Role of Manual Therapy in Cervical Spondylosis
Patients
Nezar Suliman Al Torairi*
Chief Physiotherapist, PSMMC, Riyadh, KSA
ngsrr2011@gmail.com
Abstract
Cervical spondylosis,
a prevalent degenerative condition, is characterized by chronic pain,
incapacity, and restricted cervical mobility. Manual therapy is commonly
utilized in clinical practice, although its effects beyond exercise treatment
are unclear. Assess the effects of cervical manual treatment and exercise on
the disabilities, pain sensitivity to thermal and pressure stimuli, cervical
spine range of motion, and pain thresholds of individuals with cervical
spondylosis. The study was a randomized, double-blind clinical trial that
included 28 patients with persistent cervical spondylosis. Manual therapy and
exercise were administered to one group, while the other group was provided with
exercise exclusively. Over the course of three to five weeks, each group
participated in therapy sessions six times. The following assessments were
implemented: cervical range of motion (ROM), Numeric Pain Rating Scale (NPRS),
Neck Disability Index (NDI), pressure pain threshold (PPT), heat pain threshold
(HPT), cold pain threshold (CPT), and assessments at baseline, immediately
post-intervention, and the final session. Independent t-tests and mixed-model
repeated-measures ANOVA were implemented. In comparison to the comparator
group, the experimental group demonstrated substantial improvements in cervical
range of motion (ROM), disability (NDI), and pain intensity (NPRS) (p <
0.05). The experimental group demonstrated a significant increase in pressure pain
threshold, particularly at the cervical spine and C7 dermatome. The categories
did not exhibit any substantial differences. The sensitivity to thermal
discomfort was consistent across both groups. Significant correlations were
observed between improvements in neck dysfunction and reductions in pain
severity (r = 0.82, p < = 0.001). Cervical manual therapy and exercise are
superior to exercise alone in alleviating pain, enhancing neck function, and
increasing cervical mobility in cervical spondylosis patients, despite the fact
that they do not alter thermal pain sensitivity.
Keywords: Cervical spondylosis, manual
therapy, neck pain, physiotherapy, cervical mobilization, randomized controlled
trial
INTRODUCTION
The biggest cause of
disability globally, cervical spondylitis (CS), costs patients and healthcare
systems heavily in social, economic, and financial terms. More severe damage
and a poorer prognosis are associated with prolonged neck discomfort than low
back pain [1]. About 66% of people will have neck pain throughout their lives
due to its prevalence [2]. Low back pain was the main reason to seek CIM in
2007, followed by neck pain. Since no anatomical or pathological variables are
implicated, most neck pain sufferers have mechanical or non-specific causes.
Non-specific cervical pain is linked to increased healthcare costs, more
primary care visits, lost work days, and worse productivity [3,4]. Many persons
experience non-specific cervical pain, which may hamper daily activities and
functional performance even though most instances do not include neurological
deficits or substantial illness [5]. After 12 months of therapy, almost a third
of individuals have persistent or recurrent symptoms, which may cause chronic
pain [6].
Mechanical neck
discomfort may arise from muscle palpation, sustained neck positions, or
cervical motions. It may or may not reach the shoulder. Cervical mechanical
neck discomfort restricts range of motion (ROM), hinders physical function, and
incurs significant expenses [7]. Numerous manual therapy techniques, including
manipulation and mobilization, are employed to address soft tissues and joints.
Manual therapy alleviates cervical discomfort and enhances functionality in
many trials [8–11]. Manipulation employs low-amplitude thrusts at spinal
joints, whereas mobilization utilizes slower, regulated rhythmic motions.
Cervical spine manipulation offers several advantages in clinical settings;
nonetheless, concerns regarding associated dangers need cautious selection of
procedures by clinicians [12].
Maitland's joint
mobilization theory uses active, rhythmic, oscillatory movements within
specified ranges to diagnose and treat joint issues [13]. Mobilizations are
divided into five types by patient complaints and joint mobility. Grades I and
II use low-amplitude oscillations to relieve discomfort in the early range of
motion. Grades III and IV enhance mobility and reduce joint stiffness in the
end range. Manipulation thrusts with high velocity and low amplitude are Grade
V. Manual treatments are commonly employed in clinical settings, but additional
high-quality randomized trials are required to verify their effectiveness with
exercise for cervical spondylosis patients. This study examines how exercising
and cervical manual therapy improve cervical spondylosis patients' discomfort,
disability, pain sensitivity, and mobility.
OBJECTIVES
1.
To
assess how cervical manual treatment and exercise affect patients with cervical
spondylosis in terms of pain, disability, and cervical range of motion.
2.
To
compare changes in pain sensitivity (pressure and temperature thresholds)
between manual treatment with exercise versus exercise alone.
RESEARCH METHODOLGY
Research design
Clinical trials that
are randomized and double-blind comply with the CONSORT Guidelines. The study
was approved by the Institutional Ethical Committee prior to its commencement,
subject to the ethical considerations and principles outlined in the
Declaration of Helsinki on research involving human subjects. Participants were
not made aware of their assignment or the purpose of study until completion of
the research, nor was outcome assessors, who were physical therapists and
independent with respect to study investigators and employers. Participant
Monitoring at out-patient physiotherapy facilities located in tertiary-level
hospitals occurred over a period of 8 months [14].
Sample Size
Calculation
The required sample
size was determined using the pain intensity variations from the pilot study
with patients suffering cervical spondylosis (G*Power, 3.1.9.2 version) as the
premise for a sample size estimate. An a priori power analysis was conducted
using a.05 alpha level, an 80% power (or.80) to determine statistical
significance, two groups (control and experimental), and three distinct
occasions to measure the experiment's outcome. A repeated-measures ANOVA (a
within-and-between interaction) was employed to conduct the analysis. The
effect size of.44 indicated that a total of 28 patients were required in both
categories. The subjects were to be recruited at 14 in each of two groups
(total n = 28) according to the presumption that subjects may withdraw from the
study.
Participants
The participants were adults who had just received a diagnosis of cervical
spondylosis, and they were chosen at random. Our criteria for inclusion were:
•
Age
range of 30 to 65 years
•
Chronic
cervical discomfort persisting for a length of three months or longer
•
Radiological
confirmation of cervical spondylosis (X-ray or MRI)
•
Diminished
cervical range of motion accompanied with mechanical neck discomfort
Exclusion criteria
included:
Informed written
permission was acquired from all individuals before to participation.
Randomization and
Blinding
A randomized sequence
that was created by a computer was used to split the participants into two
parallel groups with a ratio of one subject to each other. In order to conceal
the allocation, we utilized envelopes that were opaque and sealed. [15] The
administration of group assignments was the responsibility of a therapist who
was not involved in either the assessment or therapeutic services.
Interventions
Every participant in
the study attended six sessions of treatment over the course of three to five
weeks. A qualified physiotherapist who has been working in the field for more
than five years was responsible for providing all of the services that were
rendered.
Experimental Group
(Manual Therapy + Exercise)
The experimental group's cervical manual treatment methods were determined
by clinical evaluation and administered to the following participants:
Mobility exercises were conducted at Grade III oscillations for two minutes
during each set, with a total of three sets completed during each session.
These exercises were designed to target the cervical segments that were causing
the greatest difficulty. Following the completion of manual therapy, exercises
were performed to strengthen the deep neck flexors [16]. These exercises
included craniocervical flexion while the individual was flat on their back.
Comparison Group
(Exercise Therapy Only)
The comparison group got just exercise treatment immediately after the
conclusion of the deep neck flexor strengthening exercises. Rather than relying
on manual treatment, this strategy used an organised exercise regimen to focus
on the cervical area. Throughout the procedure, all participants got regular
instruction on ergonomics, activity moderation, and proper posture.
Outcome Measures
No changes were made to
the assessment of outcome measures between baseline, first session, and last
session, with the exception of the last session.
Primary Outcomes
·
The severity of pain is quantified using the Numeric
Pain Rating Scale (NPRS).
•
Pressure
Pain Threshold (PPT) assessed with a computerized pressure algometer at
cervical paraspinal muscles
Secondary Outcomes
·
The Neck Disability Index (NDI) was assessed prior
to and following treatment.
·
The active cervical range of motion (ROM) in
flexion, extension, rotation, and lateral flexion is assessed using a cervical
goniometer.
Statistical Analysis
A data analysis was
performed using IBM SPSS version 20, which was provided. The mean plus or minus
the standard deviation was used to depict descriptive statistics for continuous
data, while frequency distributions were employed for categorical variables
[17]. The Shapiro-Wilk test was implemented to verify the data's normality. In
order to evaluate temporal variations, a mixed-model repeated-measures analysis
of variance (ANOVA) was implemented both within and across groups. Every
scenario that involved multiple comparisons was subjected to the Bonferroni
adjustment. The mean alterations between the categories were compared using
independent t-tests. The significance criterion employed in this investigation
was p < 0.05.
Figure
1. CONSORT flow diagram
RESULT
The methodologies and
techniques utilized in the research study are succinctly summarized in Figure
1. A total of 101 patients underwent an eligibility assessment. The inclusion
criteria were met by seventy individuals; however, three declined to participate
in the study [18]. A total of 28 individuals with a history of persistent
cervical radiculopathy were randomly assigned to either the experimental group
or the control group. Twenty-five of these individuals were female, while three
were male. Two participants from the experimental group and one participant
from the control group elected to withdraw from the study. No patient has been
taken out of the study due to adverse treatment responses, as far as we are
aware. The demographic data of patients is divided into two distinct
categories, as illustrated in Table 1.
Table 1.
Baseline Characteristics of Participants
|
Variable |
Investigational
Group (n = 14) |
Assessment Group
(n = 14) |
|
Gender
(female/male) |
12 / 1 |
13 / 1 |
|
Age (years) |
42 ± 6 |
42 ± 6 |
|
Body mass index (kg/m²) |
32 ± 4 |
29 ± 3 |
|
Numeric Pain
Rating Scale (0–10) |
6 ± 2 |
6 ± 1 |
|
Neck Disability
Index (0–50) |
36 ± 1 |
35 ± 13 |
|
Duration of cure
(weeks) |
4 ± 2 |
3 ± 1 |
|
Symptom period (months) |
26 ± 24 |
21 ± 28 |
|
Affected side |
||
|
Left |
5 |
5 |
|
Right |
9 |
9 |
|
Dermatome complex |
||
|
C5 |
0 |
1 |
|
C5
& C7 |
1 |
0 |
|
C6 |
7 |
5 |
|
C6
& C7 |
2 |
2 |
|
C7 |
4 |
4 |
|
C8 |
0 |
2 |
|
Most painful
cervical region |
||
|
C4 |
2 |
1 |
|
C5 |
4 |
4 |
|
C6 |
5 |
4 |
|
C7 |
3 |
5 |
|
Suppository useᵃ |
||
|
Yes |
9 |
6 |
|
No |
5 |
8 |
Values are presented
as mean ± standard deviation or frequency.
Abbreviations:
BMI = Body Mass Index;
NPRS = Numeric Pain
Rating Scale;
NDI = Neck Disability
Index.
As part of their
treatment protocol, both groups were administered standard medical management,
which encompassed analgesics, vitamin B-complex supplements, and non-steroidal
anti-inflammatory medications (NSAIDs). The mean age of participants in both
categories was 42 years, which was less than the 47.6–48.2 years reported in
previous studies. This implies that the current investigation involved
individuals who were relatively younger and experienced symptoms related to the
cervical vertebrae. The control group had a mean symptom duration of 22 ± 29
months, while the experimental group had a mean symptom duration of 27 ± 25
months. These findings suggest that both groups had been experiencing symptoms
for a significant period prior to the intervention. This is indicative of the
chronic character of cervical spine-related disorders among the study
participants. 9 participants in the experimental group and 5 participants in
the control group reported symptoms affecting the right side of the cervical
spine, indicating a higher prevalence of right-sided involvement in the
experimental group. This is in regards to the side of involvement. The C6 dermatome
was the most frequently affected level in terms of dermatome distribution, with
7 participants in the experimental group and 5 participants in the control
group exhibiting the maximum involvement at this level. Additionally, the
patients' most painful regions were identified as the cervical vertebrae
segments C4, C5, C6, and C7. These results underscore the fact that the middle
and lower cervical spine segments were the most frequently affected regions,
which is consistent with the prevalent pattern of cervical spondylotic
alterations. Table 2 illustrates the initial comparability of the study groups
prior to intervention by providing the baseline mean values and clinical
characteristics of both groups[19].
.Table
2. Baseline Outcome Measures for Both Groups
|
Outcome
Degree |
Investigational
Group (n = 14) Mean ± SD |
Assessment
Group (n = 14) Mean ± SD |
Mean
Difference (95% CI) |
|
Pressure
Pain Threshold (PPT) (kPa) |
|||
|
Cervical
spine |
347 ±
212 |
292 ±
100 |
51
(−78.0, 183.0) |
|
C7 hand |
474 ±
183.0 |
435 ±
131 |
42
(−82.1, 165.4) |
|
Affected
dermatome |
421 ±
123 |
424 ±
187.8 |
−4
(−162.0, 157.8) |
|
Tibialis
anterior |
517 ±
173.4 |
475 ±
148.0 |
43
(−80.2, 166.0) |
|
Heat
Pain Threshold (HPT) (°C) |
|||
|
Cervical
spine |
44.3 ±
4.0 |
45.4 ±
4.2 |
−0.2
(−3.4, 2.6) |
|
C7 hand |
44.2 ± 3.0 |
45.7 ±
3.0 |
−0.2
(−3.3, 2.0) |
|
Affected
dermatome |
43.3 ±
3.0 |
43.8 ±
2.0 |
0.5
(−1.7, 3.0) |
|
Tibialis
anterior |
45.2 ±
3.2 |
45.0 ±
2.4 |
0.1
(−2.0, 2.3) |
|
Cold
Pain Threshold (CPT) (°C) |
|||
|
Cervical
spine |
15.2 ±
8.4 |
16.0 ±
10.0 |
−0.6
(−8.0, 6.0) |
|
C7 hand |
17.1 ±
9.0 |
18.3 ±
7.0 |
−1.7
(−8.0, 4.2) |
|
Affected
dermatome |
18.1 ±
9.1 |
19.3 ±
7.3 |
−1.2
(−9.4, 7.0) |
|
Tibialis
anterior |
12.3 ±
9.2 |
18.7 ±
10.2 |
−6.0
(−13.6, 1.2) |
|
Pain
and Disability |
|||
|
NPRS
(0–10) |
6.2 ±
1.0 |
6.4 ±
1.7 |
0
(−1.0, 1.0) |
|
NDI
(0–50) |
36.3 ±
7.2 |
35.5 ±
13.9 |
1.0
(−7.3, 9.7) |
|
Cervical
Range of Motion (degrees) |
|||
|
Flexion |
48 ± 10.3 |
41 ±
11.6 |
4
(−3.3, 13.9) |
|
Extension |
54 ± 16.4 |
46 ±
15.6 |
−3
(−18.2, 9.7) |
|
Rotation
(affected side) |
58 ± 12.0 |
55 ± 10.6 |
−3
(−6.0, 13.6) |
|
Rotation
(unaffected side) |
61 ± 8.3 |
62 ±
10.4 |
−1
(−8.8, 5.6) |
|
Lateral
flexion (affected side) |
33 ± 8.6 |
32 ± 8.2 |
−1
(−5.2, 7.5) |
|
Lateral
flexion (unaffected side) |
34 ± 5.6 |
39 ± 7.7 |
5
(−0.7, 9.6) |
Values are presented
as mean ± standard deviation.
Table 3 shows the
different findings of the experimental group and the comparison group during
the investigation
Table 3.
Mean Intra-Group and Inter-Group Variations from Baseline for Outcome Metrics
Immediately Following Intervention and Session 6
Pressure
Pain Threshold (PPT) (kPa)
|
Outcome |
Time |
Investigational
Group (n=14) Mean Alteration (95% CI) |
Assessment
Group (n=14) Mean Alteration (95% CI) |
Between-Group
Mean Change (95% CI) |
|
Cervical
spine |
Directly |
34
(−4.4, 75.2) |
−13
(−52.1, 27.7) |
48
(−9.0, 103.0) |
|
Session
6 |
122ᵃ
(53.0, 190.2) |
68
(−0.42, 133.6) |
57
(−37.3, 152.1) |
|
|
C7 hand |
Directly |
−3
(−57.9, 62.6) |
12
(−47.2, 73.0) |
−14
(−101.0, 72.3) |
|
Session
6 |
98ᵃ
(3.3, 192.7) |
83.4
(−12.0, 178.2) |
16
(−114.3, 151.0) |
|
|
Affected
dermatome |
Directly |
−17
(−96.0, 57.7) |
−30
(−105.2, 46.4) |
11
(−97.0, 117.9) |
|
Session
6 |
74
(−29.3, 176.2) |
24
(−79.6, 124.0) |
53
(−93.2, 196.2) |
|
|
Tibialis
anterior |
Directly |
−36
(−118.2, 43.3) |
1
(−78.1, 80.9) |
−37
(−152.0, 76.1) |
|
Session
6 |
78
(−5.8, 161.7) |
82
(−1.5, 165.7) |
−2
(−124.6, 115.7) |
Heat
Pain Threshold (HPT) (°C)
|
Outcome |
Time |
Experimental
Group |
Comparison
Group |
Between-Group
Difference |
|
Cervical
spine |
Directly |
0.7
(−1.4, 2.7) |
−2.2
(−4.4, −0.1) |
3.0
(−0.2, 6.0) |
|
Assembly
6 |
0.0
(−2.0, 2.2) |
−0.5
(−2.6, 1.3) |
0.5
(−2.2, 3.4) |
|
|
C7 hand |
Directly |
0.1
(−1.0, 1.1) |
−0.2
(−1.4, 0.2) |
0.3
(−1.0, 2.2) |
|
Assembly
6 |
0.2
(−2.0, 2.3) |
−1.3
(−3.5, 0.6) |
1.4
(−1.4, 4.7) |
|
|
Affected
dermatome |
Directly |
−1.2
(−3.2, 3.1) |
0.0
(−1.5, 1.6) |
−1.0
(−3.6, 1.3) |
|
Assembly
6 |
−0.1
(−3.5, 3.1) |
−1.0
(−4.3, 2.0) |
0.7
(−3.2, 5.6) |
|
|
Tibialis
anterior |
Directly |
0.2
(−0.7, 1.2) |
−0.6
(−1.9, 0.2) |
1.0
(−0.1, 2.7) |
|
Assembly
6 |
0.3
(−1.0, 1.6) |
−0.8
(−1.7, 1.3) |
0.4
(−1.6, 2.8) |
Cold
Pain Threshold (CPT) (°C)
|
Outcome |
Time |
Experimental
Group |
Comparison
Group |
Between-Group
Difference |
|
Cervical
spine |
Directly |
−1.5
(−6.4, 3.0) |
−3.2
(−8.2, 1.5) |
−1.6
(−8.7, 5.3) |
|
Assembly
6 |
1.5
(−3.8, 6.9) |
−2.5
(−8.0, 2.0) |
−4.2
(−12.0, 2.6) |
|
|
C7 hand |
Directly |
−3.3
(−6.9, −0.2) |
−1.3
(−4.4, 2.0) |
2.2
(−2.0, 6.7) |
|
Assembly
6 |
−0.7
(−5.2, 3.2) |
−2.0
(−6.0, 2.1) |
−1.0
(−7.2, 5.0) |
|
|
Affected
dermatome |
Directly |
−1.0
(−6.3, 3.7) |
−2.1
(−7.2, 2.3) |
−0.7
(−8.0, 6.0) |
|
Assembly
6 |
0.4
(−4.3, 5.3) |
−2.2
(−7.0, 2.1) |
−3.0
(−9.7, 4.0) |
|
|
Tibialis
anterior |
Directly |
−3.0(−5.2,
−0.1) |
0.2
(−2.3, 3.0) |
3.3
(−0.4, 7.1) |
|
Assembly
6 |
−2.2
(−5.3, 1.8) |
1.7
(−2.0, 5.3) |
3.7
(−1.4, 9.0) |
Discomfort,
Impairment, and Cervical Mobility
|
Consequence |
Time |
Experimental
Group |
Comparison
Group |
Between-Group
Difference |
|
Numeric
Pain Rating Scale (0–10) |
Directly |
1.8ᵃ
(0.7, 2.6) |
0.5
(−0.7, 1.2) |
−1.4ᵃ
(−2.7, −0.0) |
|
Session
6 |
2.9ᵃ
(2.3, 5.1) |
1.3
(−0.1, 2.3) |
−2.3ᵃ
(−4.5, −0.6) |
|
|
Neck
Disability Index
(0–50) |
Session
6 |
16.2ᵃ
(9.3, 22.0) |
2.3 (−4.2,
9.0) |
−14.0ᵃ
(−23.2, −4.0) |
|
Flexion |
Session
6 |
5
(−2.1, 11.5) |
4
(−2.4, 11.2) |
0.3
(−9.3, 10.0) |
|
Extension |
Session
6 |
10ᵃ
(1.3, 17.7) |
−4
(−12.6, 3.8) |
14.0ᵃ
(2.3, 25.5) |
|
Rotation
(affected) |
Session
6 |
12ᵃ
(7.7, 17.4) |
−3
(−7.9, 1.8) |
15.6ᵃ
(8.8, 22.5) |
|
Lateral
flexion (affected) |
Session
6 |
8ᵃ
(3.2, 13.4) |
−1
(−1.3, 13.4) |
9.5ᵃ
(2.3, 16.8) |
ᵃ Denotes a
statistically significant disparity (p < 0.05).
The experimental group
revealed considerably higher gains over time in mechanical pressure pain
threshold (PPT), self-reported pain intensity, neck disability and cervical
range of motion (CROM) than the control group. The analysis demonstrated no
significant between-group differences in PPT at the cervical spine (F = 1.999,
p > 0.050), C7 hand dermatome (F = 0.166, p > 0.050), affected dermatome
(F = 0.433, p > 0.050), and tibialis anterior (F = 0.280, p > 0.050), but
there was a significant improvement over time at the cervical spine (F =
11.757, p < 0.050) and tibialis anterior (F = 7.108, p < 0.050). The
experimental group had a mean increase of 124 kPa (95% CI: 57–191.1 kPa) at the
cervical spine and 99 kPa (95% CI: 3.6–194.9 kPa) at the C7 dermatome from pre
to post evaluation showing greater tolerance to mechanical pressure and lower
pain sensitivity. For thermal pain sensitivity, no significant group x time
interactions were seen for heat pain threshold (HPT) (F = 0.460–2.657, p
≥ 0.080) or cold pain threshold (CPT) (F = 0.496–1.852, p ≥ 0.167),
showing that the intervention had no meaningful effect on thermal hyperalgesia.
The temporal effects of HPT were non-significant (F = 0.292–0.865, p >
0.433). There was no difference in temperature sensitivity with hot pack or
high-performance treatment (0.6°C, 95% CI: -3.5°C to 2.3°C) that was not
clinically relevant. Patient rotation also did not significantly benefit with
HPT, with a mean change of 1.7 °C (95% CI: -4.8 °C to 1.5 °C). However, cold
pain threshold (CPT) was able to reduce discomfort in several anatomical
regions: cervical spine, C7 hand dermatome, afflicted dermatome and tibialis
anterior, with an improvement of 15.6°C (95% CI: 8.9°C to 8.8°C; p = 0.001; F =
5.583). There was also a 15.6 degree (p = 0.001) improvement in cervical range
of motion toward the afflicted side. Results showed that the decrease in pain
severity was closely related to the enhanced mobility of the neck and
functional recovery, and suggested that the intervention was mainly targeting
mechanical pain mechanisms and not heat pain sensitivity[20].
Table 4.
Pearson correlation coefficient was employed to quantify the strength and
direction of the association between the outcome measures.
|
Outcome
Measures |
r |
r² |
P
value |
|
Numeric Pain Rating
Scale vs. |
|||
|
Neck Disability
Index |
0.80 |
0.67 |
< 0.000* |
|
Cervical range of
motion —Delay |
−0.01 |
0.00 |
0.918 |
|
Cervical range of
motion —Adjacent flexion (affected) |
−0.04 |
0.00 |
0.817 |
|
Cervical range of
motion —Alternation (affected) |
−0.31 |
0.10 |
0.100 |
|
Pressure pain
threshold —Cervical
spine |
−0.32 |
0.11 |
0.086 |
|
Pressure pain
threshold —Pretentious
dermatome |
−0.02 |
0.00 |
0.906 |
|
Heat pain
threshold —Cervical
spine |
0.03 |
0.00 |
0.833 |
|
Heat pain
threshold —Pretentious
dermatome |
−0.18 |
0.03 |
0.475 |
|
Cold pain threshold —Cervical spine |
0.10 |
0.01 |
0.587 |
|
Cold pain
threshold —Pretentious
dermatome |
0.11 |
0.01 |
0.683 |
|
Neck Disability
Index vs. |
|||
|
Cervical range of
motion —Postponement |
−0.21 |
0.04 |
0.304 |
|
Cervical range of
motion —Adjacent flexion (affected) |
−0.18 |
0.04 |
0.339 |
|
Cervical range of
motion —Spin (affected) |
−0.25 |
0.07 |
0.180 |
|
Pressure pain
threshold —Cervical
spine |
−0.15 |
0.03 |
0.426 |
|
Pressure pain
threshold —Pretentious
dermatome |
0.15 |
0.03 |
0.538 |
|
Heat pain
threshold —Cervical
spine |
0.06 |
0.00 |
0.727 |
|
Heat pain
threshold —Pretentious
dermatome |
−0.21 |
0.05 |
0.362 |
|
Cold pain
threshold —Cervical
spine |
−0.02 |
0.00 |
0.875 |
|
Cold pain
threshold —Pretentious
dermatome |
0.20 |
0.05 |
0.370 |
*Statistically
significant correlation (p < 0.05)
DISCUSSION
This randomized
controlled trial examined if cervical spondylosis patients who exercised with
cervical manual therapy had better results. Manual therapy improved clinical
outcomes, specifically pain, disability, and cervical range of motion, compared
to exercise alone [20].
NPRS showed clinically significant pain intensity reductions immediately after
the intervention and during the final session. This shows a positive
group-by-time interaction for the experimental group. Other investigations have
demonstrated that cervical mobilization activates mechanoreceptors and blocks
spinal nociceptive input to alleviate pain. The substantial association between
NPRS and NDI supports the therapeutic relevance of pain reduction for cervical
spondylosis patients' functional ability. At the end of therapy, the
experimental group had a large improvement in the Neck Disability Index score,
whereas the comparison group had a little gain. This suggests that hand
rehabilitation and exercise might result in better functional recovery.
Furthermore, the considerable reduction in NDI scores suggests an increase in
cervical mobility and a decrease in discomfort, which allows patients to engage
in more everyday activities[21]
The experimental group
demonstrated a larger improvement in cervical range of motion (CROM),
especially in extension, rotation, and lateral flexion toward the afflicted
side, compared to the control group. These findings indicate that joint
mobilization treatments may be beneficial in increasing neck mobility in
patients with degenerative cervical disorders. These treatments may assist
reduce joint stiffness and improve flexibility of movement, which may minimize
mobility constraints and allow patients to conduct everyday tasks with more
ease and comfort. The results show the potential of joint mobilization as a
major therapeutic intervention to restore functional neck motions and improve
the quality of life of patients with cervical degenerative illnesses. It may
also enhance the efficiency of strength training exercises and therefore
increase the potential for beneficial outcomes. An increase in the cervical
spine pressure pain threshold in the experimental group suggests that there was
a decrease in sensitivity to mechanical pain; however, the overall effect of manual
therapy on local pain tolerance was not statistically significant (although
there are potential confounding factors such as exercise and time).
Additionally, as shown by the lack of change in thermal pain thresholds (CPT
& HPT), manual therapy does not appear to have any impact on the central
processing of thermal pain, with a much greater impact on the processing of
mechanical pain. These findings support previous findings that physical
therapies do not significantly influence centrally or globally mediated sensory
systems.
Study results indicated
no significant changes in temperature sensitivity, suggesting that the observed
benefits are related mainly to local biomechanical and neurophysiological
changes rather than processes of central pain modulation. In non-technical
language, that suggests the therapy may have worked by directly enhancing the
function of muscles, joints and surrounding tissues in the afflicted cervical
area rather than modifying how the brain perceives pain. This is a significant
therapeutic aspect as manual treatment procedures are mainly aimed to reduce
mechanical pain by decreasing joint stiffness, enhancing mobility and releasing
muscle tension in persons with cervical spondylosis. These findings offer
valuable insights for clinical practice in that they reinforce the relevance of
manual therapy in the management of mechanical neck pain and functional
outcomes. However, several limitations should be taken into account while
interpreting these results. The limited sample size may restrict the
generalizability of the findings and the short-term follow-up prevents knowing
whether the advantages may be sustained over a longer time period. However, the
study design is randomized and double-blinded, which increases the reliability of
the findings. The consistency in the application of treatment procedures among
participants improves the methodological quality of the study. Further studies
with bigger sample sizes and longer follow-up periods are required to validate
these results and to further investigate the long-term benefits of manual
treatment in patients with cervical spondylosis. Such research would offer
greater evidence and help guide more successful treatment choices in clinical
practice.
CONCLUSION
This study found that
exercising on its own is not as useful as exercising in combination with
cervical manual therapy in terms of treating pain, lowering impairments related
with the neck, and increasing cervical range of motion in those who have cervical
spondylosis. This was the conclusion reached by the researchers. Manual therapy
does not have an impact on thermal pain thresholds; however, it does help with
mechanical pain sensitivity. This is the case with both thermal and mechanical
pain thresholds. The concept that cervical manual therapy, when paired with
exercise-based rehabilitation, may be able to aid in the relief of symptoms
associated with cervical spondylosis is given legitimacy by the results that
have been obtained, such as these.
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