Physical Therapy for Neck Pain

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

200 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Cervical Spine Clinical Practice Guidelines, Mechanical Diagnosis and Therapy for neck pain?

The revised clinical practice guidelines for neck pain, updated in 2017, suggest that nonsurgical treatments provided by physical therapists can improve pain and disability in many types of neck pain. These guidelines are based on evidence and help ensure that physical therapists use the best available practices to treat neck pain effectively. ^{1 2 3 4 5}

Is physical therapy for neck pain safe?

Physical therapy for neck pain, including manual therapy, is generally safe with a low risk of increased symptoms like dizziness (1%-2%) and an extremely low risk of serious complications (0.0001%). Proper training and competency are important for safe treatment. ^{6 7 8 9 10}

How does the treatment 'Cervical Spine Clinical Practice Guidelines, Mechanical Diagnosis and Therapy' differ from other treatments for neck pain?

This treatment is unique because it uses updated clinical practice guidelines to provide a structured approach for physical therapists to diagnose and treat neck pain, focusing on evidence-based, nonsurgical interventions tailored to individual patient needs. ^{1 2 5 11 12}

What is the purpose of this trial?

The goal of this clinical trial is to compare physical therapy treatments in people with neck pain. The main aim is to compare the short-term effectiveness of physical therapy treatment for neck pain as delivered through Mechanical Diagnosis and Therapy (MDT) as compared to the Cervical Spine Clinical Practice Guidelines (CPGs) in patients with neck pain. Participants will be randomly allocated to receive treatment according to MDT or CPG guidelines. Researchers will compare outcomes between the two groups over 1 year.

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Utilization of Clinical Practice Guideline Interventions in the Conservative Management of Mechanical Neck Pain: A Retrospective Analysis. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Neck Pain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice. [2017]

3. United States pubmed.ncbi.nlm.nih.gov

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care. [2017]

6. United States pubmed.ncbi.nlm.nih.gov

Manual therapy in the treatment of neck pain. [2019]

7. Canada pubmed.ncbi.nlm.nih.gov

Determining adverse events in patients with neck pain receiving orthopaedic manual physiotherapy: a pilot and feasibility study. [2021]

8. Scotland 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. [2022]

9. Scotland pubmed.ncbi.nlm.nih.gov

Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Manual therapy interventions in the management of adults with prior cervical spine surgery for degenerative conditions: a scoping review. [2022]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study. [2021]

12. United States pubmed.ncbi.nlm.nih.gov

Role of physical therapy in the treatment of cervical disk disease. [2017]