive, easy to apply, inexpensive, and has a low side effect profile.

A network analysis can be used to quantitatively assess and graphically describe multiple interactions. This study applied network analyses to determine the interaction between physical and pain-related factors and fear of movement in people with whiplash-associated disorders (WAD) during periods of acute and chronic pain. Physical measurements, including pressure pain-thresholds (PPT) over neural structures, cervical range of motion, neck flexor and extensor endurance and the cranio-cervical flexion test (CCFT), in addition to subjective reports including the Tampa Scale of Kinesiophobia (TSK-11), Neck Disability Index (NDI) and neck pain and headache intensity, were assessed at baseline in 47 participants with acute WAD. TSK-11, NDI and pain intensity were assessed for the same participants 6 months later (n = 45). Two network analyses were conducted to estimate the associations between features at baseline and at 6 months and their centrality indices. Both network analyses revealed that the greatest weight indices were found for NDI and CCFT at baseline and for neck pain and headache intensity and NDI and TSK-11 at both time points. Associations were also found betweeen cervical muscle endurance and neck pain intensity in the acute phase. Cervical muscle endurance assesssed during the acute phase was also associated with NDI after 6 months - whereas PPT measured at baseline was associsated with headache intensity after 6 months. The strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute pain and when mesured 6 months later. The extent of neck endurance and measures of PPT at baseline may be associated with neck disability and headache, respectively, 6 months after a whiplash injury. Through two network analyses, we evaluated the interaction between pain-related factors, fear of movement, neck disability and physical factors in people who had experienced a whiplash injury. We demonstrated that physical factors may be involved in the maintenance and development of chronic pain after a whiplash injury. Nevertheless, the strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute and chronic phases.

ObjectiveThe objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability.MethodsIt was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons.ResultsThere was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05).ConclusionsThe present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.Trial registrationRCT20190325043109N1.

The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. RCT20190325043109N1.

BACKGROUND: Many studies suggest that myofascial pain syndrome is an important source of musculoskeletal dysfunction. Also, on examining the trigger points, highest prevalence was seen in upper trapezius which was 94.79% followed by neck extensors 72.97% and levator scapulae 63.54%. Positional release technique and Myofascial release technique both have been used individually on both active and latent trigger points and have shown their effects on pain, functional disability and movement restriction. With considering the previous literature, aim of the study is to compare the effect of positional release technique and myofascial release technique on upper trapezius and levator scapulae latent trigger points in undergraduate students. METHODOLOGY: 40 subjects fulfilling the inclusion and exclusion criteria were selected and randomly allocated into two groups via chit method. All the subjects were assessed for pain using VAS, neck disability using Neck Disability Index and cervical range of motion using goniometer before initiating the treatment. Group A was given Positional release technique along with conventional exercises of cervical movements and shoulder girdle exercises. Group B was given Myofascial release technique along with same conventional exercises. Data was collected and analysed. There was not a statistically significant difference when post scores of Group A and Group B were compared for pain, neck disability and cervical range of motion. On comparing the differences of scores of Group A and group B, statistically significant difference was seen only in cervical flexion range of motion (p&lt;0.0016), cervical right rotation (p&lt;0.0002) and left lateral flexion (p&lt;0.0062) showing better results in Group A than Group B.&#x0D; KEYWORDS: Myofascial trigger points, Positional release technique, Myofascial release technique, Visual analog scale, Neck disability index

The influence of physical and psychosocial variables on self-rated disability in patients with chronic mechanical neck pain has not been fully determined. This study examined the relationship of pain, physical impairment, and pain-related fear to disability in individuals with chronic mechanical neck pain. A cross-sectional study was conducted. Ninety-seven (n = 97) subjects (28 men, 69 women; mean age, 39.3 yrs) with chronic mechanical neck pain were prospectively recruited. Demographic information, duration of pain symptoms, pain intensity, pain-related fear, and cervical range of motion were collected on all subjects. Self-reported disability was measured with the Neck Disability Index. Correlation and regression analyses were performed to determine the association among the variables and to determine the proportions of explained variance in disability. Significant positive correlations existed between disability and previous history of neck pain (r = 0.45; P < 0.001), disability and pain intensity (r = 0.32, P = 0.01), and disability and kinesiophobia (r = 0.23, P = 0.02). In addition, a significant negative correlation existed between disability and cervical extension range of motion (r = -0.18, P = 0.04). Stepwise regression analyses revealed that previous neck pain episodes, intensity of neck pain, kinesiophobia, and cervical extension range of motion were significant predictors of disability (r = 0.400; r adjusted = 0.372; F = 14.64; P < 0.001). This study found that previous episodes of neck pain, pain intensity, pain-related fear, and cervical extension range of motion explained 37.2% of the variability of self-report disability. Future longitudinal studies will help to determine the clinical implications of these findings.

Objective : To compare efficacy of Maitland Thoracic Mobilisation and Deep Neck Flexor (DNF) Endurance training with only Deep Neck Flexor Endurance training on Cervical Range Of Motion (ROM), Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI) in patients with Mechanical Neck Pain. Study design : Experimental Methodology : 30 mechanical neck pain patients between the age 18 -35 who met inclusion&exclusion criteria were selected. They were then randomly assigned to one of the 2 treatments groups: Group A (Maitland thoracic mobilisation with DNF endurance exercises) or Group B (only DNF endurance exercises) The training groups were assigned to their respective treatment programs for a period of 4 weeks. Participants were assessed on the following outcome measures before and after 4 weeks of treatment. 1) Numerical Pain Rating Scale 2) Neck Disability Index 3) Cervical Range of Motion Result : On comparison, Maitland Thoracic Mobilisation with DNF Endurance training was found to produce more statistically significant reduction in pain and greater improvement in Cervical Lateral Flexion and Rotation range of motion. However there was more reduction even in NDI scoring in this group, but when compared with only DNF Endurance training exercises it was not statistically significant. There were no statistical significant differences when the groups were compared for cervical sagittal mobility. Conclusion : In patients with Mechanical Neck Pain, DNF Endurance training exercises with Maitland Thoracic mobilisations is more effective than only DNF Endurance training exercises reducing pain and improving cervical lateral flexion and rotation ROM, but there was no statistically significant difference between groups on cervical sagittal mobility and NDI scoring.

Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults

Efficacy and safety of Shi's cervical manipulation versus diclofenac for patients with acute and subacute neck pain: a multicenter clinical randomized trial.

Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain. Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain.

Objectives: Variety of physiotherapy interventions have proven to be efficient in reducing pain and neck disability, to improve range of motion (ROM) which results in the improvement in quality of life (QoL) in head and neck cancer (HNC) patients. The aim of this study was to determine the effect of myofascial release (MFR) versus muscle energy technique (MET) on trapezius spasm for pain, disability, ROM, and QoL in postoperative HNC patients. Materials and Methods: Twenty-four patients with HNC cancers who underwent surgery were recruited in the study. The pre–post assessment for neck disability, pressure pain threshold, cervical and shoulder ROM, and QoL was done at baseline and after 6 days of intervention using Neck Disability Index, pressure algometer, universal goniometer, and Functional Assessment of Cancer Therapy - Head and Neck scale, respectively. Results: MFR and MET groups are effective for pain reduction P = 0.0001 and neck disability P = 0.0022 when compared within the groups. Cervical and shoulder ranges showed significant improvement in cervical flexion (P = 0.0162), cervical extension (P = 0.0096), shoulder flexion (P = 0.0205), shoulder extension (P = 0.0408), shoulder abduction (P = 0.0037), and shoulder adduction (P = 0.0037) when compared between the two groups. When compared within the two groups cervical and shoulder ranges showed significant improvements (P = 0.0001) in both the groups. Conclusion: MFR and MET are effective when applied individually to reduce pain and neck disability and increase cervical and shoulder ROM in HNC patients.

Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

Background/aims The Örebro Musculoskeletal Pain Questionnaire is categorised as a ‘yellow flag’ pain-associated psychological distress screening tool, which predicts long-term disability. The aim of this study was to assess the validity and reliability of the Turkish translation of the Örebro Musculoskeletal Pain Questionnaire in patients with acute and subacute neck pain. Methods The test–retest reliability and internal consistency were assessed with the intraclass correlation coefficient and Cronbach's α. Construct validity was assessed with a visual analogue scale, the Neck Disability Index and the Fear Avoidance Belief Questionnaire. Results Cronbach's α value was found to be 0.790, test–retest reliability was 0.99. The intraclass correlation coefficient was 0.999 (95% confidence interval: 0.998–0.999; P=0.000). The Örebro Musculoskeletal Pain Questionnaire showed a moderate positive correlation with the Neck Disability Index (r=0.544; P=0.0001), a weak correlation with the Fear Avoidance Belief Questionnaire (r=0.264; P=0.0001) but no correlation with the visual analogue scale. Conclusions The Turkish version of the Örebro Musculoskeletal Pain Questionnaire is a valid, reliable and acceptable screening tool in patients with acute and subacute neck pain.

BackgroundCervical and lumbar range of motion limitations are usually associated with musculoskeletal pain in the neck and lower back, and are a major health problem among nurses. Physical exercise has been evaluated as an effective intervention method for improving cervical and lumbar range of motion, and for preventing and reducing musculoskeletal pain. The purpose of this study was to investigate the effects of a home-exercise therapy programme on cervical and lumbar range of motion among intensive care unit nurses who had experienced mild to moderate musculoskeletal pain in the neck and or lower back during the previous six months.MethodsA quasi-experimental study was conducted among intensive care unit nurses at Tartu University Hospital (Estonia) between May and July 2011. Thirteen nurses who had suffered musculoskeletal pain episodes in the neck and or lower back during the previous six months underwent an 8-week home-exercise therapy programme. Eleven nurses without musculoskeletal pain formed a control group.Questions from the Nordic Musculoskeletal Questionnaire and the 11-point Visual Analogue Scale were used to select potential participants for the experimental group via an assessment of the prevalence and intensity of musculoskeletal pain. Cervical range of motion and lumbar range of motion in flexion, extension, lateral flexion and (cervical range of motion only) rotation were measured with a digital goniometer. A paired t-test was used to compare the measured parameters before and after the home-exercise therapy programme. A Student’s t-test was used to analyse any differences between the experimental and control groups.ResultsAfter the home-exercise therapy, there was a significant increase (p < 0.05) in cervical range of motion in flexion, extension, lateral flexion and rotation, and in lumbar range of motion in lateral flexion. Cervical range of motion in flexion was significantly higher (p < 0.01) in the experimental group compared to the control group after therapy.ConclusionsOur results suggest an 8-week intensive home-exercise therapy programme may improve cervical and lumbar range of motion among intensive care nurses. Further studies are needed to develop this simple but effective home-exercise therapy programme to help motivate nurses to perform such exercises regularly.Trial registrationCurrent Controlled Trials ISRCTN19278735. Registered 27 November 2015.