Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial

Abstract

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion–rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion–rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion–rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion–rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion–rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.

Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial

“…The MT+Exercise Group was more effective than the Exercise Group, increasing right and left flexion-rotation tests and active cervical range of motion. The manual therapy approach, aimed at restoring the mobility of the upper cervical joints, has shown to improve values in the flexion-rotation test by treating C0-1 ( Hidalgo García et al, 2016 ; Malo-Urriés et al, 2017 ; González-Rueda et al, 2020 ), C2-3 ( Carrasco-Uribarren et al, 2020 ), and C1-2 ( Hidalgo García et al, 2016 ), when necessary. This test measures the upper cervical rotation, mainly in C1-2 segment ( Takasaki et al, 2011 ).…”

Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial

“…Most rotational movement of the upper cervical spine occurs at the C1-2 segment [ 3 ]. The flexion-rotation test is the most used test to assess the range of movement (ROM) in the transverse plane of the upper cervical spine, and it is a valid and reliable test [ 4 , 5 , 6 , 7 ]. This test is an easily applied method of manual examination that localizes the presence of joint dysfunction at C1-2 level [ 8 ].…”

Effects of occipital-atlas stabilization in the upper cervical spine kinematics: an in vitro study

“…The C0–C1 restriction of movement may have had an influence on alar ligament tightening. Further support for the contribution of C0–C1 during UCS axial rotation is reported clinically showing an increase of C1–C2 ROM following C0–C1 mobilization 15 – 19 , although scientific evidence about the specific segmental effect in C0–C1 and not in adjacent segments of C0–C1 translatoric mobilization is needed.…”

“…However small the actual motion occurring during rotation at C0–C1, there is an emerging body of evidence supporting the notion that C0–C1 plays a relevant role in the rotation ROM at C1–C2. Improvement of C1–C2 rotation has been demonstrated following the application of manual therapy in the form of translatoric mobilization to C0–C1 in participants with restricted UCS axial rotation 15 , patients with cervicogenic headache 16 , and patients experiencing chronic cervicalgia 17 – 19 . This approach is based on a rationale that restricted mobility of the C0–C1 segment could limit C1–C2 movement during rotation due to the alar ligament connection across each joint 20 , 21 .…”