{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:42:19Z","timestamp":1790289739901,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Shoulder and neck dysfunctions resulting from spinal accessory nerve injury impair quality of life. This study aims to investigate the effects of manual therapy in combination with standard physiotherapy on the mechanical properties of muscle, neck and shoulder function, pain, and quality of life in head and neck cancer patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective, randomized, controlled, double\u2010blind clinical trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Department of Otorhinolaryngology Head and Neck Surgery of a university hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 26 participants were randomized into two groups. The control group (n\u2009=\u200911) received standard physiotherapy including therapeutic exercises, scar tissue massage, and education. The intervention group (n\u2009=\u200910) received manual therapy consisting of soft tissue, myofascial release, and mobilization techniques in combination with standard physiotherapy. Outcome measures were mechanical properties of muscle, neck and shoulder active range of motion, shoulder pain and disability, and quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Upper trapezius and sternocleidomastoid muscle stiffness increased significantly in the control group (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01), whereas a significant reduction was observed in the intervention group compared to the control group (<jats:italic>P<\/jats:italic>\u2009=\u2009.001). A reduction in muscle thickness was observed bilaterally in both groups (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01). Moreover, all participants showed improvements in neck and shoulder active range of motion, shoulder pain, and quality of life (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Manual therapy in addition to standard physiotherapy was more effective in improving neck and shoulder function, quality of life, and reducing muscle stiffness compared to standard physiotherapy alone. Therefore, clinicians should consider incorporating manual therapy into their treatment protocols to optimize patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1236","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T02:17:03Z","timestamp":1742869023000},"page":"115-125","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Can Manual Therapy Alter Muscle Stiffness in Patients With Spinal Accessory Nerve Injury?"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9413-6395","authenticated-orcid":false,"given":"Ferhat","family":"Simsek","sequence":"first","affiliation":[{"name":"Graduate School of Natural and Applied Sciences Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3764-2421","authenticated-orcid":false,"given":"Baha","family":"Naci","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences Fenerbahce University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9952-0329","authenticated-orcid":false,"given":"Meltem Bozaci","family":"Kilicoglu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0454-418X","authenticated-orcid":false,"given":"Zeynep","family":"Alkan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-3395","authenticated-orcid":false,"given":"Osman Melih","family":"Topcuoglu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-2881","authenticated-orcid":false,"given":"Aysegul","family":"Gormez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunter","family":"Hafiz","sequence":"additional","affiliation":[{"name":"American Hospital Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-7547","authenticated-orcid":false,"given":"Ali Fethi","family":"Okyar","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Yeditepe University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2014.05.015"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818821885"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050312116645731"},{"issue":"5","key":"e_1_2_9_5_1","article-title":"Identifying unmet needs and limitations in physical health in survivors of head and neck cancer","volume":"30","author":"Van Hinte G","year":"2021","journal-title":"Eur J Cancer Care"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.03.019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819883295"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489.2010.532157"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-44462-4_6"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00067.2006"},{"key":"e_1_2_9_11_1","first-page":"287","volume-title":"Basic Biomechanics of the Musculoskeletal System","author":"Loren T","year":"2012"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00201.2008"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.23356"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27129"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2021\/6678184","article-title":"Clinical evidence for the effects of manual therapy on cancer pain: a systematic review and meta\u2010analysis","volume":"2021","author":"Yao C","year":"2021","journal-title":"Evid Based Complement Alternat Med"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.17784\/mtprehabjournal.2014.12.190"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.718827"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2016.05.010"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.4028\/www.scientific.net\/KEM.345-346.1241"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11030524"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2018.01.007"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2021.07.005"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/77.10.1079"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-2008-21108"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19960601)77:11<2294::AID-CNCR17>3.0.CO;2-S"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23536"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-4875-x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/15347354211040827"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23712"},{"issue":"4","key":"e_1_2_9_30_1","first-page":"230","article-title":"Motor and functional recovery after neck dissection: comparison of two early physical rehabilitation programmes","volume":"34","author":"Baggi F","year":"2014","journal-title":"Acta Otorhinol Ital"},{"key":"e_1_2_9_31_1","volume-title":"Fascial Release for Structural Balance","author":"Earls J","year":"2010"},{"key":"e_1_2_9_32_1","first-page":"220","article-title":"Myofascial release: hands\u2010on guides for therapists","author":"Duncan RA","year":"2014","journal-title":"Hum Kinet"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17124381"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0205782"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelekin.2019.06.009"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-20452-9"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2011.09.013"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare8030316"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2009.02.022"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23646"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.1185"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2023.106608"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153245"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07482-9"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaa147"},{"issue":"4","key":"e_1_2_9_46_1","article-title":"Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer","volume":"2012","author":"Carvalho AP","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.3138\/ptc.2011-23O"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298544"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.25259\/IJPC_10_2021"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2020.21.8.2389"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.2217\/pmt.15.39"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.32.1.20"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.106214"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:24:36Z","timestamp":1760963076000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ohn.1236"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1236","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,24]]},"assertion":[{"value":"2024-11-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}