Immediate Effects on Neck Pain and Active Range of Motion After a Single Cervical High-Velocity Low-Amplitude Manipulation in Subjects Presenting with Mechanical Neck Pain: A Randomized Controlled Trial
Raquel Martínez-Segura PT, DO, César Fernández-de-las-Peñas PT, Mariana Ruiz-Sáez PT, CO, Cristina López-Jiménez PT, DO and Cleofás Rodríguez-Blanco PT, DO
Escuela de Osteopatía de Madrid, Madrid, Spain
Escuela de Osteopatía de Madrid, Madrid, Spain; and Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
Escula de Osteopatía de Madrid, Madrid, Spain; and Escula de Osteopatía de Madrid, Madrid, Spain
Escula de Osteopatía de Madrid, Madrid, Spain
Department of Physical Therapy, Universidad de Sevilla, Sevilla, Spain
Received 1 December 2005; revised 5 January 2006; accepted 20 April 2006. Available online 1 September 2006.
Abstract
Purpose: The objective of this study is to analyze the immediate effects on neck pain and active cervical range of motion after a single cervical high-velocity low-amplitude (HVLA) manipulation or a control mobilization procedure in mechanical neck pain subjects. In addition, we assessed the possible correlation between neck pain and neck mobility.
Methods: Seventy patients with mechanical neck pain (25 males and 45 females, aged 20-55 years) participated in this study. The lateral gliding test was used to establish the presence of an intervertebral joint dysfunction at the C3 through C4 or C4 through C5 levels. Subjects were divided randomly into either an experimental group, which received an HVLA thrust, or a control group, which received a manual mobilization procedure. The outcome measures were active cervical range of motion and neck pain at rest assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation of the patient. Intragroup and intergroup comparisons were made with parametric tests. Within-group effect sizes were calculated using Cohen’s d coefficient.
Results: Within-group changes showed a significant improvement in neck pain at rest and mobility after application of the manipulation (P < .001). The control group also showed a significant improvement in neck pain at rest (P < .01), flexion (P < .01), extension (P < .05), and both lateral flexions (P < .01), but not in rotation. Pre-post effect sizes were large for all the outcomes in the experimental group (d > 1), but were small to medium in the control mobilization group (0.2 < d < 0.6). The intergroup comparison showed that the experimental group obtained a greater improvement than the control group in all the outcome measures (P< .001). Decreased neck pain and increased range of motion were negatively associated for all cervical motions: the greater the increase in neck mobility, the less the pain at rest.
Conclusions: Our results suggest that a single cervical HVLA manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain.