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Immediate Effects on
Neck Pain and Active Range of Motion After a Single
Cervical High-Velocity Low-Amplitude Manipulation in
Subjects Presenting with Mechanical Neck Pain: A
Randomized Controlled Trial
Raquel Martínez-Segura PT, DO, César
Fernández-de-las-Peñas PT, Mariana Ruiz-Sáez PT, CO,
Cristina López-Jiménez PT, DO and Cleofás
Rodríguez-Blanco PT, DO
Escuela de Osteopatía de Madrid, Madrid, Spain
Escuela de Osteopatía de Madrid, Madrid, Spain; and
Department of Physical Therapy, Occupational Therapy,
Physical Medicine and Rehabilitation, Universidad Rey
Juan Carlos, Alcorcón, Spain
Escula de Osteopatía de Madrid, Madrid, Spain; and
Escula de Osteopatía de Madrid, Madrid, Spain
Escula de Osteopatía de Madrid, Madrid, Spain
Department of Physical Therapy, Universidad de Sevilla,
Sevilla, Spain
Received 1 December 2005; revised 5 January 2006;
accepted 20 April 2006. Available online 1 September
2006.
Abstract
Purpose: The objective of this study is to
analyze the immediate effects on neck pain and
active cervical range of motion after a single
cervical high-velocity low-amplitude (HVLA)
manipulation or a control mobilization procedure in
mechanical neck pain subjects. In addition, we
assessed the possible correlation between neck pain
and neck mobility.
Methods: Seventy patients with mechanical
neck pain (25 males and 45 females, aged 20-55 years)
participated in this study. The lateral gliding test
was used to establish the presence of an
intervertebral joint dysfunction at the C3 through
C4 or C4 through C5 levels. Subjects were divided
randomly into either an experimental group, which
received an HVLA thrust, or a control group, which
received a manual mobilization procedure. The
outcome measures were active cervical range of
motion and neck pain at rest assessed pretreatment
and 5 minutes posttreatment by an assessor blinded
to the treatment allocation of the patient.
Intragroup and intergroup comparisons were made with
parametric tests. Within-group effect sizes were
calculated using Cohen's d coefficient.
Results: Within-group changes showed a
significant improvement in neck pain at rest and
mobility after application of the manipulation (P
< .001). The control group also showed a significant
improvement in neck pain at rest (P < .01),
flexion (P < .01), extension (P <
.05), and both lateral flexions (P < .01),
but not in rotation. Pre-post effect sizes were
large for all the outcomes in the experimental group
(d > 1), but were small to medium in the
control mobilization group (0.2 < d < 0.6).
The intergroup comparison showed that the
experimental group obtained a greater improvement
than the control group in all the outcome measures (P
< .001). Decreased neck pain and increased range of
motion were negatively associated for all cervical
motions: the greater the increase in neck mobility,
the less the pain at rest.
Conclusions: Our results suggest that a
single cervical HVLA manipulation was more effective
in reducing neck pain at rest and in increasing
active cervical range of motion than a control
mobilization procedure in subjects suffering from
mechanical neck pain.
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