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Title: The effect of cervical spine manipulation compared to muscle energy technique on neck muscle activity and range of motion in asymptomatic participants
Authors: King, Sasha Lee 
Keywords: Muscle activity;Muscle energy technique;Range of motion;Spinal manipulative therapy
Issue Date: 10-Jun-2020
Background: Clinical evidence supports the use of spinal manipulative therapy (SMT)
and muscle energy technique (MET) for the treatment of cervical spine dysfunctions.
However, the physiologic mechanism behind their effectiveness is not well understood.
Joint dysfunctions are associated with hypertonicity of segmentally related muscles and
can occur in both symptomatic and asymptomatic individuals. Neck pain (NP) has been
associated with cervical muscle dysfunction, due to the presence of altered muscle
activity and impaired kinematics, demonstrated in NP patients. This includes the upper
trapezius and posterior cervical muscles, whose dysfunction can be a source of NP.
Spinal manipulative therapy and MET are mechanical interventions, that when applied to
joint dysfunctions, produce neurophysiological changes, specifically the modulation of
muscle activity and improved range of motion (ROM). However, the demonstration and
comparison of the neurophysiological effects of SMT and MET in the neck, and its related
musculature, are unknown.
Aim: The aim is to determine the effect of cervical spine manipulation compared to MET
on neck muscle activity and range of motion in asymptomatic participants.
Method: This is a quasi-experimental study utilising a pre-test, post-test design, which
employed 50 asymptomatic participants aged between 18 – 35 years of both genders and
all races. The participants were randomly allocated into one of two treatment groups.
Group 1 received cervical spine manipulation (CSM) and Group 2 received MET. Before
and after the respective interventions, resting upper trapezius and posterior cervical
electromyographic muscle activity and the cervical spine range of motion (CROM) (lateral
flexion and extension) were measured. The IBM SPSS version 24 was used to analyse
the data. The intra-group changes were compared pre- and post-intervention using paired
Wilcoxon signed ranks tests. Median changes between pre- and post- were compared
between the two treatment groups using Mann-Whitney U tests. A p value < 0.05 was
considered as statistically significant.
Results: None of the demographic or background variables differed significantly between
the two groups. Both treatments had an effect, although not all significant, involving mostly reductions in resting electromyographic muscle activity and improvements in
CROM. This was significant for the right posterior cervical muscles in the SMT group (p
= 0.012) and for ROM in both groups (p < 0.001). No evidence of a difference in treatment
effect was found.
Conclusion: The results of this study suggest that SMT and MET mostly decrease resting
neck muscle activity and improve CROM. Muscle energy technique may possibly be
equally as effective as CSM. Concurrent changes in both outcomes suggest that more
than one physiologic mechanism may likely explain these effects.
Dissertation submitted in partial compliance with the requirements for the Master’s
Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2019.
Appears in Collections:Theses and dissertations (Health Sciences)

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