Efeito da manipulação da região supra-hioidea e da língua na dor, mobilidade e incapacidade cervical de indivíduos com cervicalgia inespecífica crônica: ensaio clínico randomizado duplo cego

Abstract

Introduction: Neck pain is described as an unpleasant sensory and emotional experience that begins at the upper nuchal line and continues to the level of the scapular spine. Although it may be associated with degenerative processes and other pathologies, often the local tissue that produces pain remains unidentified in these cases neck pain may be considered non-specific (NS-NP). Thus, this condition may be related to functional anatomic imbalances between structures that interconnect with the cervical region, such as the mandible, tongue and hyoid bone. Objective: To evaluate the effect of manipulation of the suprahyoid region and tongue on cervical pain, mobility and disability in individuals with chronic NS-NP. Methods: This was a randomized, double-blind controlled trial consisting of 40 individuals with chronic NS-NP, randomly divided into two groups: i) Control - received multimodal treatment (manual therapy and exercise program), ii) Experimental - received the same treatment as the control group plus a protocol for manipulation of the suprahyoid region and tongue. The treatment was performed twice a week for 3 weeks (total of 6 sessions). The primary endpoint evaluated was cervical pain, as assessed by the Numeric Pain Rating Scale (NPRS), and the secondary end points: the intensity of Pain Catastrophizing Scale (PCS) about cervical pain, the degree of neck disability, the patient's specific functional scale, cervical mobility, amplitude of mouth opening, and TMJ-related symptoms. Possible differences between groups were tested using linear mixed models considering differences between groups and intention to treat. Paired T-test was used for intragroup analyzes. Results: Between the groups, only the right neck rotation movement and the PCS showed significant differences between the groups (p <0.01). In the intragroup analysis, significant differences (p <0.01) were found for all clinical outcomes for the experimental group. For the control group, with the exception of neck range of motion, all clinical outcomes showed significant post treatment differences (p <0.05). Conclusions: In this study it was demonstrated that the addition of suprahyoid and tongue manipulation to a multimodal intervention for the treatment of patients with chronic nonspecific neck pain can contribute to the improvement of cervical rotation as well as catastrophic thinking about pain.