Manual therapy and stretching for neck pain

Manual therapy group. Patients will receive 2 treatments weekly for 5 weeks. Treatment will consist of 2 components: 1. Local cryotherapy during each session will be performed just before manual therapy. 2. Low-velocity osteopathic type mobilisation of cervical joint. No manipulations, i.e. high-velocity thrusts with low-amplitude, will be applied. 1. Local cryotherapy will be performed using KRIOPOL R 30 (Kriomedpol, Poland). A stream of cold nitrogen vapor at temperature -130 degrees Celsius will be applied during 3 minutes to the muscles on both sides of the cervical spine and to the muscles on both sides of the shoulder girdle. The distance among the apparatus nozzle and patients body surface will be 10 centimeters. 2. Manual therapy will be based on 6 osteopathic-type mobilisation techniques, which will be performed while the patient is placed supine. A. Translation upwards: the head and upper cervical spine is lifted up by pushing the spinous processes with both hands to apply force to the movement segment lying between the lifted vertebra and the one immediately below it. B. Translation sideways: the cervical vertebra is pushed alternately towards the right and the left side by force applied to each facet joint. Hands tightly support each side of the head and upper cervical column, which are moved directly sideways at each level being treated. C. Side bending: the cervical spine is bent alternately to each side. Hands support along each side of the head and cervical column with the pads of the finger tips over the mobilised facet joint. The head and cervical column are bent to each side and finger tips are then moved upwards over the next facet joint. D. Rotation and side bending in the same direction: the head is supported by the therapist's lower mid-abdomen and hands support the head and upper cervical spine. Hands overlie each other forming a bridge so that the heads of the metacarpal bones are over the facet joints. Prior to mobilisation the cervical column is moped sideways and rotated in the same direction to about half of total range of movement (ROM). The movement is then continued so that connective tissues become stretched without causing pain. The head and neck are returned after each movement to its starting position. The head is rotated to the other side for the same treatment. E. Rotation with small ROM: the pads of the tips of the middle and the ring fingers are placed over the spinous processes and the fingers then are straightened so that the middle phalanx of the fingers is over the facet joint. The head is supported with the hand on the opposite side allowing the movement to happen and the head returns to the middle position. The other side is treated by moving to the opposite side of the treatment table. F. Mobilization of upper cervical joints: both hands support the occiput with the tips of the middle and the ring fingers over the arch of the atlas on each side. The head is bent sideways slightly and turned in the opposite direction, causing the atlas to move against the finger tips. The mobilization will be performer 3 times in each direction. Each manual therapy session will not exceed 20 minutes. The treating practitioner will be physiotherapists with post-graduate qualification in manual therapy, recognized as titled musculoskeletal physiotherapists or specialist musculoskeletal physiotherapists by Polish Physiotherapy Association and have at least 10 years experience. The treating practitioners will receive specific training in implementation of the trial protocol, work-health and safety induction and training in emergency procedures. The treatment will take place in the Physiotherapy Laboratory of the Regional Hospital.