Neck Pain Clinical Trial
Official title:
Effectiveness of the Osteopathic Treatment in Patients With Nonspecific Cervical Pain: Randomized Controlled Pragmatic Clinical Trial
In Spain cervical pain affects practically 20% of the population annually, while globally it
is estimated that between 22% and 77% of the population will suffer cervical pain at some
point in their life. Prevalence increases with age, and is more common in women than in men
(1.6: 1). Although the natural evolution of cervical pain tends to improve, the rates of
recurrence and chronicity are high. And therefore it becomes an anatomical region of interest
in relation to the assessment of the effectiveness and / or effectiveness of the osteopathic
therapeutic approach. Different studies prove the efficacy of various manual therapy
techniques applied on the cervical and / or upper dorsal region, suggesting significant
positive changes in cervical pain and mobility levels in patients with nonspecific cervical
pain. It is necessary to bear in mind that the reality of the osteopathic approach to the
patient is not limited to the use of a single technique, but that the treatment is formed
from a set of them. The ultimate goal is to restore mobility and functionality to a specific
region, especially taking into account the concepts of individuality and holism.
A pragmatic experimental comparative trial with three branches of study (osteopathic
treatment with 2 different dosages versus active muscle exercise) is proposed.
At the beginning of the 1st session, a battery of questions will be made as an anamnesis with
the objective of evidencing possible risk factors at the therapeutic level. The presence of
one or more risk factors will suppose the exclusion of the patient from the study.
Next, a brief osteopathic musculoskeletal evaluation will be made to the patient. This
exploration will follow a standardized protocol for all patients in the experimental groups
(1 and 2).
The tests to be carried out will be:
- Observation (standing patient):
- Assessment of the anterior projection of the head
- Assessment of the variation in the physiological curves of the spine
- Active test of the cervical spine with the patient in a sitting position.
o Flexo-Extension / Rotations / Lateral inclinations
- Segmental test of joint mobility of the cervical and dorsal spine (patient in sitting
and supine position)
- Passive mobility test of the cervical spine (patient in the supine position):
- Flexo-Extension / Rotations / Lateral inclinations
The combination of exercises scheduled at home for all groups is based on the conclusions of
different studies, and will consist of:
- Self-resisted active exercise in flexion, rotations and inclinations of the cervical
spine.
- Active mobility in its maximum travel (without forcing pain) in flexion, rotations and
inclinations of the cervical spine.
- Stretching upper trapezius muscles and scalenes.
- Active mobility in circumferential joints of the glenohumeral joint, and in
flexo-extension of the thoracic spine.
The work schedule will be carried out for 7 weeks, at a rate of 5 sessions per week.
It will be the patient himself who will keep a diary record of the activity carried out
during the weeks that the trial lasts. The diary will be facilitated by the therapists, and
in it the exercises to be performed will be indicated.
For groups 1 and 2, a total of 3 techniques selected from a list of 7 available techniques
common to all centers will be applied in each session. The choice of techniques will be based
on the results of the examination performed, the particularities of the patient and the
clinical experience of the osteopath. In each session the techniques can change under the
criteria of the osteopath. However, they will always be 3 and always within the list of
available techniques.
For groups 1 and 2, a total of 3 techniques selected from a list of 7 available techniques
common to all centers will be applied in each session. The choice of techniques will be based
on the results of the examination performed, the particularities of the patient and the
clinical experience of the osteopath. In each session the techniques can change under the
criteria of the osteopath. However, they will always be 3 and always within the list of
available techniques.
For groups 1 and 2, a total of 3 techniques selected from a list of 7 available techniques
common to all centers will be applied in each session. The choice of techniques will be based
on the results of the examination performed, the particularities of the patient and the
clinical experience of the osteopath. In each session the techniques can change under the
criteria of the osteopath. However, they will always be 3 and always within the list of
available techniques.
The OMT (Osteopathic Manipulative Treatment) techniques that may be applied will be the
following:
1. Technique of Inhibition of the suboccipital muscles
2. Functional technique for the middle and deep cervical fascia
3. High-speed cervical spine technique (Cervical wheel C1-C6)
4. High-speed technique in the cervico-dorsal junction (prone position)
5. High speed technique in dorsal column (D1-D12) - (Dog Technique)
6. Muscle stretching technique of the diaphragm (supine decubitus)
7. Thorax joint mobility technique (long lever)
Main Variable:
o Neck Disability Index (NDI). The investigators establish the minimum change to be detected
(minimum clinically relevant change) at 5 points. The Spanish version of the NDI will be
used, validated by Andrade Ortega et al.24
Secondary Variable:
o Degree of general quality of life, through the "SF-36" Health Survey25.
The data will be reported in the form of a report by the patient himself, who will receive
via e-mail (whenever possible) or in printed form the questionnaire to be completed and will
deliver to the same center in which the intervention has been carried out.
;
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