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Post by Lauren on Apr 1, 2016 21:08:24 GMT
I reviewed an article (link below) comparing the efficacy of manual therapy, dry needling + stretching, and soft tissue techniques when treating mechanical neck pain. The study had a very short duration (2 visits in 48 hours) with a one week follow up . Outcome measures included pain intensity, cervical AROM, and pressure pain threshold, as well as the NDI and pain catastrophizing scale. Manual therapy was the only treatment studied that showed a decrease in pain, an increase in cervical AROM into flexion and extension, decreased pain catastrophizing, and a clinically significant reduction in neck disability. The study results do not carry over that well into everyday practice as PTs very rarely use dry needling or soft tissue techniques without incorporating the use of manual therapy. www.ncbi.nlm.nih.gov/pmc/articles/PMC4657116/ Article Review cervical.docx (32.24 KB)
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Post by Jeff on Apr 4, 2016 20:31:19 GMT
I wonder how the author's decided on what manual therapy techniques to use in the orthopaedic manual therapy (OMT) treatment group. The article states the techniques follow a neural/joint approach. The three techniques they used were a AP (flexion) glide for the upper cervical spine, lateral glide to the C4-5 region, and a AP glide at the T4-T5 level. They mobilized in multiple regions of the spine including the upper cervical, mid and lower cervical, and mid thoracic but how did they decided to mobilize the C4-5, and T4-5 levels and leave the other levels alone? It doesn't seem like it was based on segmental mobility assessment or objective findings.
In the DN group they used the levator scapulae and upper trapezius muscles since they reported these muscles are involved with patient's with neck pain. The STT group also used the levator scapulae and upper trapezius muscles for ischemic compression which is consistent with the DN group. But again how did they decided on these three manual therapy techniques? Does the lateral glides at level C4-5 relate to the spinal level innervation of upper trapezius being 2,3,4 and levator scapulae being 3,4,5?
From my understanding the mobilizations that were directed at the joints were the upper cervical AP mob and C4-5 lateral glide and the neural glide was the AP glide of T4-5. Is the thoracic technique considered a neural technique due to mobilizing the sympathetic chain? I'm familiar with a similar technique intended to mobilize the sympathetic chain.
A quick point about inclusion criteria. Bilateral neck pain was one inclusion criteria. If one had unilateral neck pain they were excluded from the study. Thoughts why this might be.
I did find the pressure pain threshold interesting since I've never seen this measurement before. I'm assuming this is something that is measured frequently when practicing DN to evaluate improvement.
Manual therapy came out on top, good for manual therapy, but I would like to see more articles comparing DN to acupressure techniques and cervical mobs including manipulation.
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