The subjects for this study will be recruited in the Sant Ildefons Rehabilitation Service in Cornellà de Llobregat (Barcelona), a public Primary Care centre of the Catalan Institut of Health. All patients referred to this service must be seen by a specialist in Physical Medicine and Rehabilitation before receiving treatment. All those diagnosed with chronic mechanical neck pain (of more than 3 months duration) and classified in Grade I or Grade II according to the classification of the Neck Pain Task Force [19 ] during that appointment will be referred to a physiotherapist, who will check whether they meet the other inclusion and exclusion criteria before offering them the opportunity to participate in the study.
The inclusion criteria will be: subjects diagnosed with chronic mechanical neck pain, who are over 18 years old and with a positive result in the flexion-rotation test corresponding to a rotation deficit. The flexion-rotation test (FRT) will be considered as positive if in a position of maximum cervical flexion, there is a difference of 10 degrees or more in the rotation in one direction compared to the contralateral direction, or if there is a cervical rotation of less than 32 degrees measured with the CROM [12 (link), 20 (link)].
The exclusion criteria will be: contraindication to manual therapy, post-traumatic neck pain or red flags according to Rushton et al. [13 ], an inability to maintain the supine position, use of pacemakers, an inability to perform the FRT, language difficulties that hinder understanding of informed consent or completion of the questionnaires necessary for this study, and subjects with litigation or lawsuits pending.
Patients who meet all inclusion criteria and none of the exclusion criteria will be offered the opportunity to participate in the study and provided with all the relevant information verbally and in writing. They will be told that they will be randomly distributed among the study groups and that each group will be treated with different techniques, all of which are appropriate for their condition, and that the objective of the study is to determine which technique produces the best results. The patients will not be informed about which group they have been assigned to in order to maintain blinding in this regard.
If they decide to participate they will be asked to sign an informed consent form and the same physiotherapist responsible for recruitment will perform the baseline assessment.
The inclusion criteria will be: subjects diagnosed with chronic mechanical neck pain, who are over 18 years old and with a positive result in the flexion-rotation test corresponding to a rotation deficit. The flexion-rotation test (FRT) will be considered as positive if in a position of maximum cervical flexion, there is a difference of 10 degrees or more in the rotation in one direction compared to the contralateral direction, or if there is a cervical rotation of less than 32 degrees measured with the CROM [12 (link), 20 (link)].
The exclusion criteria will be: contraindication to manual therapy, post-traumatic neck pain or red flags according to Rushton et al. [13 ], an inability to maintain the supine position, use of pacemakers, an inability to perform the FRT, language difficulties that hinder understanding of informed consent or completion of the questionnaires necessary for this study, and subjects with litigation or lawsuits pending.
Patients who meet all inclusion criteria and none of the exclusion criteria will be offered the opportunity to participate in the study and provided with all the relevant information verbally and in writing. They will be told that they will be randomly distributed among the study groups and that each group will be treated with different techniques, all of which are appropriate for their condition, and that the objective of the study is to determine which technique produces the best results. The patients will not be informed about which group they have been assigned to in order to maintain blinding in this regard.
If they decide to participate they will be asked to sign an informed consent form and the same physiotherapist responsible for recruitment will perform the baseline assessment.
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