Abstract
M.Tech. (Chiropractic)
Mechanical neck pain is the general term that refers to any type of pain within the
cervical spine caused by placing abnormal stress and strain on muscles of the
vertebral column. This is a very common musculo-skeletal disorder within the
population, with 45% to 54% reporting neck pain at any given time of their lives
(Martinez-Segura, Fernandez-de-las-Penas, Ruiz-Saez, Lopez-Jimenez and
Rodriguez-Blanco, 2006). A vast majority of individuals do not experience a
complete resolution of symptoms and as such often becomes a chronic pain
(Cote, Cassidy, Carol and Kristman, 2004). Chronic pain by definition is one
which is present for a period longer than six weeks (Segen, 2002).
Accompanying the neck pain is often a limited or reduced range of motion within
the cervical spine. Some studies suggest that hyper-tonicity and strain of the
supporting muscles within this region due to an altered biomechanics also
contributes to the pain and dysfunction (Armstrong, McNair and Williams, 2005
and Dall’Alba et al. 2001). One of the major muscle groups involved in this is the
posterior cervical musculature. This is a general term used to describe the
muscles located on the posterior aspect of the neck and includes longissimus
capitis, semispinalis capitis, semispinalis cervicis, rotatores and multifidus (Dalley
and Moore, 2006).
Chiropractic adjustment therapy has been shown to have many effects of the
body and especially the cervical spine including a decrease in pain perception
and muscle hypertonicity (Kirkaldy-Willis and Cassidy, 1985), an increase in
cervical range of motion (Bergmann, Peterson and Lawrence, 1993) as well as
an increased skin pain tolerance level (Terrett and Vernon, 1984). Dry needling
therapy has also been proven to have similar effects, including, a reduction in
pain perception, an increase in range in motion of the specific linked
biomechanical section, and most importantly a reduction of muscle tension
(Travell and Simons, 1993). The purpose of this study was to see if a synergistic
effect of the two above mentioned treatments would occur when combined under
one treatment protocol.
The aim of this study was to determine how effectively cervical adjustment
therapy, dry needling of the posterior cervical muscles and a combination of the
two treatments was in treating chronic mechanical neck pain with regards to pain,
disability and cervical spine range of motion over a three week period.
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 word of mouth as
well as with the use of advertisements that were placed around the respective
campuses of the University of Johannesburg.
Thirty participants who presented with chronic mechanical neck pain, volunteered
for this comparative study. This trial is a randomised controlled clinical trial which
used convenience sampling. Group A received a combination treatment of dry
needling and cervical manipulation. Group B received cervical adjustment only
while group C received dry needling of the posterior cervical musculature alone.
participants were treated for a total of 6 visits. Subjective and objective
measurements were done at visits 1, 4 and a final visit 7 during which only
measurements were taken.
These effects are based on Vernon-Mior Pain and Disability Index, Numerical
Pain Scale Rating, Pressure Algometer as well as Cervical Spine Range of
Motion measuring instrument (CROM).
The results of this trial indicated that all three treatments were effective in treating
chronic mechanic neck pain. While one treatment was not statistically more
effective than the other the dry needling and cervical manipulation alone
produced a superior result. While combining these treatments was effective the
synergistic effect one would expect was not as evident.