{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:10:23Z","timestamp":1780513823549,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Objectives: This study aimed to evaluate the effects of a combined treatment consisting of O2O3 injections and McKenzie-based physiotherapy exercises, compared to a Control group treated with O2O3 injections and a Back School physiotherapy program, in reducing pain and disability in individuals with chronic non-specific neck pain. Methods: In this prospective double-arm pilot study, patients with chronic non-specific neck pain and a Numerical Rating Scale (NRS) &gt; 4 were enrolled. All patients received eight weekly sessions of O2O3 injections (10 \u03bcg\/mL, 10 mL total, and 2 mL bilaterally into the cervical paravertebral muscles). Patients were then randomly assigned (1:1 ratio) to either an experimental group receiving McKenzie physiotherapy or a Control group undergoing Back School techniques, with five sessions per week over two weeks. Outcome measures included the Neck Disability Index (NDI), NRS, EuroQol-5D-3L (EQ5D3L), and EuroQol Visual Analog Scale (EQ-VAS). Results: A total of 41 patients were included and divided into two groups: Back School (n = 21; mean age: 63.9 \u00b1 13.4 years) and McKenzie (n = 20; mean age: of 57.3 \u00b1 12.9 years). Both groups showed significant improvement in NDI, NRS, EQ5D3L, and EQ-VAS following the O2O3 injection cycle (\u2206T0\u2013T1 p &lt; 0.001). The subsequent addition of physical therapy led to further improvements across all outcomes in both groups (\u2206T1\u2013T2 p &lt; 0.001), with the McKenzie group showing slightly greater benefits, despite the lack of significant differences. Conclusions: This study demonstrated the effects of combining O2O3 injections with either McKenzie or Back School therapy in improving pain, disability, and quality of life in patients with chronic non-specific neck pain.<\/jats:p>","DOI":"10.3390\/jfmk11020227","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:08:07Z","timestamp":1780510087000},"page":"227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Oxygen\u2013Ozone Therapy and Physiotherapy on Functioning in Patients with Chronic Non-Specific Neck Pain: A Prospective Double-Arm Pilot Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-8346","authenticated-orcid":false,"given":"Alessandro","family":"de Sire","sequence":"first","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"},{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Parente","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-4275","authenticated-orcid":false,"given":"Andrea","family":"Demeco","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"},{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Prestifilippo","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Cocco","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"},{"name":"Physical and Rehabilitative Medicine, ASL Cagliari, 09047 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fasano","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemen","family":"Grabljevec","sequence":"additional","affiliation":[{"name":"Department for Rehabilitation After Central Nerve System Lesions, University Rehabilitation Institute, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4063-9821","authenticated-orcid":false,"given":"Umile Giuseppe","family":"Longo","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5568-7909","authenticated-orcid":false,"given":"Nicola","family":"Marotta","sequence":"additional","affiliation":[{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"},{"name":"Physical and Rehabilitative Medicine Unit, Department of Experimental and Clinical Medicine, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2828-2455","authenticated-orcid":false,"given":"Antonio","family":"Ammendolia","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"},{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.pmr.2011.03.008","article-title":"The Anatomy and Pathophysiology of Neck Pain","volume":"22","author":"Bogduk","year":"2011","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/10538127241304110","article-title":"The efficacy of manual therapy and therapeutic exercise for reducing chronic non-specific neck pain: A systematic review and meta-analysis","volume":"38","author":"Calafiore","year":"2025","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1097\/BRS.0000000000004071","article-title":"Epidemiology of Neck Pain and Its Impact on Quality-of-Life\u2014A Population-Based, Cross Sectional Study in Singapore","volume":"46","author":"Hey","year":"2021","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e142","DOI":"10.1016\/S2665-9913(23)00321-1","article-title":"Global, regional, and national burden of neck pain, 1990\u20132020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021","volume":"6","author":"Wu","year":"2024","journal-title":"Lancet Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"925","DOI":"10.3233\/BMR-210003","article-title":"Reliability of cervical vertebral maturation compared to hand-wrist for skeletal maturation assessment in growing subjects: A systematic review","volume":"34","author":"Ferrillo","year":"2021","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/s40520-019-01436-8","article-title":"Myostatin as a potential biomarker to monitor sarcopenia in hip fracture patients undergoing a multidisciplinary rehabilitation and nutritional treatment: A preliminary study","volume":"32","author":"Baricich","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e704","DOI":"10.1016\/S2214-109X(16)30168-1","article-title":"Health in times of uncertainty in the eastern Mediterranean region, 1990\u20132013: A systematic analysis for the Global Burden of Disease Study 2013","volume":"4","author":"Mokdad","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.1007\/s00586-017-5121-8","article-title":"National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy","volume":"26","author":"Kjaer","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jphys.2022.09.007","article-title":"Some conservative interventions are more effective than others for people with chronic non-specific neck pain: A systematic review and network meta-analysis","volume":"68","author":"Castellini","year":"2022","journal-title":"J. Physiother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/ejp.1679","article-title":"Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines","volume":"25","author":"Corp","year":"2021","journal-title":"Eur. J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/10538127251360867","article-title":"Efficacy of oxygen-ozone therapy and proprioceptive neuromuscular facilitation on pain and disability in patients affected by acute or subacute low back pain: A randomized controlled trial","volume":"39","author":"Parente","year":"2026","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/10538127251358732","article-title":"Intra-articular injections of oxygen-ozone versus hyaluronic acid for the treatment of knee osteoarthritis: A randomized controlled trial","volume":"39","author":"Sconza","year":"2026","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_13","first-page":"6034","article-title":"Oxygen-ozone therapy for the treatment of low back pain: A systematic review of randomized controlled trials","volume":"25","author":"Sconza","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.4103\/2045-9912.374388","article-title":"Intramuscular paravertebral oxygen-ozone therapy for chronic neck pain and low back pain: Evaluation of 6-month clinical outcomes","volume":"14","author":"Latini","year":"2024","journal-title":"Med. Gas Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sconza, C., Di Matteo, B., Queirazza, P., Dina, A., Amenta, R., Respizzi, S., Massazza, G., Ammendolia, A., Kon, E., and de Sire, A. (2023). Ozone Therapy versus Hyaluronic Acid Injections for Pain Relief in Patients with Knee Osteoarthritis: Preliminary Findings on Molecular and Clinical Outcomes from a Randomized Controlled Trial. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24108788"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/10538127251379512","article-title":"Ultrasound guided paravertebral ozone-oxygen injection versus pure oxygen for chronic discogenic low back pain: A double-blind randomized controlled trial","volume":"39","author":"Forogh","year":"2026","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_17","first-page":"119","article-title":"Low back pain related to a sacral insufficiency fracture: Role of paravertebral oxygen-ozone therapy in a paradigmatic case of nociplastic pain","volume":"34","author":"Baricich","year":"2019","journal-title":"Funct. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.3233\/BMR-240023","article-title":"The efficacy of ultrasonography-guided oxygen-ozone therapy versus corticosteroids in patients with knee osteoarthritis: A multicenter randomized controlled trial","volume":"37","author":"Aslan","year":"2024","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hidalgo-Tall\u00f3n, F.J., Torres-Morera, L.M., Baeza-Noci, J., Carrillo-Izquierdo, M.D., and Pinto-Bonilla, R. (2022). Updated Review on Ozone Therapy in Pain Medicine. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.840623"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1080\/09638288.2024.2342491","article-title":"Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: A proof-of-concept study","volume":"47","author":"Marotta","year":"2025","journal-title":"Disabil. Rehabil."},{"key":"ref_21","unstructured":"Mann, S.J., Lam, J.C., and Singh, P. (2025, May 20). McKenzie Back Exercises, StatPearls [Internet], Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539720\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1080\/10669817.2024.2337979","article-title":"McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: A randomized clinical trial","volume":"32","author":"Chaiyawijit","year":"2024","journal-title":"J. Man. Manip. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"408","DOI":"10.2522\/ptj.20060009","article-title":"Effect of Neck Exercise on Sitting Posture in Patients with Chronic Neck Pain","volume":"87","author":"Falla","year":"2007","journal-title":"Phys. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.math.2010.02.007","article-title":"Manual therapy and exercise for neck pain: A systematic review","volume":"15","author":"Miller","year":"2010","journal-title":"Man. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4103\/jehp.jehp_239_23","article-title":"Effectiveness of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: An experimental study","volume":"12","author":"Avaghade","year":"2023","journal-title":"J. Educ. Health Promot."},{"key":"ref_26","first-page":"e39218","article-title":"The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults with Moderate-to-Severe Neck Pain: A Systematic Review with Meta-Analysis","volume":"15","author":"Baumann","year":"2023","journal-title":"Cureus"},{"key":"ref_27","first-page":"3138","article-title":"The effect of McKenzie protocol vs. deep neck flexor and scapulothoracic exercises in subjects with chronic neck pain\u2014A randomized controlled study","volume":"26","author":"Mohamed","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1179\/jmt.2008.16.3.155","article-title":"Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis","volume":"16","author":"May","year":"2008","journal-title":"J. Man. Manip. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hernandez-Lucas, P., Leir\u00f3s-Rodr\u00edguez, R., Lopez-Barreiro, J., and Garc\u00eda-Soid\u00e1n, J.L. (2024). The Effects of Back Schools on Non-Specific Back Pain: A Systematic Review and Meta-Analysis. J. Pers. Med., 14.","DOI":"10.3390\/jpm14030272"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1097\/j.pain.0000000000000640","article-title":"Back schools for the treatment of chronic low back pain: Possibility of benefit but no convincing evidence after 47 years of research-systematic review and meta-analysis","volume":"157","author":"Straube","year":"2016","journal-title":"Pain"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/BSD.0000000000001459","article-title":"Neck Disability Index as a Prognostic Factor for Outcomes Following Cervical Disc Replacement","volume":"36","author":"Hartman","year":"2023","journal-title":"Clin. Spine Surg. Spine Publ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jmpt.2008.08.006","article-title":"The Neck Disability Index: State-of-the-Art, 1991\u20132008","volume":"31","author":"Vernon","year":"2008","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Jandura, J., Vajda, M., Cech, M., and Ryska, P. (2024). Oxygen\u2013Ozone Therapy of Musculoskeletal Neck Pain: A Review. J. Pers. Med., 14.","DOI":"10.3390\/jpm14030326"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"170","DOI":"10.4103\/2045-9912.286980","article-title":"Retrospective observational study of intramuscular oxygen-ozone therapy for the treatment of neck pain: Cervical paravertebral injection","volume":"10","author":"Ucar","year":"2020","journal-title":"Med. Gas Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Rania, V., Marcian\u00f2, G., Casarella, A., Vocca, C., Palleria, C., Calabria, E., Spaziano, G., Citraro, R., De Sarro, G., and Monea, F. (2022). Oxygen\u2013Ozone Therapy in Cervicobrachial Pain: A Real-Life Experience. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010248"},{"key":"ref_36","first-page":"47","article-title":"The use of oxygen ozone therapy in the treatment of cervicobrachial pain: Case series study","volume":"34","author":"Martinelli","year":"2020","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jmpt.2019.03.007","article-title":"Reliability and Responsiveness of Patient-Reported Outcome Measures of Neck Disability to Physical Therapy: Comparison of the Copenhagen, Northwick Park, and Neck Bournemouth Questionnaires and the Neck Disability Index","volume":"42","author":"Amirfeyz","year":"2019","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_38","first-page":"347","article-title":"Systematic rapid \u201cliving\u201d review on rehabilitation needs due to COVID-19: Update to March 31st, 2020","volume":"56","author":"Ceravolo","year":"2020","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/2045-9912.385439","article-title":"Effects of adjuvant ozone autohemotherapy combined with routine treatment on clinical and paraclinical features of mechanically ventilated COVID-19 patients in the intensive care unit: A pilot randomized controlled trial","volume":"14","author":"Aghamohammadi","year":"2024","journal-title":"Med. Gas Res."},{"key":"ref_40","first-page":"839","article-title":"International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and COVID-19: The Cochrane Rehabilitation 2020 rapid living systematic review. Update as of August 31st, 2020","volume":"56","author":"Andrenelli","year":"2020","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kuculmez, O. (2026). Efficacy of major ozone autohemotherapy in patients with post-COVID syndrome. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1720578"},{"key":"ref_42","first-page":"181","article-title":"International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER Action. Rehabilitation and COVID-19: A rapid living systematic review by Cochrane Rehabilitation Field updated as of December 31st, 2020 and synthesis of the scientific literature of 2020","volume":"57","author":"Andrenelli","year":"2021","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"de Sire, A., Moggio, L., Marotta, N., Agostini, F., Tasselli, A., Drago Ferrante, V., Curci, C., Calafiore, D., Ferraro, F., and Bernetti, A. (2022). Impact of Rehabilitation on Fatigue in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis. Appl. Sci., 12.","DOI":"10.3390\/app12178593"}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:39:22Z","timestamp":1780511962000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jfmk11020227"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11020227","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]}}}