Joint Mobilization vs. Strengthening Exercises on Cervical Proprioception for Nonspecific Neck Pain (CervPro-RCT)

Imam Abdulrahman Bin Faisal University

Status: Completed

Conditions: Chronic Neck Pain; Nonspecific Neck Pain

Treatments: Other: cervical strengthening exercises; Other: Cervical joint mobilization

Study type: Interventional

Funder types: Other

Identifiers

NCT06960525

IRB-PGS-2024-03-574

14-2024-06-07-95 (Registry Identifier)

Details and patient eligibility

About

This clinical trial aims to compare the effects of cervical joint mobilization versus cervical strengthening exercises in patients with chronic neck pain. The study will assess neck proprioception, pain intensity, cervical muscle strength, range of motion, and neck disability.

The main question it aims to answer is:

Which treatment is superior, or do they have equal effects after the first session and after the 12th session?

Participants will:

Receive either cervical joint mobilization or cervical strengthening exercises for 12 sessions.

Do not perform any physical therapy treatment outside the trial. Visit the clinic three times per week for treatment.

Full description

Neck pain refers to a type of generalized neck discomfort characterized by mechanical features. This condition is a widespread issue, causing significant levels of pain, disability, and can lead to economical strain. Patients suffering from neck pain often experience functional impairments, including weak neck muscles and impaired proprioception. Strengthening exercises and cervical joint mobilization offer effective relief of pain and improve disability. Exploring the superiority of these techniques in improving cervical proprioception to prevent recurrence is still a vague topic. Therefore, this study will investigate the effect of Maitland joint mobilization versus cervical strengthening exercises in patients with nonspecific chronic neck pain on neck proprioception, pain intensity, cervical muscles strength, range of motion and neck disability. This is a double-blinded randomized clinical trial with a parallel-group design. Twenty-six participants will be allocated randomly to one of two groups. Group one (Mobilization) will have cervical joint mobilization according to Maitland approach. Group two (Exercises) will perform craniocervical, cervical and axioscapular muscles strengthening exercises. Treatment will be provided for 12 sessions. Both groups will receive standardized care, including patient education and transcutaneous electrical nerve stimulation.

Enrollment: 26 patients

Sex: All

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 to 50 years
• Pain ≥ 3 months
• Neck pain on VAS ≥ 3/10
• NDI ≥ 5/50 points
• ZZ Errors ≥ 9 or the time to complete the task ≥ 28s

Exclusion criteria

• Unilateral headache aggravated by neck movement.
• Upper extremity symptoms beyond the elbow.
• Any history of neck trauma including whiplash
• Recent fractures (last 8 weeks)
• Cervical surgery (last 3 months)
• Current neck-related dizziness
• Known or suspected ves3bular pathology
• Internal fixation of the cervical spine
• Physical therapy for the neck (last 3 months)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

---

26 participants in 2 patient groups

Joint mobilization group

Experimental group

Description:

This group will receive passive cervical joint mobilization following Maitland's approach for 3 sets of 1 minute on the most painful segment with one minute rest between sets. The specific technique and most painful level will be determined during the clinical examination. The participant lies prone on a treatment bed, then the therapist uses both thumbs to apply grade III or IV based on the patient's irritability using posteroanterior pressure to the cervical spinous process or articular pillar, with a rhythm of 2 to 3 Hz per second. This intervention could be applied in different positions of the cervical spine, depending on the patient's response, in a pain-free manner.

Treatment:

Other: Cervical joint mobilization

Strengthening exercises group

Experimental group

Description:

The exercise program will include concentric and eccentric training of the craniocervical, cervical flexors, extensors, muscles involved in cervical spine rotation and axioscapular muscles. The strengthening exercises with high frequency - low intensity will be performed. Low frequency - high intensity will be implemented when the patient's irritability is low.

Treatment:

Other: cervical strengthening exercises