Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain

Snodgrass, Suzanne J., Rivett, Darren A., Sterling, Michele and Vicenzino, Bill (2014) Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain. Journal of Orthopaedic and Sports Physical Therapy, 44 3: 141-152. doi:10.2519/jospt.2014.4778


Author Snodgrass, Suzanne J.
Rivett, Darren A.
Sterling, Michele
Vicenzino, Bill
Title Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain
Journal name Journal of Orthopaedic and Sports Physical Therapy   Check publisher's open access policy
ISSN 0190-6011
1938-1344
Publication date 2014-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.2519/jospt.2014.4778
Open Access Status
Volume 44
Issue 3
Start page 141
End page 152
Total pages 12
Place of publication Alexandria, VA, United States
Publisher American Physical Therapy Association * Orthopedic Section
Language eng
Abstract STUDY DESIGN: Randomized controlled trial.
Formatted abstract
Study Design: Randomized controlled trial.

Objective: To determine if force magnitude during posterior-to-anterior mobilization affects immediate and short-term outcomes in patients with chronic, nonspecific neck pain.

Background: The optimal dose of mobilization to effectively treat patients with neck pain is not known.

Methods: Patients with neck pain of at least 3 months in duration (n = 64) were randomized to receive a single treatment of posterior-to-anterior mobilization applied with 30 N or 90 N of mean peak force (3 sets of 30 seconds) or a placebo (detuned laser) on the spinous process at the painful spinal level. Pressure pain threshold, pain measured with a visual analog scale (range, 0–100 mm), cervical range of motion, and spinal stiffness at the painful spinal level (measured with a custom device and normalized as a percentage of C7 stiffness) were assessed before, immediately after, and at a mean ± SD follow-up of 4.0 ± 1.8 days following treatment. Repeated-measures analysis of covariance and Bonferroni-adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow-up.

Results: At follow-up, the 90-N group had less pain than the 30-N group (mean difference, 11.3 mm; 95% confidence interval: 0.1, 22.6 mm; P = .048) and lower stiffness than the placebo group (mean difference, 17.5%; 95% confidence interval: 4.2%, 30.9%; P = .006). These differences were not present immediately after treatment. There were no significant between-group differences in pressure pain threshold or range of motion after treatment or at follow-up.

Conclusion: A specific dose of mobilization, in terms of applied force, appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain. Changes were not observed immediately after mobilization, suggesting that its effects are not directly mechanical.

Trial registration: Australian and New Zealand Clinical Trials Registry (http://www.anzctr.org.au/): ACTRN12611000374965.
Keyword Biomechanics
Cervical vertebrae
Manual therapy
Musculoskeletal manipulations
Neck
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
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