Chiropractic manipulative therapy and proprioceptive neck exercises for the treatment of chronic mechanical neck pain and its effect on head repositioning accuracy

M.Tech. (Chiropractic)Mechanical neck pain is the most common type of cervical spine pain encountered. It is also referred to as simple or non-specific neck pain and is common in all groups of people (Plaugher, 1993). A majority of individuals with neck pain do not experience a resolution in their pain and disability and this thus results in chronicity (Cote, Cassidy, Carrol and Kristman, 2004). Chiropractic manipulative therapy (CMT) is a specific form of articular manipulation, especially of the vertebral column. This is performed either manually, mechanically, actively or passively in order to restore normal articular alignment and function (Gatterman, 2005). Proprioceptive neck exercises are designed to retrain the cervical musculature to regain its position sense in space. Specific exercises are designed to locate the head to a neutral position and then to do a series of movements in other planes, and then to return the head to the neutral position (Revel, Minguet, Gergoy, Valliant and Manuel, 1994). Chiropractic manipulative therapy does have documented positive effects on the proprioceptive system within the cervical spine (Palmgren, 2006) as does proprioceptive exercises (Sarig-Bahat, 2003; Revel, Minguet, Gergoy, Vaillant, Manuel, 1994). The desired effects of combining both these treatments would be to increase the response rate in patients suffering from chronic mechanical neck pain. The aim of this study was to compare the effects of Chiropractic manipulative therapy (CMT) and proprioceptive neck exercises as stand-alone treatment protocols, as well as a combination treatment protocol with regards to neck pain, disability, cervical spine range of motion and Head Repositioning Accuracy (HRA). Participants were recruited from the University of Johannesburg Chiropractic Day Clinic. They were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of advertisements that were placed around the respective campuses of the University of Johannesburg as well as by word of mouth. Thirty participants, who presented with chronic mechanical neck pain, volunteered for this randomised comparative clinical study. The participants, aged between 18 - 40, were randomly divided into three groups of ten, with a half female to male ratio. Group 1 received Chiropractic manipulative therapy to the restricted joints in the cervical spine, Group 2 received proprioceptive neck exercises and Group 3 received a combination of both treatments. Participants were treated for a total of 6 visits over a three week period. Subjective and objective measurements were taken at the beginning of visits 1, 4 and at a final visit 7 during which only measurements were taken. Subjective measurements consisted of the Vernon-Mior Neck Pain and Disability Index (VMNPDI) and the Numerical Pain Rating Scale (NPRS) to assess the participants‟ neck pain and disability as well as their perception of pain. Objective measurements were obtained by using the Cervical Range of Motion device (CROM) as well as measuring the Head Repositioning Accuracy (HRA) as described by Revel, Andre-Deshays and Minguet (1991). Based on the results of the study, it could be concluded that both Group 1 (Chiropractic manipulative therapy to the restricted joints in the cervical spine) and Group 3 (a combination of cervical spine manipulation and proprioceptive neck exercises) can be used effectively to treat chronic mechanical neck pain and improve HRA. Group 1, 2 and 3 showed statistical improvements in certain areas and clinical improvements in all areas over time. It could not be statistically concluded whether one treatment is superior to the other, although clinically, Group 1 and Group 3 seemed to be more effective. Considering that Group 3 is a combination of cervical spine manipulation and proprioceptive neck exercises, it could be considered as a valid treatment protocol for chronic mechanical neck pain and improving HRA and could thus be used in a clinical setting