Moustafa IM, Diab AA, Hegazy F, et al. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskelet Disord. 2018 Nov 12;19(1):396. doi: 10.1186/s12891-018-2317-y. (Original study)

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.

METHODS: A randomized 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.

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). 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. 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 favoring 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).

CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings.

TRIAL REGISTRATION: Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

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

Physician rater

I gave up reading the article after the first 2 paragraphs. It's written in such poor English as to render it incomprehensible.

Physician rater

This is an RCT of correction of cervical saggital alignment using a denneroll cervical traction device in patients with defined cervical saggital posture abnormalities complicated by chronic cervical myofascial pain syndrome. The outcomes were neck pain intensity, neck disability, pressure pain thresholds and cervical range of movement with a 10-week treatment period and follow-up at 10 weeks and 1 year. Both treatment groups received integrated neuromuscular inhibition technique, only one group received denneroll cervical traction. 120 patients entered the study and at 10 weeks both groups improved with the only differences being in pressure pain thresholds and cervical range of movement favouring the cervical traction group. However, at 1-year follow-up, the control group regressed to baseline measurements with a significant benefit for the active treatment group for all outcome measures, which suggests a significant and durable benefit.

Physician rater

A complicated musculoskeletal intervention that may mean more to physical therapists, chiropractors and osteopaths. It wasn't effective immediately after treatment (at 10 weeks), but was at 1 year. Is that credible? I think I would want to see replication before referring for this specific treatment.

Physician rater

This is an interesting option for relatively young patients (the study group was in their early thirties).

Physician rater

This was interesting but of limited relevance in my work life as I think PTs help with most problems. If not in getting better, than at least coping better.

Rehab Clinician (OT/PT) rater

It is a study examining the denneroll traction effect.
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