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

Analysis of posture and balance impairments in individuals with chronic nonspecific neck pain-an observational study

Background

Neck pain is one of the most burdensome chronic musculoskeletal problems globally. Impaired proprioception is associated with Chronic Nonspecific neck pain as the structures of the cervical spine are crucial for proprioception and balance. There is a paucity of literature examining objective measures of balance and postural sway in patients with Nonspecific neck pain.

Methods

This study was observational and consisted of 126 samples (63 cases and 63 controls who were recruited using convenience sampling. The demographics of the samples were collected and the postural and balance impairment was assessed using Biodex Balance SD. Mean, Median, and SD were obtained and the inferential analysis was done using the Whitney U Test and the level of significance was accepted at p < 0.05.

Results

The subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts. There are significant differences in the overall static stability index, (p < 0.001). There was a significant difference in static sway index(p = 0.003), and static stability index lateral (p = 0.004). There was no significant difference for static sway index forward and backward (p = 0.550) and lateral sway index (p = 0.711).

Conclusion

Subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts and there was a significant difference between the static sway and static stability index in forward and backward directions as well as in lateral direction. These findings may help to assess the specific balance parameters and address the underlying causes of balance issues in patients with neck pain and also provide a comprehensive care to the patients.

Clinical Trial Registration

The trial was registered with CTRI India with registration number: CTRI/2022/07/044222.

The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials

BACKGROUND

Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice.

OBJECTIVE

The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum.

METHODS

A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool.

RESULTS

A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias.

CONCLUSION

Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.

Comparison of Prescribed Physical Therapy to a Home Exercise Program for Pediatric Sports-Related Concussion Patients

The purpose of this retrospective chart review was to compare sports-related concussion (SRC) recovery time in protracted recovery (≥28 days) patients who were prescribed physical therapy (PPT) with those who were only provided a home exercise program (HEP). We hypothesized PPT would be associated with shorter recovery times relative to HEP. Associations were evaluated with multivariable zero-truncated negative binomial regressions. Among the 48 (30.2%) PPT and 111 (69.8%) HEP patients, the majority were female (57.9%), the mean age was 15.3 ± 1.4 (PPT) and 14.2 ± 2.8 (HEP), and time to clinic was a median 6.0 (IQR = 3.0–27.0; PPT) and 7.0 (IQR = 3.0–23.0; HEP) days. After adjusting for demographic (age, sex) and clinical measures (concussion history, convergence, VOMS, PCSS score, and days to clinic), PPT unexpectedly was associated with 1.21 (95% CI: 1.05, 1.41) additional recovery days compared with HEP. One reason for this could be related to patients adhering to the number of a priori prescribed PT sessions which may or may not have aligned with the patient’s symptom resolution. Future research should explore this hypothesis while aiming to evaluate the effect of PPT versus HEP using a randomized design. If confirmed, these findings are encouraging for patients who could not otherwise access or afford specialty rehabilitation.

Mechanical Parameters and Trajectory of Two Chinese Cervical Manipulations Compared by a Motion Capture System

Objective: To compare the mechanical parameters and trajectory while operating the oblique pulling manipulation and the cervical rotation–traction manipulation.

Methods: An experimental research measuring kinematics parameter and recording motion trajectories of two cervical manipulations were carried out. A total of 48 healthy volunteers participated in this study, who were randomly divided into two groups of 24 representing each of the two manipulations. A clinician performed two manipulations in two groups separately. A motion capture system was used to monitor and analyze kinematics parameters during the operation.

Results: The two cervical manipulations have similar thrust time, displacement, mean velocity, max velocity, and max acceleration. There were no significant differences in active and passive amplitudes between the two cervical rotation manipulations. The thrust amplitudes of the oblique pulling manipulation and the cervical rotation–traction manipulation were 5.735 ± 3.041° and 2.142 ± 1.742°, respectively. The thrust amplitudes of the oblique pulling manipulation was significantly greater than that of the cervical rotation–traction manipulation (P < 0.001).

Conclusion: Compared with the oblique pulling manipulation, the cervical rotation–traction manipulation has a less thrust amplitudes.