Indirect Approach of C0-1 and C2-3 Segments in Flexion-rotation Test

University of Zaragoza

Status: Unknown

Conditions: Rotation; Cervical Spine Disease; Neck Pain

Treatments: Other: Manual therapy techniques in C0-1 and C2-3 with cervical exercise; Other: Cervical Exercise

Study type: Interventional

Funder types: Other

Identifiers

NCT04406753

N13/2020

Details and patient eligibility

About

Restrictions on upper cervical spine are associated with cervical pain. The vast majority of upper cervical spine rotation occurs at the C1-2 segment. Flexion-rotation test is a valid measure that predominantly measures rotation in C1-2 segment, however upper cervical spine rotation also implies C0-1 and C2-3 due to ligament anatomy. Restriction in flexion-rotation may be due to direct restriction in C1-2, but also to a premature tightening of the alar ligament as a result of lack of movement in C0-1 or C2-3.

The objective is to compare the effect of a 20-minutes single cervical exercise session with or without manual therapy of C0-1 and C2-3 segment in flexion-rotation test in patients with chronic neck pain and positive flexion-rotation test.

To carry out the objective, the following will be designed a randomized controlled assessor-blind clinical trial with primary healthcare patients.

This population will be patients with chronic neck pain and positive flexion-rotation test. These patients will be assigned in manual therapy + exercise group or in exercise group.

Exercise will be focused on deep anterior cervical muscles. Manual therapy will combine techniques in C0-1 and C2-3 with this exercise. Flexion-rotation test, neck pain intensity, pain intensity during the flexion-rotation test and cervical range of motion will be measured before and after the intervention.

Enrollment: 48 estimated patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• A medical diagnosis of chronic neck pain with more than 3 months of evolution.
• A positive result in the flexion-rotation test (less than 33º or a difference of 10º or more between the two rotations).
• Being over 18 years old.
• Having signed the informed consent.

Exclusion criteria

• Contraindications for manual therapy or exercise.
• Having participated in exercise or manual therapy programs in the last three months.
• Presenting warning signs or having suffered a relevant neck trauma.
• An inability to maintain supine position.
• The use of pacemakers (the magnets in the CROM device could alter their signal)
• An inability to perform flexion-rotation test
• Language difficulties.
• Pending litigation or lawsuits.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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48 participants in 2 patient groups

Manual Therapy + Exercise Group

Experimental group

Description:

Manual Therapy + Exercise group will carry out 20-minute session of treatment. The techniques will be applied depending on the clinical findings in each patient and the objective will be to restore the function of C0-1 and C2-3 segments before applying cervical exercises. We will use manipulation (high velocity low amplitude) and/or mobilization (low velocity high amplitude) techniques of C0-1 and C2-3 segments with cervical exercise. Manipulations will be in the direction of traction, with the head in a neutral position. A maximum of two trials at each level on each side will perform (2-6 thrusts). Mobilization will be performed for 5 minutes using repeating cycles of 45 seconds of mobilization and 15 seconds of rest. The cervical exercise will perform by this group will follow the same methodology as the Exercise group.

Treatment:

Other: Manual therapy techniques in C0-1 and C2-3 with cervical exercise

Exercise Group

Active Comparator group

Description:

This group will perform the cervical stabilization exercise. They will be teach to perform the contraction of deep neck flexor muscle activity with the help of the Stabilizer Pressure Biofeedback Unit (Chattanooga, USA) in supine. Exercise will be always carry out without pain, because pain can be an inhibitor of muscle contraction. The Exercise group will carry out one 20-minute session, composed of 2 sets of 10 repetitions, holding each repetition for 10 seconds, a 40-second rest between each repetition and 2 minutes between sets.

Treatment:

Other: Cervical Exercise