Joint Mobilization vs. Strengthening Exercises on Cervical Proprioception for Nonspecific Neck Pain

NCT06960525 | Completed DMC

• 2 other identifiers: IRB-PGS-2024-03-57414-2024-06-07-95
• Study Type: interventional
• Target: 26
• Locations: 1 country
• Sites: 1

Brief Summary

This clinical trial aims to compare the effects of cervical joint mobilization versus cervical strengthening exercises in patients with chronic neck pain. The study will assess neck proprioception, pain intensity, cervical muscle strength, range of motion, and neck disability. The main question it aims to answer is: Which treatment is superior, or do they have equal effects after the first session and after the 12th session? Participants will: Receive either cervical joint mobilization or cervical strengthening exercises for 12 sessions. Do not perform any physical therapy treatment outside the trial. Visit the clinic three times per week for treatment.

Conditions

Chronic Neck Pain; Nonspecific Neck Pain

Keywords

chronic neck pain; Nonspecific neck pain; cervical proprioception; cervical mobilization; cervical strengthening exercises; neck; cervical; proprioception; mobilization; manual; strengthening; pain

Outcome Measures

Primary Outcomes (2)

• Active cervical movement sense

  Participants will be comfortably seated upright on a chair with a backrest, positioned 1 meter away from a board displaying a zigzag pattern (ZZ). They will wear a headband with a laser pointer attached. The pattern is affixed to the board in a manner that directs the laser beam to the pattern's centre.

  Three points: 1) baseline, 2) immediately after intervention, and 3) week 4

• Cervical joint position error

  Participants were comfortably seated upright on a chair with a backrest, positioned 0.9 meters away from a wall. Using a distance laser meter, for accurate measurement, the distance between the forehead of the participant and the wall was measured after the participant wore a headband with a laser pointer attached. A point on the wall was located as the patient was in a self-neutral position. A warm-up session was given as the patient with open eyes was instructed to perform flexion, extension, and rotation on both sides and return to the selected point after each movement. After that, the patient was asked to perform the movement for three trials in each movement direction with their eyes closed.

  Three points: 1) baseline, 2) immediately after intervention, and 3) week 4

Secondary Outcomes (4)

• Visual Analogue Scale

  Three points: 1) baseline, 2) immediately after intervention, and 3) week 4

• Cervical muscles strength

  Three points: 1) baseline, 2) immediately after intervention, and 3) week 4

• Cervical range of motion

  Three points: 1) baseline, 2) immediately after intervention, and 3) week 4

• Neck Disability Index

  Three points: 1) baseline, 2) week 4

Study Arms (2)

Joint mobilization group

EXPERIMENTAL

This group will receive passive cervical joint mobilization following Maitland's approach for 3 sets of 1 minute on the most painful segment with one minute rest between sets. The specific technique and most painful level will be determined during the clinical examination. The participant lies prone on a treatment bed, then the therapist uses both thumbs to apply grade III or IV based on the patient's irritability using posteroanterior pressure to the cervical spinous process or articular pillar, with a rhythm of 2 to 3 Hz per second. This intervention could be applied in different positions of the cervical spine, depending on the patient's response, in a pain-free manner.

Other: Cervical joint mobilization

Strengthening exercises group

EXPERIMENTAL

The exercise program will include concentric and eccentric training of the craniocervical, cervical flexors, extensors, muscles involved in cervical spine rotation and axioscapular muscles. The strengthening exercises with high frequency - low intensity will be performed. Low frequency - high intensity will be implemented when the patient's irritability is low.

Other: cervical strengthening exercises

Interventions

Cervical joint mobilization OTHER

Passive cervical joint mobilization following Maitland's approach for 3 sets of 1 minute on the most painful segment with one minute rest between sets.

Joint mobilization group

cervical strengthening exercises OTHER

concentric and eccentric training of the craniocervical, cervical flexors, extensors, muscles involved in cervical spine rotation and axioscapular muscles.

Strengthening exercises group

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• to 50 years
• Pain ≥ 3 months
• Neck pain on VAS ≥ 3/10
• NDI ≥ 5/50 points
• ZZ Errors ≥ 9 or the time to complete the task ≥ 28s

You may not qualify if:

• Unilateral headache aggravated by neck movement.
• Upper extremity symptoms beyond the elbow.
• Any history of neck trauma including whiplash
• Recent fractures (last 8 weeks)
• Cervical surgery (last 3 months)
• Current neck-related dizziness
• Known or suspected ves3bular pathology
• Internal fixation of the cervical spine
• Physical therapy for the neck (last 3 months)

Sponsors & Collaborators

• Imam Abdulrahman Bin Faisal University: lead
• Al Hada Military Hospital: collaborator

Study Sites (1)

Armed Forces Hospital - Al Hada

Ta'if, Mecca Region, Saudi Arabia

Location

Related Publications (4)

• Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017 Jul;47(7):A1-A83. doi: 10.2519/jospt.2017.0302.

  PMID: 28666405 BACKGROUND

• de Zoete RMJ. Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management. J Clin Med. 2023 Nov 15;12(22):7108. doi: 10.3390/jcm12227108.

  PMID: 38002720 BACKGROUND

• de Zoete RM, Armfield NR, McAuley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Br J Sports Med. 2020 Nov 2:bjsports-2020-102664. doi: 10.1136/bjsports-2020-102664. Online ahead of print.

  PMID: 33139256 BACKGROUND

• Ernst MJ, Williams L, Werner IM, Crawford RJ, Treleaven J. Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals. Musculoskelet Sci Pract. 2019 Oct;43:64-69. doi: 10.1016/j.msksp.2019.06.006. Epub 2019 Jul 2.

  PMID: 31277033 BACKGROUND

MeSH Terms

Conditions

Pain

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Ali M Alshami, Phd

  Imam Abdulrahman Bin Faisal University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Model Details: This is a double-blinded randomized clinical trial with a parallel-group design.

Study Record Dates

• First Submitted: April 6, 2025
• First Posted: May 7, 2025
• Study Start: October 20, 2024
• Primary Completion: February 18, 2025
• Study Completion: February 20, 2025
• Last Updated: December 30, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

SA (1)