Manual Mobilization for Neck Pain Patients is Superior to Massage and Physical Therapies

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Editors Summary

Cervical mobilization in comparison to other therapies has not been reported, but several researchers have found positive effects of mobilization. The purpose of this study is to address two problems:

1. Do patients with restricted mobility and pain in cervical mobile segments benefit from mobilizing manual therapy?
2. Is there any relationship between reduction of pain and increase of the total cervical spine mobility?

Subjects were patients with restricted movement in the pain-producing segment. The patients were examined and randomized into three groups:

Group 1 - Patients were told that they should try a new type of drug known to reduce pain most efficiently; they received salicylate daily for 3 weeks.

Group 2 - Patients had the same information as those in group 1, and in addition were told that they would have some special information to help ease their pain, and also treatment by a skilled physiotherapist; they received salicylate, and their manual (mock) therapy consisted of superficial massage, electrical stimulation, and slight relaxing traction given three times a week for three weeks.

Group 3 - Patients had the same information as those in group 2; they received salicylate, and their specific therapy consisted of relaxation techniques such as superficial heat, soft tissue treatment and slight traction, and specific manual mobilization of the actual mobile segments in the cervical spine; three treatments were given each week for three weeks.

(The special information given to groups 2 and 3 included anatomy and pathophysiology of the cervical spine as well as biomechanical problems and practical problems such as lifting, carrying and relaxation).

Each patient estimated their pain and reported the actual level each week. Total cervical mobility in the coronal, sagittal and transverse planes was recorded before and after therapy each week and even one week after the therapy finished by a physiotherapist. In addition, social conditions were recorded by a social worker, and Eysenck personality inventory tests were used by assistants.

Results showed that the initial pain level was about the same in all three groups. Before the treatment, tender spots with increased consistency in the muscle were frequent in 80-90% of the patients in all three groups. Manual examination revealed the same distribution of hypo mobile segments, C7-T2, in the three groups. The effect on pain was evaluated by the pain level and the decrease of pain. Group 3 showed a significant difference in pain level after treatment from the other groups. Group 3 also showed a significant difference in decrease of pain one week after the treatment and at the conclusion of the treatment. Mobility increased significantly at the final treatment for group three compared to the other groups.

This study concludes that cervical pain patients can be improved by simple manual technique as a first step towards complete treatment.

1. H. Brodin, Manuelle Medizin 1982; 20:90-94. From the Institution of Physical Medicine, Karolinska, Sjukhuset, Sweden.

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