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The Somatic Connection  |   May 2014
Several Manual Therapies Proven Beneficial for Patients With Chronic Neck Pain
Article Information
The Somatic Connection   |   May 2014
Several Manual Therapies Proven Beneficial for Patients With Chronic Neck Pain
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 405-406. doi:10.7556/jaoa.2014.078
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 405-406. doi:10.7556/jaoa.2014.078
Web of Science® Times Cited: 57
Pérez HI, Perez JLA, Martinez AG, et al. Is one better than another? a randomized clinical trial of manual therapy for patients with chronic neck pain [published online January 11, 2014]. Man Ther. doi:10.1016/j.math.2013.12.002.  
Chronic neck pain is a common problem found in patients of all ages at ambulatory primary care clinics. Osteopathic physicians employ a wide range of osteopathic manipulative treatment techniques to address somatic dysfunction associated with chronic neck pain. Often, multiple techniques are used during 1 treatment session. It is rare to find a research investigation that compares the efficacy of 1 manual therapy procedure with that of another. 
In a double-blind, randomized clinical trial, researchers in Madrid, Spain, assessed the effectiveness of 3 manual therapy techniques—high-velocity, low-amplitude; mobilization; and sustained natural apophyseal glide—on otherwise healthy patients with mechanically reproducible, nonradicular, chronic neck pain of greater than 12 weeks duration. Participants were randomly assigned to 1 of the 3 treatment groups. All treatments were performed by a physiotherapist with more than 10 years of clinical experience. For mobilization, the physiotherapist applied an oscillatory (2 Hz) posterior-anterior pressure on the patient's restricted hypomobile facet joint for 2 minutes and repeated the movement 3 times, with a 1-minute refractory period between applications. For sustained natural apophyseal glide, the physiotherapist facilitated active motion of the patient's cervical joint into the restrictive and painful barrier through contact on the dysfunctional vertebra's transverse process, resisting it when returning to neutral. This procedure was repeated 10 times in 3 sets. Each patient received a total of 4 treatment sessions over 2 weeks. Standard outcome measures compared the immediate and short-term effectiveness of the 3 maneuvers in terms of pain, disability, mobility, and the global rating of change scale at baseline. Measures were taken at the end of treatment and 1, 2, and 3 months after treatment. 
Sixty-one patients from local primary care physicians' offices were enrolled in the study. Dropouts occurred in each group, but the 51 patients (35 women, 26 men; mean [standard deviation] age, 36.5 [9.4] years) that completed the study met the prestudy power analysis sample size requirements to detect significant differences in pain scores between groups (0.86-cm difference on a visual analog scale). Participants in all groups showed improvement in all measures, as well as in satisfaction. There were no adverse events reported with any intervention. Although there was more improvement in cervical extension in the high-velocity, low-amplitude group, there was no long-term (ie, 3-month) difference between the groups for pain, disability, and other cervical ranges of motion. The authors concluded that all 3 manual techniques are effective for chronic neck pain management and recommended that further studies be conducted to investigate whether more sessions, longer follow-up, and combinations of different techniques have different effects.