Neck Pain
Conditions
Keywords
Manual therapy, Sensorimotor exercises, Balance exercises, Cervical mobilization, Specific neck muscle exercises
Brief summary
The sensorimotor disturbance and postural instability have been demonstrated to be associated with neck pain. Specific therapeutic exercise and manual therapy for the cervical spine are effective interventions for improving dizziness symptoms, neck impairments, functional ability and quality of life. However, the effects of these interventions on the actual impairment of joint position sense and balance remain uncertain. Adaptive changes in the sensorimotor and postural control systems may need to be specifically addressed.
Detailed description
The sensorimotor (joint position sense and oculomotor control) and postural stability (balance) disturbances have been demonstrated to be associated with neck pain. Specific therapeutic exercise directed to neuromuscular impairments and manual therapy for the cervical spine are effective interventions for improving dizziness symptoms, neck impairments, functional ability and quality of life. However, the effects of these interventions on the actual impairment of joint position sense and balance remain uncertain. Adaptive changes in the sensorimotor and postural control systems may need to be specifically addressed. Currently, it is not known whether the clinician has to train every impairment or can choose between sensorimotor training and balance training in the rehabilitation of neck pain. Different training approaches may have specific influences on the different outcomes and their outcomes will be important to inform the optimal and efficient management of persons with chronic neck pain.
Interventions
OTHERLocal neck treatment (LNT)
The local neck treatment consists of cervical mobilization and specific therapeutic exercises (30 minutes). The participants will attend 12 individual treatment sessions (2 visits per week for 6 weeks).
OTHERLNT plus sensorimotor exercises
The local neck treatment (30 minutes) plus the sensorimotor exercise program (15 minutes). The sensorimotor exercises include cervical joint position sense and oculomotor training. The participants will attend 12 individual treatment sessions (2 visits per week for 6 weeks).
OTHERLNT plus balance exercises
The local neck treatment (30 minutes) plus the balance exercise program (15 minutes).The balance program includes with static balance and progress to dynamic balance and gait. The participants will attend 12 individual treatment sessions (2 visits per week for 6 weeks).
OTHERLNT plus sensorimotor/balance exercises
The local neck treatment (30 minutes) plus the sensorimotor exercise program (15 minutes) and the balance exercises (15 minutes). The participants will attend 12 individual treatment sessions (2 visits per week for 6 weeks).
Sponsors
The University of Queensland
University of Applied Sciences and Arts of Southern Switzerland
Chiang Mai University
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Intervention model description
a 2 x 2 factorial blinded design
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* insidious neck pain for at least 3 months * an average neck pain intensity over the past week ≥ 30 mm on a 100 mm visual analog scale (VAS) * a score of neck pain and disability ≥ 10/ 100 on the Neck Disability Index-Thai version * an absolute error of cervical joint position error \> 4.5° * an inability to stand in tandem stance with eyes closed for 30 seconds * cervical segmental joint dysfunction (pain provoked \>2/10 with abnormal tissue resistance)
Exclusion criteria
* a previous history of neck and head injury or surgery * known or suspected vestibular pathology * vertigo or dizziness caused by underlying pathology in the ear, brain, or sensory nerve pathways (e.g. benign paroxysmal positional vertigo and BPPV) * vascular disorders (e.g. a migraine and hypertension) * any musculoskeletal or neurological conditions that could affect a balance * inflammatory joint disease * systemic conditions * cognitive impairment * taking four or more medications * received physiotherapy treatment for their neck disorder in the past 12 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postural sway area | Change from baseline at immediate, and 3, 6, 12 months follow-ups | The sway area during narrow stance on firm and soft surfaces with eyes open and eyes closed and during neck torsion maneuver (head turned 45 degrees to the left and right) on firm and soft surfaces, using a swaymeter device. |
| Postural sway displacement | Change from baseline at immediate, and 3, 6, 12 months follow-ups | The sway displacement during narrow stance on firm and soft surfaces with eyes open and eyes closed and during neck torsion maneuver (head turned 45 degrees to the left and right) on firm and soft surfaces, using a swaymeter device. |
| Cervical joint position error | Change from baseline at immediate, and 3, 6, 12 months follow-ups | The ability to perform an active movement (extension and rotation to the left and right) and return to the starting head position as accurately as possible, using a target on the wall and a laser-pointer attached to a lightweight headband. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neck pain disability | Change from baseline at immediate, and 3, 6, 12 months follow-ups | How neck pain affects a patient's daily life and to assess the self-rated disability, using NDI. |
| Pain extent | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Pain extent using a digital device (iPad Air 2) and sketching software (SketchBook Pro). |
| Pain location | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Pain location using a digital device (iPad Air 2) and sketching software (SketchBook Pro). |
| Gait speed | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Walk barefoot over 10 meters at a comfortable speed and then with head turns from side to side. |
| Functional ability status | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Participants' functional status using the patient-specific functional scale (PSFS). |
| Health-related quality | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Participants' health-related quality of life, using Short Form-36. |
| Global perceived benefit of treatment | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Participant rated perceived benefit of treatment, using a six-point ordinal Likert scale. |
| Cervical range of motion | Change from baseline at immediate, and 3, 6, 12 months follow-ups | Cervical range of motion in flexion, extension, left-right lateral flexion and left-right rotation, using CROM. |
| Dizziness intensity | Change from baseline at immediate, and 3, 6, 12 months follow-ups | an average dizziness intensity over the past week on VAS 0-10 |
| Neck pain intensity | Change from baseline at immediate, and 3, 6, 12 months follow-ups | an average intensity of neck pain experienced in the past week on VAS 0-10. |
Countries
Thailand
Outcome results
None listed