Comparison of Upper Cervical MWM Versus Cervicothoracic Junction Manipulation on Neck Proprioception in Mechanical Neck Pain

Abstract

Background: Mechanical neck pain (MNP) is a prevalent musculoskeletal disorder characterized by pain and disability associated with altered cervical proprioception. Manual therapy interventions such as mobilization with movement (MWM) and cervicothoracic junction (CTJ) manipulation are commonly used, yet their comparative effects on proprioceptive function remain unclear, representing a critical knowledge gap in rehabilitation strategies. Objective: To compare the effectiveness of upper cervical MWM and CTJ manipulation in improving proprioception, pain intensity, cervical range of motion (ROM), and disability in patients with chronic mechanical neck pain. Methods: A single-blind randomized controlled trial was conducted with 68 participants aged 18–45 years with chronic MNP, randomized into two equal groups receiving either MWM or CTJ manipulation combined with conventional physical therapy three times weekly for four weeks. Outcomes included joint position error (JPE), Visual Analog Scale (VAS) for pain, Neck Pain and Disability Scale (NPDS), and cervical ROM. Data were analyzed using non-parametric tests with a significance level of p ≤ 0.05. Results: Both interventions significantly improved all outcomes (p < 0.001). However, MWM produced superior reductions in JPE (median reduction 6° vs 3°, p < 0.001), greater pain relief (median VAS reduction 6 vs 4 points, p < 0.001), larger NPDS improvements (36 vs 48 points, p < 0.001), and greater ROM gains (7–10° vs 3.5–5°, p < 0.001). Conclusion: Upper cervical MWM was more effective than CTJ manipulation in improving proprioception, pain, ROM, and disability in individuals with chronic MNP, supporting its preferential use in clinical practice.