Myofascial Pain and Treatment

Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with non-specific chronic neck pain: A pragmatic randomized controlled trial

Neck pain is a common condition with a reported prevalence ranging from 22% to 70% among the general population, and it is more common in women than in men (Blanpied et al., 2017). Neck pain, as well as low back pain, is the leading cause of disability measured in years lived with disability (L. Carroll, 2000; Hogg-Johnson et al., 2008; Palmer et al., 2001; Vos et al., 2016). Studies show that up to 54% of people will suffer from cervical pain at some point in their lives, and almost all of them will still have symptoms during the first five years after the first episode of pain (L. J. Carroll et al., 2009; Côté et al., 2004; Wright et al., 1999). Consequently, neck pain results in major health costs, mainly due to absenteeism from work (Blanpied et al., 2017; Bronfort et al., 2001).

Since the cause of pain is unknown in most cases, neck pain is labeled as non-specific chronic neck pain (NCNP) (Hidalgo et al., 2017). However, several factors may contribute to NCNP, such as mechanical and biological aspects (age, gender, history of trauma and musculoskeletal diseases), and other factors related to psychosocial characteristics (physical activity, beliefs, expectations and job satisfaction). These factors are known as having an influence on the transition from acute to chronic pain (Bronfort et al., 2001; Curatolo et al., 2011; Hidalgo et al., 2017).

There are several NCNP management options, including manual therapy, conventional physiotherapy, drug treatment, exercise, pain education, among others (Borghouts et al., 1999; Cleland et al., 2005; Gross et al., 2015; Lau et al., 2011). Manual therapy is a widely used approach, and there has been a significant increase in the number of clinical trials investigating this practice in recent years (Cross et al., 2011; Miller et al., 2010; Vincent et al., 2013). Although there is moderate evidence to support the use of manipulative treatments for cervical pain, the literature shows it is more effective than no intervention or placebo treatment (González-Iglesias et al., 2009; Gross et al., 2010; Schwerla et al., 2008).

A combination of several treatment modalities is referred as multimodal care. Combined manual therapy and exercises have also led to the improvement of patient outcomes when compared to manual therapy or exercises alone (Walker et al., 2008).

Osteopathic manipulative treatment (OMT) is a noninvasive approach that incorporates manual diagnostic and treatment techniques in accordance to pre-established principles, such as interrelation between structure and function, intrinsic self-regulation and homeostasis, and concept of body unity (Kuchera, 2007).

Current evidence indicates that OMT is more effective than placebo treatment or no treatment for pain and function (Franke et al., 2015; Hamilton et al., 2007; Mandara et al., 2010). A recent systematic review (Franke et al., 2015) demonstrated clinically relevant effects of OMT for reducing pain in patients with NCNP. However, these studies have not investigated the effectiveness and impact of OMT combined with exercises on NCNP patients.

Therefore, the objective of this clinical trial was to assess the effectiveness of osteopathic manipulative treatment combined with stretching and strengthening exercises on the cervical region for conservative treatment of individuals with NCNP.