Efficacy of conventional multimodal therapy in the management of non-specific cervical pain in young people aged 18 to 24 years

Authors

DOI:

https://doi.org/10.47197/retos.v71.112927

Keywords:

Neck pain, physical therapy modalities, transcutaneous electric nerve stimulation, massage, pain perception , musculoskeletal pain, cervical vertebrae

Abstract

Introduction. Non-specific neck pain is a recurrent public-health issue that affects 48 %–78 % of university students, undermining both their well-being and academic performance. Although various physiotherapeutic techniques can relieve these symptoms, comparative evidence on their effectiveness in this population remains scarce.

Objective. This study compared the efficacy of transcutaneous electrical nerve stimulation (TENS) and massage therapy, each embedded in a multimodal protocol, for treating non-specific neck pain in university students aged 18–24 years.

Methodology. A longitudinal randomised experimental design was applied. Eighteen participants were allocated to one of three groups: (1) standard multimodal therapy; (2) multimodal + TENS; and (3) multimodal + massage therapy. All protocols incorporated thermotherapy and stretching. Pain intensity (Visual Analogue Scale, VAS), neck disability (Neck Disability Index, NDI) and craniovertebral angle were assessed before and after the intervention.

Results. All groups showed reductions in pain intensity, decreases in NDI scores and increases in craniovertebral angle. However, no statistically significant differences emerged among the treatments, indicating that none outperformed the others.

Discussion. The evidence supports incorporating electrophysical or manual agents as adjuncts to multimodal interventions for managing cervical pain.

Conclusions. Adding TENS or massage therapy to a multimodal regimen yields benefits comparable to those of the standard protocol for managing non-specific neck pain in university students. Treatment choice can therefore be based on resource availability and patient preference. Replication with larger samples and longer follow-up is recommended to confirm these findings.Principio del formulario

Author Biographies

Sebastián Andrés Astorga Verdugo, Universidad Autónoma de Chile

Departamento de Kinesiología

Soledad Patricia González Silva, Universidad Autónoma de Chile, Chile

Physical Therapy, Master in Orthopedic Manual Therapy.

References

Aycart Acosta, Christopher Adrian, Guaman Macias, Genessis Jaritza, Villacrés Caicedo, Sheyla Eliza-beth, Rivera Malan, Emily Kristin, Odila Grijalva, Isabel, & Chang Catagua, Eva de Lourdes. (2021). Prevalencia de las alteraciones de la movilidad cervical en los estudiantes de una uni-versidad. Vive Revista de Salud, 4(12), 127-136. Epub 00 de diciembre de 2021.https://doi.org/10.33996/revistavive.v4i12.113

Bakhtadze, M., Vernon, H., Zakharova, O. B., Kuzminov, K., & Bolotov, D. A. (2015). The Neck Disability Index–Russian Language version (NDI-RU). Spine (Philadelphia, Pa. 1976)/Spine, 40(14), 1115-1121. https://doi.org/10.1097/brs.0000000000000880

Bervoets, D. C., Luijsterburg, P. A. J., Alessie, J. J. N., Buijs, M. J., & Verhagen, A. (2015). Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal Of Physiotherapy, 61(3), 106-116. https://doi.org/10.1016/j.jphys.2015.05.018

Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, George SZ. Desentrañar los mecanismos de la terapia manual: modelando un enfoque. J Orthop Sports Phys Ther. 2018 Jan;48(1):8-18. doi: 10.2519/jospt.2018.7476. Epub 2017 15 de octubre. PMID: 29034802.

Bijur, PE, Silver, W. y Gallagher, EJ (2001), Fiabilidad de la escala analógica visual para la medición del dolor agudo. Medicina de Emergencia Académica, 8: 1153-1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x

Blanpied, P., Gross, A., Elliott, J. M., Devaney, L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck Pain: Revision 2017. The Journal Of Orthopaedic And Sports Physical Thera-py/Journal Of Orthopaedic And Sports Physical Therapy, 47(7), A1-A83. https://doi.org/10.2519/jospt.2017.0302

Brosseau, L., Wells, G. A., Tugwell, P., Casimiro, L., Novikov, M. L., Loew, L., Sredic, D., Clément, S., Gravelle, A., Hua, K., Kresic, D., Lakic, A., Ménard, G., Côté, P., Leblanc, G., Sonier, M., Cloutier, A., McEwan, J., Poitras, S., . . . Cohoon, C. (2012). Ottawa panel evidence-based clinical practice guidelines on therapeutic massage for neck pain. Journal Of Bodywork And Movement Thera-pies, 16(3), 300 325. https://doi.org/10.1016/j.jbmt.2012.04.001

Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., & Flynn, T. W. (2008). Neck pain. Journal Of Orthopaedic & Sports Physical Therapy, 38(9), A1-A34. https://doi.org/10.2519/jospt.2008.0303

Climent, J. M., Barberá, J. M. C., Fenollosa, P., Vázquez, P. F., & Del Rosario, F. M. M. (2012). Cervicalgia. Rehabilitación intervencionista: fundamentos y técnicas. (pp. 50-59).

Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015 Feb;90(2):284-99. doi: 10.1016/j.mayocp.2014.09.008. PMID: 25659245.

Escortell-Mayor, E., Riesgo-Fuertes, R., Garrido-Elustondo, S., Barco, Á. A., Díaz-Pulido, B., Blanco‐Díaz, M., & Bejerano-Álvarez, E. (2011). Primary care randomized clinical trial: Manual therapy ef-fectiveness in comparison with TENS in patients with neck pain. Manual Therapy, 16(1), 66-73. https://doi.org/10.1016/j.math.2010.07.003

Gallego‐Izquierdo, T., Arroba-Díaz, E., García-Ascoz, G., Del Alba Val-Cano, M., Pecos‐Martín, D., & Cano‐de‐la‐Cuerda, R. (2020). Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study. International Journal Of Environmen-tal Research And Public Health/International Journal Of Environmental Research And Public Health, 17(18), 6521. https://doi.org/10.3390/ijerph17186521

Gao Y, Chen Z, Chen S, Wang S, Lin J. Risk factors for neck pain in college students: a systematic review and meta-analysis. BMC Public Health. 2023 Aug 8;23(1):1502. doi: 10.1186/s12889-023-16212-7. PMID: 37553622; PMCID: PMC10408143.

Gerardo, D. G. L., Luis, A. M. J., Gerardo, D. C. L., Gerardo, D. G. L., Luis, A. M. J., & Gerardo, D. C. L. (s. f.). Síndrome miofascial cervical por comunicación escrita en teléfono celular. https://www.scielo.org.mx/scielo.php?pid=S1870-72032018000200108&script=sci_arttext

Girden, E. R. (1992). ANOVA: Repeated measures. Newbury Park, CA: Sage Publications.

Glass, G. V., Peckham, P. D., & Sanders, J. R. (1972). Consequences of failure to meet assumptions un-derlying the fixed effects analyses of variance and covariance. Review of Educational Research, 42(3), 237–288. https://doi.org/10.3102/00346543042003237

Gross , A., Forget, M., St George, K., Fraser, M. M. H., Graham, N., Perry, L., Burnie, S. J., Goldsmith, C. H., Haines, T., & Brunarski, D. (2012). Patient education for neck pain. The Cochrane Library, 3. https://doi.org/10.1002/14651858.cd005106.pub4

Gross, A. R., Lee, H., Ezzo, J., Chacko, N., Gelley, G., Forget, M., Morien, A., Graham, N., Santaguida, P. L., Rice, M., & Dixon, C. (2024). Massage for neck pain. Cochrane Library, 2024(2). https://doi.org/10.1002/14651858.cd004871.pub5

Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteo-arthritis Pain (ICOAP). Arthritis care & research, 63 Suppl 11, S240–S252. https://doi.org/10.1002/acr.20543

Harwell, M. R., Rubinstein, E. N., Hayes, W. S., & Olds, C. C. (1992). Summarizing Monte Carlo results in methodological research: The one- and two-factor fixed effects ANOVA cases. Journal of Educa-tional Statistics, 17(4), 315–339. https://doi.org/10.3102/10769986017004315

Hidalgo, B., Hall, T., Bossert, J., Dugeny, A., Cagnie, B., & Pitance, L. (2018). The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. Journal Of Back And Musculoskeletal Rehabilitation (Print), 30(6), 1149-1169. https://doi.org/10.3233/bmr-169615

Hoy, D., March, L., Woolf, A., Blyth, F., Brooks, P., Smith, E., Vos, T., Barendregt, J., Blore, J., Murray, C., Burstein, R., & Buchbinder, R. (2014). The global burden of neck pain: estimates from the Glob-al Burden of Disease 2010 study. Annals Of The Rheumatic Diseases, 73(7), 1309-1315. https://doi.org/10.1136/annrheumdis-2013-204431

Jiménez Murillo, L., & Montero Pérez, F. J. (2021). Cervicalgia. Compendio de Medicina de Urgencias: Guía Terapéutica de Bolsillo (5a ed.) (pp. 443-444). Elsevier.

Johnson, M. I., Paley, C. A., Jones, G., Mulvey, M. R., & Wittkopf, P. G. (2022). Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a sys-tematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open, 12(2), e051073. https://doi.org/10.1136/bmjopen-2021-051073

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj‐Khodaei, M., Sullman, M. J. M., Ko-lahi, A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Muscu-loskeletal Disorders, 23(1). https://doi.org/10.1186/s12891-021-04957-4

Kroeling, P., Gross, A., Graham, N., Burnie, S. J., Szeto, G., Goldsmith, C. H., Haines, T., & Forget, M. (2013). Electrotherapy for neck pain. Cochrane Library, 2013(8). https://doi.org/10.1002/14651858.cd004251.pub5

Lau, H. M. C., Chiu, T., & Lam, T. (2010). Measurement of craniovertebral angle with Electronic Head Posture Instrument: Criterion validity. Journal Of Rehabilitation Research And Development, 47(9), 911. https://doi.org/10.1682/jrrd.2010.01.0001

Rani, B., Paul, A., Chauhan, A. K., Pradhan, P., & Dhillon, M. S. (2023). Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis. Indian Journal Of Orthopae-dics. https://doi.org/10.1007/s43465-023-00820-x

Rasmussen-Barr, E., Bohman, T., Hallqvist, J., Holm, L. W., & Skillgate, E. (2013). Do physical activity level and body mass index predict recovery from persistent neck pain in men and women of working age? A population-based cohort study. European Spine Journal, 22(9), 2077-2083. https://doi.org/10.1007/s00586-013-2801-x

Safiri, S., Kolahi, A. A., Hoy, D., Buchbinder, R., Mansournia, M. A., Bettampadi, D., Ashrafi-Asgarabad, A., Almasi-Hashiani, A., Smith, E., Sepidarkish, M., Cross, M., Qorbani, M., Moradi-Lakeh, M., Woolf, A. D., March, L., Collins, G., & Ferreira, M. L. (2020). Global, regional, and national bur-den of neck pain in the general population, 1990-2017: systematic analysis of the Global Bur-den of Disease Study 2017. BMJ (Clinical research ed.), 368, m791. https://doi.org/10.1136/bmj.m791

Sánchez, L. G. A., De la Casa Almeida, M., Roldán, J. R., Manzano, A. R., Valero, R. M., & Serrano, C. S. (2017). Eficacia ante el dolor y la discapacidad cervical de un programa de fisioterapia indivi-dual frente a uno colectivo en la cervicalgia mecánica aguda y subaguda. Atención Primaria, 49(7), 417-425. https://doi.org/10.1016/j.aprim.2016.09.010

Sheikhhoseini, R., Shahrbanian, S., Sayyadi, P., & O’Sullivan, K. (2018). Effectiveness of therapeutic exercise on forward head posture: A systematic review and meta-analysis. Journal of Manipula-tive and Physiological Therapeutics, 41(6), 530–539. https://doi.org/10.1016/j.jmpt.2018.02.002

Shin, H., Kim, S., Hahm, S., & Cho, H. (2020). Thermotherapy Plus Neck Stabilization Exercise for Chronic Nonspecific Neck Pain in Elderly: A Single-Blinded Randomized Controlled Trial. In-ternational Journal Of Environmental Research And Public Health/International Journal Of En-vironmental Research And Public Health, 17(15), 5572. https://doi.org/10.3390/ijerph17155572

Skillgate, E., Pico-Espinosa, O. J., Côté, P., Jensen, I., Viklund, P., Bottai, M., & Holm, L. W. (2020b). Ef-fectiveness of deep tissue massage therapy, and supervised strengthening and stretching exer-cises for subacute or persistent disabling neck pain. The Stockholm Neck (STONE) randomized controlled trial. Musculoskeletal Science & Practice/Musculoskeletal Science And Practice, 45, 102070. https://doi.org/10.1016/j.msksp.2019.102070

Stevens, J. P. (2009). Applied multivariate statistics for the social sciences (5th ed.). New York, NY: Routledge.

Wang, V. C., & Mullally, W. J. (2020). Pain Neurology. The American journal of medicine, 133(3), 273–280. https://doi.org/10.1016/j.amjmed.2019.07.029

Yesil, Hilal MD; Hepguler, Simin MD; Dundar, Umit MD; Taravati, Sahel MD; Isleten, Banu MD. Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improv-ing Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study. SPINE 43(20):p E1174-E1183, October 15, 2018. | DOI: 10.1097/BRS.0000000000002663

Published

2025-08-19

How to Cite

Astorga Verdugo, S. A., Rojas Cabezas, G., González Silva, S. P., Sáez Selaive, R., Martinez Araya, A., Lara Arriagada, H., … Gaete Tapia, H. (2025). Efficacy of conventional multimodal therapy in the management of non-specific cervical pain in young people aged 18 to 24 years. Retos, 71, 344–357. https://doi.org/10.47197/retos.v71.112927

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Original Research Article