Cassidy J D, Lopes A A, Yong-Hing K
Department of Orthopaedic Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
J Manipulative Physiol Ther. 1992 Nov-Dec;15(9):570-5.
The main objective of this study is to compare the immediate results of manipulation to mobilization in neck pain patients.
The patients were compared in a randomized controlled trial without long-term follow-up.
The study was conducted at an outpatient teaching clinic on primary and referred patients.
One hundred consecutive outpatients suffering from unilateral neck pain with referral into the trapezius muscle were studied. Fifty-two subjects were manipulated and 48 subjects were mobilized. The mean (SD) age was 34.5 (13.0) yr for the manipulated group and 37.7 (12.5) yr for the mobilized group. Sixteen subjects had neck pain for less than 1 wk, 34 subjects had pain for between 1 wk and 6 mo and 50 subjects had pain for more than 6 mo. Seventy-eight subjects had a past history of neck pain. Thirty-one subjects had been involved in an injurious motor vehicle accident and 28 subjects had other types of minor trauma to the neck. There were no significant differences between the two treatment groups with respect to history of neck pain or level of disability as measured by the Pain Disability Index.
The patients received either a single rotational manipulation (high-velocity, low-amplitude thrust) or mobilization in the form of muscle energy technique.
Prior to and immediately after the treatments, cervical spine range of motion was recorded in three planes, and pain intensity was rated on the 101-point numerical rating scale (NRS-101). Both pre- and post-test measurements were conducted in a blinded fashion.
The results show that both treatments increase range of motion, but manipulation has a significantly greater effect on pain intensity. Eighty-five percent of the manipulated patients and 69% of the mobilized patients reported pain improvement immediately after treatment. However, the decrease in pain intensity was more than 1.5 times greater in the manipulated group (p = .05).
This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain. Both treatments increase range of motion in the neck to a similar degree. Further studies are required to determine any long-term benefits of manipulation for mechanical neck pain.
本研究的主要目的是比较对颈部疼痛患者进行手法治疗与松动治疗的即时效果。
在一项无长期随访的随机对照试验中对患者进行比较。
该研究在一家门诊教学诊所针对初诊患者和转诊患者开展。
对连续100例患有单侧颈部疼痛且牵涉至斜方肌的门诊患者进行研究。52例受试者接受了手法治疗，48例受试者接受了松动治疗。手法治疗组的平均（标准差）年龄为34.5（13.0）岁，松动治疗组为37.7（12.5）岁。16例受试者颈部疼痛少于1周，34例受试者疼痛持续1周至6个月，50例受试者疼痛超过6个月。78例受试者有颈部疼痛病史。31例受试者曾遭遇致伤机动车事故，28例受试者有其他类型的颈部轻微创伤。根据疼痛残疾指数衡量，两个治疗组在颈部疼痛病史或残疾程度方面无显著差异。
患者接受单次旋转手法治疗（高速、低幅度推力）或以肌肉能量技术形式进行的松动治疗。
在治疗前和治疗后即刻，记录颈椎在三个平面的活动范围，并采用101点数字评定量表（NRS - 101）对疼痛强度进行评定。测试前和测试后的测量均采用盲法进行。
结果显示，两种治疗均能增加活动范围，但手法治疗对疼痛强度的影响显著更大。85%接受手法治疗的患者和69%接受松动治疗的患者在治疗后即刻报告疼痛改善。然而，手法治疗组疼痛强度的降低幅度超过松动治疗组1.5倍以上（p = .05）。
本研究表明，对于机械性颈部疼痛患者，单次手法治疗在减轻疼痛方面比松动治疗更有效。两种治疗在增加颈部活动范围方面程度相似。需要进一步研究以确定手法治疗对机械性颈部疼痛的任何长期益处。
