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Zhang Y, Zheng G, Xu Y, et al. Stretching-Relaxation-Adjustment Manipulation versus Conventional Tuina for Non-Myelopathic Cervical Spondylosis: A Single-Blind Randomized Controlled Trial. J Pain Res. 2026 Aug 18;19:578490. doi: 10.2147/JPR.S578490. eCollection 2026. (Original study)
Abstract

PURPOSE: To systematically evaluate the effectiveness of the innovative massage technique-Stretching-Relaxation-Adjustment Manipulation (SRAM)-as a standalone intervention form for various types of non-myelopathic cervical spondylosis.

PATIENTS AND METHODS: A single-blind randomized controlled trial (RCT) was conducted, involving 156 patients with non-myelopathic cervical spondylosis. Patients were randomly assigned to the SRAM group (n=78) and the Tuina group (n=78). Outcome measures, including PainVision perceptual pain quantitative analysis, surface electromyography, the Improved Northwick Park Neck Pain Questionnaire, the Quality of Life Scale, the Zung Self-Rating Anxiety Scale, and the Zung Self-Rating Depression Scale, were measured at baseline and after the intervention.

RESULTS: Both groups showed significant within-group improvement from baseline in all outcomes (all p < 0.05). For the primary outcome (PV), the SRAM group demonstrated significantly greater improvement than the Tuina group for Pain Degree (between-group difference: 61.29 µA, 95% CI [29.43, 93.15], p < 0.001). However, no significant between-group difference was observed for Pain Rate (0.44%, 95% CI [-0.03, 0.89], p = 0.064). SRAM was also superior to Tuina in most secondary outcomes (except several domains (VT, GH, HT) of Quality of Life Scale dimensions).

CONCLUSION: Stretching-Relaxation-Adjustment Manipulation (SRAM), integrating Chinese Medicine and Western theories, was more effective than Tuina in improving most outcomes over a 4-week follow-up and may represent a short-term non-pharmacological option for non-myelopathic cervical spondylosis. Longer-term trials are needed to confirm sustained efficacy.

Ratings
Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
Comments from MORE raters

Physician rater

Very interesting. Easier reading if abbreviations and mnemonics explained at the beginning. I see a lot of spinal stenosis and this disorder is very distressing and can be dangerous. Nonoperative treatment is not for everyone. Neurological workup starting with a clinical exam is important before dismissing the need for surgery.

Rehab Clinician (OT/PT) rater

Expanding the specific regional breadth and depth of afferent sensory and pain modulation, in addition to vascular influences in affected neurosomatic elements, appears to yield more favourable clinical outcomes.
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