Osteopathic manipulation and exercise in the treatment of chronic neck pain: a prospective study

Idris Moudi                                                                                    Supervisor: Dawn Limbert

Abstract

Study design A non-randomised unblinded controlled trial was performed over a four-week period. Participants filled out questionnaires regarding pain and disability both before and after intervention.
Aims and objectives This study aims to investigate the efficacy of stability exercise regimens, combined with osteopathic treatment, as a method of pain reduction in patients suffering from chronic pain, compared with those receiving osteopathic manipulative treatment alone. 
Summary of background data There is an abundance of research suggesting that exercise combined with manipulation is effective in reducing pain and disability. However, little of this relates to osteopathy and there is data to suggest prescriptive exercise is not widely taught in osteopathic colleges.
Methods A total of eleven participants were divided into Group A (n=7) comprised of three males and four females, with mean age of 46.3. Group A received manual therapy combined with a structured exercise programme. Group B (n=4) comprised of two males and two females, with a mean age of 41.5. Group B received manual therapy alone. Group A was given a sheet of four exercises, (appendix 3) including craniocervical flexion, thoracic extension, exercises for the lateral rotators of the glenohumeral joint and a stretch of pectoralis major and minor muscles. For the purposes of this study osteopathic manipulative treatment is defined as a range of manual techniques performed by undergraduate osteopathy students. This range of techniques includes soft tissue manipulation, articulatory techniques, digital friction, functional techniques, muscle energy techniques and high velocity low amplitude thrusts. 
Results None of the data showed statistical significance on analysis. However, all participants reported that they felt better post-intervention. Group A showed increased mean reduction in pain scores (p=0.6319), increased mean improvement in scores relating to their understanding of the cause of their condition (p> 0.9999), an increased mean improvement in perceived control scores (p=0.7728), an increased mean reduction in disability scores (p=0.2487), and an increased mean improvement of coping score (p=0.3852), when compared with Group B. 
Conclusion According to data analysis, there was no statistical significance found. Therefore, the null hypothesis must be accepted. The exercise and manipulation intervention administered to Group A showed a clinical benefit, although not significant. This clinical benefit warrants further investigation. Mechanical neck pain continues to be a common and socio-economically costly presentation, and as such, further research into the area would be of value.