The Effects of Spinal Mobilization Added to an Exercise Program in Recreational Tennis Players With Mechanical

NCT07575542 | Completed

• 1 other identifier: tennis neck 25-77
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective, single-blind, parallel-group randomized controlled trial evaluated whether adding cervical and thoracic spinal mobilization (Maitland concept, grades I-IV) to a structured home therapeutic exercise program improves pain intensity and physical fitness parameters in recreational tennis players with mechanical neck pain. Thirty adults aged 18-45 years with body mass index (BMI) of 18-30 kg/m² and mechanical neck pain (Visual Analog Scale, VAS \> 4) lasting more than one week were randomized 1:1 into a Control Group (CG, n=15) performing an unsupervised 21-session home exercise program (one session per day for three weeks) and an Experimental Group (EG, n=15) performing the identical home exercise program plus four therapist-delivered sessions of cervical and upper thoracic spinal mobilization (one at baseline and one per week thereafter, across three weeks). Outcomes assessed at baseline (Week 0) and post-intervention (Week 3) included VAS for pain during physical activity, at rest, and during sleep; cervical range of motion measured with a Cervical Range of Motion (CROM) device; isometric neck muscle strength (handheld dynamometer); pinch and hand grip strength; ruler-drop reaction time; sit-and-reach flexibility; and vertical jump performance assessed with the My Jump Lab application.

Conditions

Mechanical Neck Pain; Tennis; Pain; Manual Therapy; Therapeutic Exercise

Keywords

Mechanical neck pain; Tennis; pain; Manual therapy; therapeutic exercise

Outcome Measures

Primary Outcomes (1)

• Pain intensity - Visual Analog Scale (VAS) during physical activity (0-10 cm)

  Self-reported pain intensity rated by the participant on a 10 cm horizontal Visual Analog Scale anchored from "no pain" (0) to "worst imaginable pain" (10), scored to one decimal in centimeters; lower scores indicate less pain. Safety Issue: No.

  Baseline (Week 0) and Post-Intervention (Week 3)

Secondary Outcomes (8)

• Pain intensity - Visual Analog Scale (VAS) at rest and during sleep (0-10 cm)

  Baseline (Week 0) and Post-Intervention (Week 3)

• Cervical Range of Motion (CROM) - degrees

  Baseline (Week 0) and Post-Intervention (Week 3)

• Isometric Neck Muscle Strength - kilograms-force (kgf)

  Baseline (Week 0) and Post-Intervention (Week 3)

• Hand Grip Strength - kilograms (kg)

  Baseline (Week 0) and Post-Intervention (Week 3)

• Pinch Grip Strength - kilograms (kg)

  Time Frame: Baseline (Week 0) and Post-Intervention (Week 3)

Study Arms (2)

Active Comparator: Control Group (CG)

ACTIVE COMPARATOR

Control Group (CG, n=15): Participants performed an unsupervised structured home therapeutic exercise program for three weeks (one session per day; 21 sessions total). The program comprised bilateral stretching of the upper trapezius and levator scapulae muscles, hamstring and lumbar extensor stretching, isometric resistance exercises for cervical flexion, extension, and bilateral lateral flexion, the chin-tuck exercise, and the cat-camel exercise. Written instructions with illustrations were provided

Behavioral: Behavioral: Home Therapeutic Exercise Program

Experimental: Experimental Group (EG)

EXPERIMENTAL

Experimental Group (EG, n=15): Participants performed the identical home therapeutic exercise program as the Control Group AND received four supervised sessions of Maitland-concept spinal mobilization (cervical and upper thoracic) delivered by a physiotherapist (one session at baseline and one session per week thereafter, total of four sessions across three weeks). Mobilizations used grades I-IV depending on the relationship between pain and motion limit, with oscillations at 2-3 Hz, \~30 seconds per bout, 3-4 bouts per segment, and 1-minute rest between bouts.

Behavioral: Behavioral: Home Therapeutic Exercise Program; Procedure: Maitland Cervical and Upper Thoracic Spinal Mobilization

Interventions

Behavioral: Home Therapeutic Exercise Program BEHAVIORAL

Three weeks (21 daily sessions) of unsupervised home exercises supported by written and illustrated instructions. Components included bilateral upper trapezius and levator scapulae stretching, hamstring and lumbar extensor stretching, isometric cervical flexion / extension / bilateral lateral flexion exercises, chin-tuck exercise, and cat-camel exercise.

Active Comparator: Control Group (CG); Experimental: Experimental Group (EG)

Maitland Cervical and Upper Thoracic Spinal Mobilization PROCEDURE

Therapist-delivered passive oscillatory mobilization to hypomobile cervical and upper thoracic segments using grades I-IV per the Maitland concept; oscillation rate 2-3 Hz; \~30-second bouts; 3-4 bouts per segment; 1-minute rest between bouts. Total of four supervised sessions (one at baseline, then once per week) across three weeks.

Experimental: Experimental Group (EG)

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18 and 45 years.
• Body Mass Index (BMI) between 18 and 30 kg/m².
• Recreational tennis player, playing tennis at least 2 days per week and at least 2 hours per week.
• Mechanical neck pain triggered by neck movement or sustained positions on the symptomatic side.
• Reduced cervical range of motion as confirmed by a positive cervical flexion-rotation test.
• Pain elicited by external pressure over at least one cervical zygapophyseal (facet) joint.
• Neck pain of at least 1 week duration, with intensity greater than 4/10 on the Visual Analog Scale (VAS), not associated with any specific medical history.
• Able to communicate in Turkish or English (verbal and written).
• Free from systemic, orthopedic, neurological, chronic, or psychiatric disease.

You may not qualify if:

• Neck pain of more than 6 months duration.
• Concomitant sensory loss (paresthesia, hypoesthesia, or anesthesia).
• Pain radiating to the upper extremities (radicular symptoms).
• History of long-term systemic corticosteroid use.
• Regular use of medications affecting musculoskeletal performance or pain perception.
• Sequelae from prior injury or any surgical history involving the cervical or thoracic spine.
• Prior interventional procedures targeting the neck region (e.g., injection therapy).
• Pregnancy or suspected pregnancy.
• During the study: pain greater than 3/10 on VAS during sessions, three consecutive missed sessions, incident illness or trauma, withdrawal request, or failure to meet exercise progression criteria.

Sponsors & Collaborators

• Istinye University: lead

Study Sites (1)

Istinye University

Istanbul, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain

Condition Hierarchy (Ancestors)

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

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Single (Outcomes Assessor). The outcome assessor performing baseline and post-intervention measurements was blinded to group allocation; participants and the treating physiotherapist were not blinded due to the nature of the manual therapy intervention
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor; PhD

Model Details: Parallel Assignment - Two-arm, single-blind randomized controlled superiority trial.

Study Record Dates

• First Submitted: May 3, 2026
• First Posted: May 8, 2026
• Study Start: April 1, 2025
• Primary Completion: July 15, 2025
• Study Completion: August 1, 2025
• Last Updated: May 8, 2026

Record last verified: 2026-05

Locations

TU (1)