Analysis of the evolution of patients with Chronic Cervicalgia as a function of the Treatment of Choice.

INTERVENTION: E02.760.169.063.500.387 H02.010.625 HP3.073.433.101 Protocol "Manual Therapy": (n=22) composed of three techniques based on scientific evidence. 1. High Thoracic Manipulation on T4 21 22 2. Cervical Articular Mobilization (2 Hz, 2 minutes x 3 series) 9 3. Suboccipital Inhibition (3 minutes) Protocol "Therapeutic Exercise": (n= 24) this protocol will be taught to patients in the first session and should be done once a day during the three weeks of treatment. It will be reinforced by the physiotherapist in each of the three individual sessions. WEEK 1: Exercises 1 and 2. 1. Cervical cervical flexion (FCC) in supine position with towel in the posterior area of ??the neck. (3 sets, 10 repetitions, 10 seconds of contraction each repetition with 10 seconds of rest). 2. FCC sitting. (3 sets, 10 repetitions, 10 seconds of contraction each repetition with 10 seconds of rest) WEEK 2: Exercises 1, 2, 3 and 4. 3. Co‐contraction of deep and superficial neck flexors in supine decubitus. (10 repetitions, 10 seconds of contraction with 10 seconds of rest). 4. Co‐contraction flexors, rotators and inclines. Cranial nerve flexion and I ask him to tilt, rotate and look towards the same side while he opposes a resistance with his hand. (10 repetitions, 10 seconds of contraction with 10 seconds of rest). WEEK 3: Exercises 1, 2, 3, 4, 5 and 6. 5. Eccentric for extenders. With the patient seated, neutral position I go to cervical extension, I ask for the cranial‐cervical flexion and then I ask for cervical flexion. (10 repetitions). 6. Eccentric for flexors. The patient will be in quadrupedal position and from here, and with a neutral position, I will go to the neck flexion, then the cranio‐cervical flexion, and maintaining that posture I will extend the neck and then finally lose the cranial‐cervical flexion. (10 repetitions). Protocol "Control": (n= 20) The patient will be placed in the supine position, the physiotherapist will lay his hands without therapeutic CONDITION: C23.888.592.612.553 Cervicalgia ; C23.888.592.612.553 SECONDARY OUTCOME: Secondary outcomes are not expected INCLUSION CRITERIA: Current neck pain. Neck pain continued for at least the last twelve weeks. PRIMARY OUTCOME: Cervical Disability Index (IDC). The IDC is a self‐assessment instrument of the specific functional status of subjects with neck pain with 10 elements that include pain, personal care, weight gain, reading, headache, concentration, work, driving, sleeping, and leisure. Each section is rated on a scale of 0 to 5, where 0 means "painless" and 5 means "the worst pain imaginable." The points obtained are added to a total score. The questionnaire was interpreted as a percentage. The disability categories for IDC are 0% ‐8%, without disability; 10% ‐28%, mild; 30% ‐48%, moderate; 50% ‐64%, serious; and 70% ‐100%, complete.; ; These variables will be measured in the pre‐evaluation, first evaluation (week 1), second evaluation (Week 4, short term) and third evaluation (Week 12, medium term). General Stability Index (OBI). We obtained this measurement through a dynamic stabilometric platform (Balance System â„¢ SD, Biodex, New York‐USA). The General Stability Test was applied in level of difficulty 4, with 1 being the highest and 8 the least difficulty. The platform is free in the anterior‐posterior and medial‐lateral axes, it allows obtaining the OBI through the deviations with respect to a zero point established before the test, with the platform stable. Two 20‐second tests were performed, with one minute between each test, with the; score of the second test that was chosen for the statistical analysis.; ; These variables will be measured in the pre‐evaluation, first evaluation (week 1), second evaluation (Week 4, short term) and third evaluation (Week 12, medium term). Pressure Pain Threshold (UDP). The UDP was recorded in Newton / cm2 using digital algometer (Force Ten â„¢ ‐Model FDX, Wagner, Greenwich‐USA) with a surface area of ??round tip of 1cm2. The measurement was taken on the spinous process of vertebra C2, the evaluator gradually and gradually increasing the pressure until the patient indicated through a "Yes" when the pain or discomfort appeared. Three measurements were made, obtaining an average value of these three measurements for the statistical analysis.; ; These variables will be measured in the pre‐evaluation, first evaluation (week 1), second evaluation (Week 4, short term) and third evaluation (Week 12, medium term). Visual Analog Scale (VAS) for pain. The subjects participating in the study indicated the intensity of their pain by means of the EVA of 100mm, they had to signal in a horizontal line of 100mm where they would place their pain, being 0mm "no pain" and the 100mm would be "the worst pain imaginable".; ; These variables will be measured in the pre‐evaluation, first evaluation (week 1), second evaluation (Week 4, short term) and third evaluation (Week 12, medium term).