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Comparison of two different manual techniques for an exercise program for the management of chronic neck pain: a randomized clinical trial study
Lytras D, Sykaras E, Iakovidis P, Kasimis K, Kottaras A, Mouratidou C
Journal of Back and Musculoskeletal Rehabilitation 2023;36(1):199-216
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Both spinal manipulation (SM) and Integrated Neuromuscular Inhibition Technique (INIT) have a positive effect in individuals with chronic neck pain (CNP), especially when they are combined with therapeutic exercise (TE). However, it has not been determined which of the above combinations is more effective in patients with CNP. OBJECTIVE: To compare the efficacy of two different manual techniques (SM and INIT), when combined with the same TE program in the management of CNP. METHODS: Eighty women with CNP, allocated into four groups of 20 persons each. The first group followed a 10-week TE program, the second TE and INIT, the third TE and SM, and the fourth was the control group. The Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), Pressure Pain Threshold (PPT) of the neck muscles, neck active Range of Motion (ROM), Maximum Isometric Strength (MIS) of the neck muscles, craniocervical flexion test (CCFT) and SF-36 questionnaire scores were evaluated before, during and after the treatment period, with a six-month follow-up. RESULTS: There was between groups differences between the three intervention groups and the control group (p < 05), with the positive effects being maintained until the six-month follow-up. However, this improvement occurred earlier in the "TE plus INIT" and "TE plus SM" groups than in the "TE" group. Differences between the "TE plus INIT" and the "TE plus SM" groups were noticed only in the neck muscles PPT values, in which the "TE plus INIT" group showed greater improvement. Furthermore, some non-statistically significant indications for further improvement of "TE plus SM" were noted in the left lateral flexion ROM. CONCLUSION: The addition of INIT as well as SM in the same TE program can further increase the beneficial effect of exercise in women with CNP. In most measurements both combinations seem to be equally effective. However, INIT improved more local muscle tenderness, whereas SM aided more in the neck lateral flexion ROM.

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