Abstract
This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323–0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (−0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042–0.395) and 15th days (−0.447 1/mm; p < 0.001; 95% CI: 0.265–0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131–8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.
Highlights
Neck pain can be defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage in the neck region” [1]
Chronic nonspecific neck pain (CNSNP) is a neck pain not due to organic pathology or that it has an unknown pathological basis as the underlying cause over the last 12 weeks or more, and is associated with a high economic cost for health [3,4,5], becoming a socio-health problem, since it is associated with disability, muscular alterations, decreased cervical range of motion (CROM) and greater sensitivity to pain [3]
We considered cervical flexion-rotation test (CFRT) and length the free software ratio (L/S) as primary outcomes, which were used as inclusion criteria in the recruitment and selection of subjects and for the calculation of the sample size, respectively
Summary
Neck pain can be defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage in the neck region” [1]. The most frequent form of clinical presentation is nonspecific or mechanical neck pain [3]. Some of these patients, after the first episode of cervical pain, will experience a new episode in the following years, most of them in the first year [3], and some of them will not experience complete resolution of pain and disability, which can become a more complex chronic pain syndrome [4]. Chronic nonspecific neck pain (CNSNP) is a neck pain not due to organic pathology or that it has an unknown pathological basis as the underlying cause over the last 12 weeks or more, and is associated with a high economic cost for health [3,4,5], becoming a socio-health problem, since it is associated with disability, muscular alterations, decreased cervical range of motion (CROM) and greater sensitivity to pain [3]. It has been proven that experimental neck muscle pain significantly impairs standing balance, suggesting the need for intact neck neuromuscular function for the maintenance of a standing posture [10]
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