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Does improvement towards a normal Cervical Sagittal configuration aid in the management of Cervical Myofascial Pain Syndrome

PUBLISHED: BMC Musculoskelet Disord. 2018 Nov 12;19(1):396. doi: 10.1186/s12891-018-2317-y. Pub Med: https://www.ncbi.nlm.nih.gov/pubmed/30419868

TITLE: Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomised controlled trial.

AUTHORS: Moustafa IM, Diab AA, Hegazy F, Harrison DE.

BACKGROUND: There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome.

However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion.

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METHODS: A randomised controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device.

Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up.

Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA.

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RESULTS: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001).

Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark.

Thus, all variables were significantly different between groups favouring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001).

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CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected chronic myofascial cervical pain syndrome (CMCPS) outcomes at long term follow up.

We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings.

 

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