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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
26
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.
concentric and eccentric training of the craniocervical, cervical flexors, extensors, muscles involved in cervical spine rotation and axioscapular muscles.
Armed Forces Hospital - Al Hada
Ta'if, Mecca Region, Saudi Arabia
Active cervical movement sense
Participants will be comfortably seated upright on a chair with a backrest, positioned 1 meter away from a board displaying a zigzag pattern (ZZ). They will wear a headband with a laser pointer attached. The pattern is affixed to the board in a manner that directs the laser beam to the pattern's centre.
Time frame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Cervical joint position error
Participants were comfortably seated upright on a chair with a backrest, positioned 0.9 meters away from a wall. Using a distance laser meter, for accurate measurement, the distance between the forehead of the participant and the wall was measured after the participant wore a headband with a laser pointer attached. A point on the wall was located as the patient was in a self-neutral position. A warm-up session was given as the patient with open eyes was instructed to perform flexion, extension, and rotation on both sides and return to the selected point after each movement. After that, the patient was asked to perform the movement for three trials in each movement direction with their eyes closed.
Time frame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Visual Analogue Scale
Pain intensity was assessed using the Visual Analogue Scale (VAS) which a ruler with 100 mm measured. The 0 mm indicates 'No pain" and 100 mm indicates " worse pain". Patient were asked to mark their level of pain.
Time frame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Cervical muscles strength
Measure the cervical muscles using a hand-held dynamometer. The patient was asked to perform flexion, extension, lateral flexion and rotation to both sides.
Time frame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Cervical range of motion
The range of motion was measured three times in flexion, extension, left-right lateral flexion and rotation using a therapeutic range of motion inclinometer.
Time frame: Three points: 1) baseline, 2) immediately after intervention, and 3) week 4
Neck Disability Index
Neck Disability Index (NDI) was used to evaluate the score of self-rated disability linked to neck pain experienced during the preceding week. This assessment consists of 10 questions, each question rated from 0 (indicating no disability) to 5 (representing total disability), with a maximum score of 50 points (see Appendix D.). Disability can be categorized as no disability (0-4 points), mild disability (5-14 points), moderate disability (15-24 points), severe disability (25-34 points), and (35-50 points) present complete disability.
Time frame: Three points: 1) baseline, 2) week 4
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