Effectiveness of Manual Therapy and Exercise vs Exercise in Subjects With Chronic Cervical Pain and Upper Cervical Spine Dysfunction
Effectiveness of Manual Therapy and Exercise vs Exercise in Subjects With Chronic Cervical Pain and Upper Cervical Spine Dysfunction
There is a lot of scientific evidence about the effectiveness of manual therapy and exercise
 / training in subjects with cervical pain. Most of the high quality systematic reviews agree
 on the need to combine manual therapy and exercise for the treatment of chronic cervical
 pain. However, articles that focus on manual therapy in the treatment of the upper cervical
 spine are not as common, being that the most commonly prescribed exercises are those of
 craniocervical flexion, (flexion of the upper cervical spine).

 The investigators believe that participants who are going to benefit more from the
 integration of manual therapy and exercise will be those who have a real restriction of the
 upper cervical spine, and for these, is indispensable, the application of manual therapy
 techniques before the integration of the active exercise to obtain optimal results.

 This project is going to try to define participants with chronic cervical pain and upper
 cervical spine restriction that may benefit more from the combination of manual therapy and
 exercise than the rest. The investigators are going to study changes in different variables
 about function, pain, ultrasound, muscle tone, joints... Strengthen the importance of
 specificity in physiotherapy interventions and increase the evidence on the importance of
 manual therapy in a subgroup of participants with chronic cervical pain, improve knowledge
 about the involvement of the upper cervical spine in cervical pathology and check the
 effectiveness of a self-treatment program for participants with chronic cervical pain.

 The objective of this trial is to compare the effectiveness of an integrative approach of
 manual therapy associated with exercise versus exercise in participants with chronic cervical
 pain and upper cervical spine dysfunction.

 For this purpose, the investigators conduct a randomized controlled trial, simple-blind (Only
 is possible to blind the evaluator).

 The Sample size is 52 participants (2 groups of 26 participants). One of the groups will
 receive 4 training sessions with exercises for the cervical spine between 30 and 45 minutes
 duration per session and the other group will receive 4 sessions of a combination of manual
 therapy and training exercises also between 30 and 45 minutes each session. In addition, all
 participants will receive self-treatment techniques for self-management of their dysfunction.

 Cervical exercises will consist of a set of training techniques to improve the function and
 symptomatology that the participant has. These exercises have been widely evidenced and do
 not suppose any health risk.

 The techniques of manual therapy can be the manipulation technique in resting position,
 vertebral mobilization and / or musculature (massage and / or stretching). All the treatments
 applied follow the safety recommendations of the International Federation of Orthopedic
 Manual Therapists (IFOMPT). If participants need clarification, they can talk to the
 principal investigator (Jacobo Rodríguez Sanz) at any time.

 One physiotherapist will perform the physical examination, and a different one will apply the
 treatment. Physical therapists doing the screening will not know which group has been
 assigned to them, so the participant will be asked not to provide the evaluators any
 information about the assignment of his group to improve the quality of the study.

 The examination will consist of tests to assess whether the participant is a candidate to
 participate in the study, the measurement of pain, the exhaustive assessment of all cervical
 musculature with different measuring instruments and the measurement of joint mobility.

 The first day theparticipant be given information about his pain, his daily habits and
 activities that he usually does.

 The assessment of his problem will consist in the measurement of the amount of movement he
 can makes in the cervical area without pain, the ability to orient himself in certain
 movements with his eyes closed, the intensity of his pain, the evaluation of the state of his
 muscles. stabilizing as a mobilizer through ultrasound, muscle test and palpation. The
 functionality of his cervical vertebrae will also be evaluated and he will be asked different
 questionnaires about the functionality, pain and condition of his cervical pain, headache (in
 case of suffering) and kinesiophobia.

 Both the evaluation and the treatment will be without pain. In addition, he will be given a
 series of personalized exercises to improve his problem, which must be done every day during
 the study.
Inclusion Criteria:

 -  18 years old and over

 -  Medical diagnosis of chronic cervical pain (more than 3 months of cervical pain
 evolution)

 -  Positive flexion rotation test

 Exclusion Criteria:

 -  Recent spine, head or mouth surgery.

 -  Diabetes mellitus

 -  Recent infection and/or inflammatory arthritis, and cervical and/or brain traumatism
 records.

 -  Contraindication for manual therapy or cervical training