Castaldo Matteo, Catena Antonella, Chiarotto Alessandro, Fernández-de-Las-Peñas César, Arendt-Nielsen Lars
Private practice, Poliambulatorio FisioCenter, Collecchio, Parma, Italy.
SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Pain Med. 2017 Apr 1;18(4):791-803. doi: 10.1093/pm/pnw266.
To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders.
Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses.
Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P = 0.021), larger pain area ( P = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P < 0.01). No changes in pressure pain thresholds were observed in either group after treatment ( P > 0.222).
The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises.
比较手法治疗和运动疗法对机械性颈痛和挥鞭样损伤相关疾病患者疼痛、相关功能障碍、活动范围及压痛阈值的短期影响。
22例机械性颈痛患者和28例挥鞭样损伤相关疾病患者参与研究。在基线期和干预后，由一名盲法评估者获取临床和身体指标结果，包括颈部疼痛强度、颈部相关功能障碍、疼痛区域，以及颈椎活动范围和斜方肌上部与胫骨前肌的压痛阈值。每位受试者接受6次手法治疗和特定的颈部运动。采用混合模型重复测量协方差分析（ANCOVA）进行分析。
与机械性颈痛患者相比，挥鞭样损伤相关疾病患者表现出更高的颈部相关功能障碍（P = 0.021）、更大的疼痛区域（P = 0.003）以及胫骨前肌更低的压痛阈值（P = 0.009）。调整后的ANCOVA显示，两组在任何结果上均无组间差异（所有P > 0.15）。临床结果和颈椎活动范围在时间上有显著的主效应，两组改善情况相似（所有P < 0.01）。治疗后两组的压痛阈值均未观察到变化（P > 0.222）。
当前临床试验发现，机械性颈痛和挥鞭样损伤相关疾病患者在多模式物理治疗干预后表现出相似的临床和神经生理反应，这表明尽管挥鞭样损伤相关疾病患者存在更明显的中枢敏化迹象，但这在短期内并不改变对手法治疗和运动疗法的反应。
