#009- Articles on Neck Pain and Ankle Sprain

Covered Topics:

1. Combining Cryotherapy and Mobilization Decreases Disability and Neck pain.

2. PNF Stretching+TENS improve pain, balance, proprioception, strength, and range of motion after Ankle Sprain.

Estimated reading time: 4 minutes, 33 seconds.


Combining Cryotherapy and Mobilization Decreases Disability and Neck pain.

This RCT (PEDro Score 7/10) tested the effectiveness of cryotherapy combined with mobilization, against the same program but with added stretching exercise for participants to do at home.


Cryotherapy: A stream of cold nitrogen vapor at 130 °C was applied during 3 minutes to the muscles on both sides of the cervical spine and to the muscles on both sides of the shoulder girdle.

Mobilization: 20 minute/session, 2 sessions/week for 5 weeks.

Osteopathic based mobilization from a supine position, 6 types of mobilization was preformed 3 times. See full program (Here)

Stretching: 3 repetitions, 30 second hold, 5 times/week for 5 weeks. Stretching included cervical flexors, extensors, rotators and side bending muscles see. Full program (Here)


60 participant in total.

Group 1 (CM) cryotherapy+mobilization, 30 participants. Group 2 (CMS) cryotherapy+ mobilization+home stretching program 30 Participants.

  • Both groups showed improvement in pain after 5 weeks.
  • But, the CM group showed better improvement than the CMS group
  • Also, CM showed better results than CMS group in Neck disability index, patient-specific functional scale (PSFS) and global rating of the change scale (GROC).

What these results indicate:

  • First, keep in mind, this trial was done on participants that had only non-specific neck pain, meaning that they excluded patients with cervical disc prolapse, stenosis, etc.
  • Second, adding cryotherapy to your treatment plan may result in better outcomes, cryotherapy slows down the circulation, which in turn help reduce inflammation and muscle spasm, allowing for the followed technique to be preformed without pain.
  • Third, prescribing neck pain patients, a home-based stretching program is a common practice, maybe with the results of this trial and its limitations in mind, doing that is not necessary for every patient.

PNF Stretching+TENS improve pain, balance, proprioception, strength, and range of motion after Ankle Sprain.

The aim of this RCT was to investigate the effect of PNF stretching alone and combined with TENS after ankle sprain injuries.

3 groups with a total of 60 participant:

PNF stretching (20 Participant) was done using “Hold relax technique” on triceps sural muscle 4 times/session, the participant was asked to perform isometric triceps sural muscle contraction for 20 seconds, after which the therapist waited for 4 seconds before resuming the triceps sural muscle stretch, slowly and continuously, until the participant reported strong but tolerable discomfort and began to feel a stretching sensation, then the stretch was maintained for approximately 30 seconds longer. 4 sessions/week for 3 weeks.

PNF+TENS (20 participant), TENS protocol: 2 4×8 cm electrodes strapped on the triceps sural muscle, one was placed 5 cm distal to the popliteal fossa, and the other was placed 5 cm distal to the proximal electrode, directly on the triceps sural muscle of the affected leg, TENS device unit was adjusted to deliver a biphasic current with a symmetrical waveform at 50 Hz for 15 seconds, tuned for a 3-second ramp up time, and a 30-second rest time with a 250-microsecond pulse duration. The intensity was set to the maximum tolerance limit by each participant and was performed 4 times per session on the affected lower limb. Session took 30 minutes for both PNF and TENS. 4 sessions/week for 3 weeks.

Control group (20 participant), no intervention, only assessment.


PNF+TENS showed better improvements compared to PNF alone in:

  1. Pain as measured by visual analog scale (VAS)
  2. Balance in anterior, posterior, posterolateral, and posteromedial directions, as measured by Star Excursion Balance Test (SEBT).
  3. Flexibility as measured by knee to wall test.
  4. Proprioception in dorsiflexion and planter flexion as measured by a digital dual inclinometer.
  5. Dorsiflexion ROM as measured by standard universal goniometer.
  6. Isometric strength of dorsiflexors and planter flexors as measured by strength dynamometer.

Note that

  • The PNF only group did improve the outcomes, but adding TENS increased the benefits of PNF.
  • The results were sustained even 2 weeks (5th week) after the end of the treatment.
  • All participants in this trial were male participants.

Final Note

  • The 2 articles included in this report combined to interventions and showed a promising result of these interventions, this should say something when therapists argue the evidence of one intervention over the other, clinically speaking and from the many, many research articles I read, using a multi-technique approach is usually the way to go, nonetheless, this does not mean combining any two techniques is a good idea, your clinical reasoning and your ability to keep up with evidence is the key to the best treatment plan.


  1. Cryotherapy With Mobilization Versus Cryotherapy With Mobilization Reinforced With Home Stretching Exercises in Treatment of Chronic Neck Pain: A Randomized Trial. (Restricted Access)
  2. Effectiveness of Low-Frequency Stimulation in Proprioceptive Neuromuscular Facilitation Techniques for Post Ankle Sprain Balance and Proprioception in Adults: A Randomized Controlled Trial. (Open Access)

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