Physical Therapy for Neck Pain

Not currently recruiting at 2 trial locations

Overseen By Ronald Schenk, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Tufts University

Disqualifiers: Spinal surgery, Cancer, Rheumatoid arthritis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine which physical therapy treatment is more effective for neck pain. Participants will be divided into two groups: one will receive Mechanical Diagnosis and Therapy (MDT), which involves specific neck movements, and the other will follow Cervical Spine Clinical Practice Guidelines (CPGs), a set of research-based recommendations. The trial will assess how well each method relieves neck pain over one year. Individuals referred to physical therapy for neck pain and who show a directional preference (a specific movement that eases pain) during their initial exam may be suitable for this study. As an unphased trial, this study allows participants to contribute to valuable research that could enhance future neck pain treatments.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on physical therapy treatments for neck pain.

What prior data suggests that these physical therapy methods are safe for neck pain?

Research shows that both the Cervical Spine Clinical Practice Guidelines (CPGs) and Mechanical Diagnosis and Therapy (MDT) are safe and well-tolerated for treating neck pain.

Studies have found that CPGs help doctors evaluate neck pain and choose safe treatment options, including exercises and other commonly used therapies. For MDT, research indicates it can effectively reduce neck pain. MDT involves specific neck movements to identify what relieves pain. This method is widely used and has a good safety record.

Both treatments aim to reduce pain and improve movement without significant risks. Participants can feel confident about the safety of both therapy options in this trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Most treatments for neck pain, like medication or general physical therapy, aim to alleviate symptoms without delving deeply into the underlying causes. But the approaches in this trial are unique. The Cervical Spine Clinical Practice Guidelines (CPGs) offer tailored examination and intervention strategies based on extensive research, which can lead to more precise treatment plans. Meanwhile, Mechanical Diagnosis and Therapy (MDT) stands out by focusing on how a patient's neck responds to specific movements, tailoring the treatment to individual reactions. Researchers are excited because these methods could provide more personalized and effective relief for neck pain beyond traditional treatments.

What evidence suggests that this trial's treatments could be effective for neck pain?

Research has shown that the Cervical Spine Clinical Practice Guidelines (CPGs), one treatment option in this trial, can reduce neck pain and disability for many people. About 45% of patients experience significant improvement in their symptoms within six weeks. Patients often expect moderate relief when treated by a physical therapist using these guidelines.

Mechanical Diagnosis and Therapy (MDT), another treatment option in this trial, has proven as effective as other methods for managing neck pain and disability. Some studies suggest MDT might offer slightly better pain relief than a placebo. Both CPGs and MDT present promising options for those dealing with neck pain. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adults aged 18-90 with neck pain who show a directional preference during initial physical therapy assessment. It's not for those with spinal surgery history, cervical instability, serious conditions like cancer or autoimmune diseases, pregnancy, upper motor neuron signs, or certain symptoms like dizziness and swallowing issues.

Inclusion Criteria

My physical therapy exam showed I respond better to certain movements.

I am referred to physical therapy for neck pain from a hospital clinic.

Exclusion Criteria

I have never had spinal surgery.

I do not show signs of upper motor neuron disease.

I do not have serious conditions like cancer or autoimmune diseases.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive physical therapy treatment according to MDT or CPG guidelines

12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Cervical Spine Clinical Practice Guidelines
• Mechanical Diagnosis and Therapy

Trial Overview The study compares two physical therapy approaches for neck pain: Mechanical Diagnosis and Therapy (MDT) versus Cervical Spine Clinical Practice Guidelines (CPGs). Participants will be randomly assigned to one of these treatments and monitored over a year to see which is more effective short-term.

How Is the Trial Designed?

Group I: Mechanical Diagnosis and Therapy (MDT) Experimental Treatment 1 Intervention

MDT is a system of examination and intervention based on the patient's response to repeated end range neck movements.

Group II: Cervical Spine Clinical Practice Guidelines (CPGs) Active Control 1 Intervention

The CPGs are guidelines for examination and intervention based on a summary of research conducted on people with neck pain.

Who Is Running the Clinical Trial?

Tufts University

Lead Sponsor

Trials

271

Recruited

595,000+

Published Research Related to This Trial

Manual therapies can effectively reduce mechanical neck pain in the short term, especially when combined with other treatments, although no single treatment protocol has been identified as the best.

The safety of manual therapy is high, with only a 1%-2% risk of mild symptom aggravation like dizziness, and an extremely low risk (0.0001%) of serious complications or death from neck manipulation, highlighting the importance of proper training for practitioners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Manual therapy in the treatment of neck pain. Gross, AR., Aker, PD., Quartly, C.[2019]

Cervical manipulation and mobilization techniques for neck pain are generally effective but can be associated with rare serious adverse events, as highlighted by a review of studies from 1998 to 2009.

The review found that while 17 out of 76 studies reported no major adverse events, minor adverse events like transient neurological symptoms and increased neck pain were noted, indicating a need for better reporting of adverse events in manual therapy research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. Carlesso, LC., Gross, AR., Santaguida, PL., et al.[2022]

In a pilot study involving 20 patients treated by Canadian orthopaedic manual physiotherapists, adverse events from cervical manipulation and mobilization were mostly benign and transient, with 95.6% occurring within 0-12 hours and lasting 0-2 days.

The study faced significant challenges in recruitment and data collection, highlighting the need for improved methods in future larger trials, but it confirmed that no serious adverse events were reported during the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Determining adverse events in patients with neck pain receiving orthopaedic manual physiotherapy: a pilot and feasibility study. Carlesso, LC., Macdermid, JC., Santaguida, PL., et al.[2021]

Citations

1. jospt.org jospt.org/doi/10.2519/jospt.2017.0302

Neck Pain: Revision 2017 - jospt The 1-year incidence of neck pain was 10.4% to 21.3%. The 1-year remission rate ranged from 33% to 65%. The 1-year prevalence of neck pain in ...

2. orthopt.org orthopt.org/uploads/content_files/files/Neck%20Pain%20CPG%20-%20Revision%202017.pdf

Neck Pain: Revision 2017 Clinicians should perform assessments and identify clinical findings in patients with neck pain to determine the potential for the presence of serious pathology ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5175452/

Patient Expectations of Benefit From Interventions for Neck ... Patients had positive expectations for treatment by a physical therapist, with more than 80% of patients expecting moderate relief of symptoms.

4. jospt.org jospt.org/doi/10.2519/josptopen.2025.0101

Translating the Neck Pain Clinical Guidelines Into Practice 05). Compliance with outcome measure collection and CPG-recommended evaluation components was 92% (186/202) and 77% (213/278), respectively.

5. academic.oup.com academic.oup.com/ptj/article/98/3/162/4689128

Clinical Practice Guideline for Physical Therapy Assessment ... In about 45% of patients with acute neck pain, the pain and disability decreased in the first 6 weeks, but no further decrease occurred ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8633772/

Cervical Spine Joint Pain Interventions Guidelines In this study, paraspinal tenderness, but not neck pain worsened by “facet loading“ (extension and rotation of the cervical spine), was highly predictive of a ...

7. cms.gov cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39762&ver=8

LCD - Cervical Fusion (L39762) These guidelines include patient education with positive reinforcing and non-nocebo content, spinal manipulative therapy, exercise, sustaining pain-relieving ...

8. mayoclinicproceedings.org mayoclinicproceedings.org/article/s0025-6196(14)00833-7/fulltext

Epidemiology, Diagnosis, and Treatment of Neck Pain Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or ...