Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial

The effect of craniocervical flexors endurance training on suprahyoid muscle activation in healthy adults: A randomised controlled trial

BACKGROUND

Cervical posture affects swallowing function through contractile and non-contractile structures. Craniocervical flexor endurance training (CCFET), which focuses on the activation of deep cervical muscles, is used to ensure cervical posture stability.

OBJECTIVE

The aim of this study was to investigate the effect of CCFET on the suprahyoid muscles (SH), which play an important role in swallowing function.

METHODS

Eighty healthy individuals (52 female and 28 male, mean age 21.77 ± 1.81 years) were recruited and randomly assigned to groups that underwent either deep cervical flexor (DCF) training with a pressure biofeedback unit (CCFET group, n = 41) or no intervention (control group, n = 39). The intervention was applied for 4 weeks (five sessions per week). Static endurance and activation of DCF muscles (Craniocervical Flexion Test, CCFT), tragus-wall distance (TWD) for forward head posture and surface electromyographic (sEMG) activation of suprahyoid muscles were evaluated.

RESULTS

The endurance and activation of the DCF muscles were significantly increased in the CCFET group (p = <.001). In the CCFET group, TWD significantly lower than the control group (p = <.001) Peak SH amplitude and mean SH amplitude were lower in the CCFET group compared to the control group (p = .013, p = .003).

CONCLUSION

The study shows that 4 weeks of CCFET reduced SH muscle activation, allowing the same work to be done with fewer motor units. CCFET can be included in rehabilitation programs as an additional method that has an effect on the muscles involved in swallowing by providing cervical motor control.

Relationship between cervical lordotic angle and cervical segmental motion during craniocervical flexion test: A cross-sectional study

The craniocervical flexion test (CCFT) is commonly used for assessing the performance and function of the deep cervical flexor muscles; however, objective measurements of cervical segmental motion during craniocervical flexion (CCF) are lacking. Therefore, the purpose of this study aimed to investigate cervical segmental motions during CCFT and determine the relationship between changes of cervical segmental motions and the cervical lordotic angle. A cross-sectional study of prospectively collected data. Twenty healthy participants without neck pain underwent standing cervical radiography (lateral view) to measure the cervical lordotic angle, followed by radiography in supine position during the CCFT. The occipito-atlantal (OA) joint angle, atlantoaxial (AA) joint angle, and cervical spinous process posterior displacement (CSPPD) of the C1-C6 vertebrae were measured using lateral cervical radiographs taken during the initial (20 mm Hg) and low-stage (24 mm Hg) CCFT conditions. The CCF motion during the low-stage CCFT was characterized by a significantly increased OA joint angle, decreased AA joint angle, and increased C1-C6 CSPPD compared with the initial stage (P < .05). The change in the value of C1-C6 CSPPD at low-stage CCFT showed a significant positive correlation with the cervical lordotic angle. These results indicate that the cervical lordotic angle is important in minimizing CSPPD and performing appropriately-isolated CCF motion during CCFT.

Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Chronic neck pain (CNP) is a common musculoskeletal disorder. Pain neuroscience education (PNE) is a promising nonpharmacological intervention for CNP, however, its effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in treating CNP.

METHODS

Electronic databases from inception to February 2023 were searched for randomized controlled trials (RCTs) on the effects of PNE on CNP. The primary outcome was the change in pain intensity, and the secondary outcome was improvement in kinesiophobia, standardized using Hedges' g. Two authors independently scrutinized eligible articles, extracted data and assessed quality; a random-effects model was employed for data pooling.

RESULTS

In total, seven RCTs comprising 479 participants were included and demonstrated that PNE significantly reduced pain intensity (Hedges' g = -0.730, 95% CI = -1.340 to -0.119, p = 0.019, I2  = 89.288%). Subgroup analysis revealed that the adult group experienced significant pain reduction after PNE, whereas the adolescent group did not. PNE also reduced kinesiophobia which was evaluated in four of seven RCTs (Hedges' g = -0.444, 95% CI = -0.735 to -0.154, p = 0.003, I2  = 36.822%). The meta-regression analysis indicated that an increased intervention duration contributed to greater pain reduction. No adverse events were reported following PNE or the control treatment.

CONCLUSIONS

PNE effectively reduced pain intensity and kinesiophobia in patients with CNP. A longer PNE time leads to greater pain reduction and is more effective in adults than in adolescents. Further studies are required to examine the long-term effects on CNP management.

SIGNIFICANCE

This is the first meta-analysis evaluating the effectiveness of treating chronic neck pain with pain neuroscience education. Pain neuroscience education is successful in reducing pain and decreasing kinesiophobia in the chronic neck pain population. Longer treatment time leads to greater pain reduction.

Effects of Interactive Telerehabilitation Practices in Office Workers with Chronic Nonspecific Neck Pain: Randomized Controlled Study

Aim: Aim of this study is to investigate the effects of interactive telerehabilitation exercises in office workers with chronic nonspecific neck pain. Methods: Office workers (n = 120) were randomly divided into three groups between February and July 2022, taking into account the inclusion and exclusion criteria, and office ergonomics training was given to all of the participants. Group 1 participants were given an interactive telerehabilitation program (strengthening, motor control, and posture correction exercises) for 45 min per day, 3 days a week, for a total of 6 weeks. Group 2 participants were trained to do the home exercise program on their own for 45 min per day, 3 days a week, for a total of 6 weeks. Only office ergonomics training was given to Group 3 patients. Results: Statistically significant improvement in pain (p < 0.001), range of motion (ROM) (p < 0.001), neck disability status (p < 0.001), functional status (p < 0.001), and quality of life (p < 0.001) of 6-week interactive telerehabilitation application in office workers was found. Discussion: In addition to office ergonomics training, interactive telerehabilitation program is the most effective method on pain, ROM, and neck disability compared with home exercise program and office ergonomics training alone, and studies are needed on the long-term effectiveness of telerehabilitation applications and telerehabilitation treatment diversity.

Effect of long-term cervical extensor exercise program on functional disability, pain intensity, range of motion, cervical muscle mass, and cervical curvature in young adult population with chronic non-specific neck pain: a randomized controlled trial

BACKGROUND

The prevalence of chronic non-specific neck pain (CNNP) is on the rise among the young adult population. We herein aimed to compare the effects of long-term specific cervical extensor training and stretching exercises on improving this chronic disorder in young adults.

METHODS

In this prospective, randomized, controlled study, 70 participants aged 18-35 years with CNNP and cervical lordosis loss were included. The participants were assigned to undergo either specific cervical extensor training (observation group) or perform usual stretching exercises (control group). The exercise duration was set at 12 months, with 9 months at the clinic and 3 months at home. The outcome assessments included changes in the neck disability index, visual analog scale from baseline, cervical range of motion (CROM), cross-sectional areas (CSAs) of cervical extensors, and cervical curvature from baseline. The outcome measures were compared between groups at 3, 6, and 12 months of follow-up.

RESULTS

All 70 participants underwent randomization, and no significant differences in demographics and baseline data were found between the two groups. The observation group showed a greater improvement in neck disability index and visual analog scale scores at the 12-month follow-up than the control group. Additionally, a more substantial increase in CROM and CSAs of cervical extensors was observed in the observation group at the 6-month and 12-month follow-ups (P < 0.05). Although more participants in the observation group achieved cervical lordosis at the 12-month follow-up, the difference was marginally nonsignificant (9% in the control group vs. 28% in the observation group, P = 0.075).

CONCLUSIONS

In young adults with CNNP, long-term specific cervical extensor training was associated with a more significant clinically meaningful improvement in disability, pain, and CROM than stretching exercises. The increased CSAs of cervical extensors may potentially contribute to the restoration of cervical lordosis. Trial registration The study is registered at the Chinese domestic clinical trial (ChiCTR2000040009) at Chictr.org. The date of registration: November 18, 2020.

Acute effects of an isometric neck warm-up programme on neck performance characteristics and ultrasound-based morphology

OBJECTIVE

Athletic performance can be enhanced immediately after an isometric warm-up, a phenomenon termed post-activation performance enhancement (PAPE). While isometric warm-ups can improve lower extremity sprint and jump performance, neck-specific isometric warm-ups need development and validation for mild traumatic brain disorders and neck pain. This study examined acute effects of isometric warm-ups on neck performance and morphology.

METHODS

Arm 1: Twenty-six adults (13 M:13F) completed neck performance testing before and after a 10-minute neck isometric warm-up or stationary bike (sham) between two visits. Testing included visual-motor reaction time, peak force, rate of force development, force steadiness, and force replication/proprioception measured by a 6-axis load cell. An inclinometer assessed range-of-motion. Paired t-tests and two-way ANOVA examined effects of neck/bike warm-up and interaction effects, respectively. Arm 2: 24 adults (11 M:13F) completed ultrasound scans of cervical muscles: before 20-minute rest (sham), and before/after a 5-min neck isometric warm-up. Longus colli cross-sectional area and sternocleidomastoid/upper trapezius thickness and stiffness, and cervical extensors thickness was assessed. One-way ANOVA compared morphological values at sham, before, and after warm-up. Significance was set at p < 0.05.

RESULTS

Isometric neck warm-up increased rate of force development in flexion (p = 0.022), extension (p = 0.001-0.003), right lateral flexion (p = 0.004-0.032), left lateral flexion (p = 0.005-0.014), while peak force improved only in left lateral flexion (p = 0.032). Lateral flexion range-of-motion increased after neck warm-up (p = 0.003-0.026). Similarly, longus colli cross-sectional area (p = 0.016) and sternocleidomastoid thickness (p = 0.004) increased.

CONCLUSIONS

Increased neck performance characteristics and morphology are likely due to PAPE effects of isometric neck warm-up. For coaches and athletes, simple isometric contractions could be added to existing warm-ups to reduce prevalence, incidence, and severity of mild traumatic brain injuries and neck pain.

The effects of basic body awareness therapy on balance in patients with chronic neck pain: a randomised crossover trial

PURPOSE

This study aimed to compare the effects of basic body awareness therapy (BBAT) and conventional treatments (CT) on balance in patients with chronic neck pain.

METHODS

Thirty-five patients with neck pain participated in this randomised two-period crossover trial. Patients were divided into A (BBAT/CT) (n = 17) and B (CT/BBAT) (n = 18) groups. Group A received BBAT twice a week for 6 weeks, whereas Group B received CT within the same parameters. After a 5-week washout period, the treatments received by the groups were changed. The primary outcome was balance, assessed via the sensory organisation test (SOT) using the computerised dynamic posturography device. The secondary outcome was pain assessed by the visual analogue scale. Assessments were performed before and after primary and secondary treatments.

RESULTS

In Group A, the SOT conditions 4, 5, 6; composites score; and visual and vestibular system scores increased after BBAT; however, only condition five scores and vestibular system scores increased (p < .05) in Group B, which started with CT. Within the groups, both treatments were effective for easing pain (p < .05).

CONCLUSIONS

Although patients who started the therapy with BBAT showed more improvement in balance, no differences were observed between the therapies.

Exercise therapy including the cervical extensor muscles in individuals with neck pain: A systematic review

OBJECTIVE

To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain.

DATA SOURCES

An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies.

REVIEW METHODS

Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes.

RESULTS

Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks.

CONCLUSION

The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters.

Immediate effect of craniocervical flexion exercise and Mulligan mobilisation in patients with mechanical neck pain - A randomised clinical trial

Background

Mechanical neck pain (MNP) is one of the most prevalent musculoskeletal pathologies in the present time. Physiotherapy management strategies comprising manual therapy and exercise therapy are routinely administered in patients with MNP.

Objective

To compare the immediate effect of craniocervical flexion (CCF) exercise and Mulligan mobilisation on pain, active cervical range of motion (CROM) and CCF test performance in patients with MNP.

Methods

This prospective, randomised, single-blinded study involved 26 patients with MNP (16 females; mean age; 31 . 12 ± 8 . 40 years) randomised to a single session of active CCF exercise (3 sets of 10 repetitions) or Mulligan mobilisation (3 sets of 6-10 repetitions). Pain intensity was measured on a numerical pain rating scale (NPRS), active CROM was measured using CROM device, and CCF test performance with surface electromyography (EMG) from bilateral sternocleidomastoid (SCM) and anterior scalene (AS) muscles recorded pre- and immediately post-intervention by an assessor blinded to the treatment groups. Mann-Whitney U test was used to analyse between groups and Wilcoxon signed rank test was used to analyse within-group significance for pain and CROM, Cochran-Mantel-Haenszel correlation test was used to analyse the CCF test performance on EMG from the bilateral SCM and AS muscles.

Results

Comparison between pre- and post-intervention readings revealed statistically significant within-group (p < 0 . 05 ) and no between-group significant difference for pain, ROM, and CCF test performance, indicating both interventions were equally effective.

Conclusion

Patients with MNP who received active CCF exercise or Mulligan mobilisation exhibited similar reduction in pain intensity and increased CROM and CCF test performance post-intervention. Surprisingly, AS surface EMG amplitudes were increased post-intervention in both groups warranting further exploration of its role in neck pain.

Efficacy of telerehabilitation exercise in patients with chronic neck pain: a protocol for a non-inferiority randomized controlled trial

The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).

Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression

OBJECTIVE: We aimed to analyze the effects and dose-response relationship of the most effective exercises for improving pain and disability in people with chronic nonspecific neck pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched the PubMed, PEDro, and CENTRAL databases from their inception to September 30, 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome. DATA SYNTHESIS: Restricted maximum-likelihood random-effects meta-analyses were modeled separately for resistance, mindfulness-based, and motor control exercises; standardized mean differences (Hedge's g, standardized mean difference [SMD]) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response relationship for therapy success of any exercise type. RESULTS: We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD, -1.27; 95% confidence interval [CI]: -2.26, -0.28; |2 = 96%; disability: SMD, -1.76; 95% CI: -3.16, -0.37; |2 = 98%), motor control exercise (pain: SMD, -2.29; 95% CI: -3.82, -0.75; |2 = 98%; disability: SMD, -2.42; 95% CI: -3.38, -1.47; |2 = 94%), and Yoga/Pilates/Tai Chi/Qui Gong exercise (pain: SMD, 1.91; 95% CI:-3.28, -0.55; |2 = 96%; disability: SMD, -0.62; 95% CI: -0.85, -0.38; |2 = 0%). Yoga/Pilates/Tai Chi/Qui Gong exercise was more effective than other exercises (SMD, -0.84; 95% CI: -1.553, -0.13; |2 = 86%) for reducing pain. For disability, motor control exercise was superior to other exercises (SMD, -0.70; 95% CI: -1.23, -0.17; |2 = 98%). There was no dose-response relationship for resistance exercise (R2 = 0.32). Higher frequencies (estimate = -0.10) and longer durations (estimate = -0.11) of motor control exercise had larger effects on pain (R2 = 0.72). Longer sessions (estimate = -0.13) of motor control exercise had larger effects on disability (R2 = 0.61). CONCLUSION: Resistance, mindfulness-based, and motor control exercises were effective for reducing neck pain (very low- to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise. J Orthop Sports Phys Ther 2023;53(8):1-41. Epub: 20 June 2023. doi:10.2519/jospt.2023.11820.

Can baseline features predict a reduction in pain and disability following neck-specific exercise in people with chronic non-specific neck pain?: A systematic review and meta-analysis protocol

INTRODUCTION

Neck-specific exercises (NSEs) are commonly used for the treatment of chronic non-specific neck pain (CNSNP). However, it remains unclear whether baseline features can predict the response to neck-specific exercise (NSE) in people with CNSNP. This systematic review aims to assess whether baseline features such as age, gender, muscle activity, fatigability, endurance and fear of movement can predict pain and disability reduction following a NSE intervention.

METHODS AND ANALYSIS

This systematic review and meta-analysis will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines checklist. The Web of Science, PubMed, Scopus, MEDLINE, Embase and CINAHL databases; key journals; and grey literature will be searched up until June 2023, including medical subject heading terms and keywords combinations. Included studies will investigate an association between the baseline features and pain and disability outcomes following NSE in people with CNSNP. Two independent reviewers will oversee the searching, screening, data extraction and assessment of risk of bias. The risk of bias will be assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) and Risk-Of-Bias tool for randomised trials 2 (ROB 2). The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Using standardised forms, details regarding study characteristics, baseline features (predictive factors), intervention, primary outcome and effect size (OR and 95% CI of each predictive factor and p value) will be extracted from included studies. Meta-analyses will be considered, if the studies are sufficiently homogeneous and if three or more studies investigate the same or comparable factors that predict the same response (pain intensity or disability). In the event that less than three studies investigated the same factors, a narrative synthesis will be conducted.

ETHICS AND DISSEMINATION

Ethical approval will not be required as this review will be based on published studies. The results of this study will be submitted to a peer-reviewed journal and presented at conferences.

PROSPERO REGISTRATION NUMBER

CRD42023408332.

Are there differences between a real C0-C1 mobilization and a sham technique in function and pressure pain threshold in patients with chronic neck pain and upper cervical restriction? A randomised controlled clinical trial

BACKGROUND

Chronic neck pain is one of the main reasons for visiting a healthcare professional. In recent years, it has been shown that upper cervical restriction may be a factor involved in neck pain.

OBJECTIVE

To compare the immediate effects of a real cervical mobilization technique versus a sham cervical mobilization technique in patients with chronic neck pain and upper cervical restriction.

METHODS

This was a randomised, controlled, double-blind clinical trial. Twenty-eight patients with chronic neck pain were recruited and divided into two groups (14 = real cervical mobilization; 14 = sham mobilization). Both groups received a single 5-minute treatment session. Upper cervical range motion, flexion-rotation test, deep cervical activation and pressure pain threshold were measured.

RESULTS

In the between-groups comparison, statistically significant differences were found in favour of the real cervical mobilization group in upper cervical extension (p= 0.003), more restricted side of flexion-rotation test (p< 0.001) and less restricted side of flexion-rotation test (p= 0.007) and in the pressure pain threshold of the right trapezius (p= 0.040) and right splenius (p= 0.049). No differences in deep muscle activation were obtained.

CONCLUSION

The real cervical mobilization group generates improvements in upper cervical spine movement and pressure pain threshold of right trapezius and right splenius compared to the sham group in patients with chronic neck pain and upper cervical restriction.

Exercise-Induced Hypoalgesia Following Proprioceptive Neuromuscular Facilitation and Resistance Training Among Individuals With Shoulder Myofascial Pain: Randomized Controlled Trial

BACKGROUND

Various exercises can attenuate pain perception in healthy individuals and may interact with the descending pain modulation in the central nervous system. However, the analgesic effects of exercise in patients with myofascial pain can be disrupted by the pathological changes during chronic pain conditions. Thus, the exercises targeted on the facilitation of the sensory-motor interaction may have a positive impact on the restoration of the descending pain modulation and the analgesia effects.

OBJECTIVE

This paper estimates the effect of proprioceptive neuromuscular facilitation (PNF) and resistance training on exercise-induced hypoalgesia (EIH) and conditioned pain modulation (CPM) among patients with myofascial pain syndrome.

METHODS

A total of 76 female patients with myofascial pain syndrome (aged 18-30 years), with the pain in the upper trapezius and a visual analog scale score of greater than 30/100 mm, were enrolled in the study. Participants were randomly assigned into 3 intervention groups, including isometric (n=18, 24%), isotonic (n=19, 25%), and PNF (n=20, 26%) exercises, as well as 1 control group (n=19, 25%) with no intervention. Pressure pain threshold and the CPM responses at the myofascial trigger point, arm, and leg sites were assessed before and after the exercise session. The effective EIH response was reflected in the improvement of pressure pain thresholds.

RESULTS

There was an increase in pressure pain thresholds and CPM responses at trigger point (P<.001 and P<.001), arm (P<.001 and P<.001), and leg sites (P<.001 and P=.03) in participants who performed PNF and isotonic exercise, while the isometric exercise only increased pressure pain thresholds at leg sites (P=.03). Compared with the control group, both the isotonic (P=.02) and PNF (P<.001) groups showed greater EIH responses at the trigger points. In comparison to the control group, only the PNF exercise (P=.01) significantly improved pressure pain thresholds and CPM responses at arm and leg sites compared to the control group.

CONCLUSIONS

PNF, isotonic, and isometric exercises could lead to local and global EIH effects. The improvement in CPM response following PNF and isotonic exercises suggested that the EIH mechanisms of different resistance exercises may be attributed to the enhancement of the endogenous pain modulation via the motor-sensory interaction from the additional eccentric and dynamic muscle contraction.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCtr202111090819166165; https://tinyurl.com/2ab93p7n.

Virtual reality and motor control exercises to treat chronic neck pain: A randomized controlled trial

AIM

To compare the effects of virtual reality (VR) and motor control (MC) exercises.

METHODS

Forty-one participants with chronic neck pain (CNP) were randomized into the VR or MC group. Both groups performed 18 sessions over 6 weeks. The primary outcomes were pain intensity (visual analogue scale), pain pressure thresholds (PPTs), joint position sense error (JPSE), and muscle performance. The secondary outcomes were the Profile Fitness Mapping Questionnaire (ProFitMap-Neck), Hospital Anxiety-Depression Scale (HADS), and quality of life (SF-36). Data were analysed using T-Tests, and Fisher's Exact Test. Mean (standard deviation), median (interquartile range), effect size and %95 confidence interval (CI) were reported.

RESULTS

The results of Independent T-Tests showed that VR was advantageous in terms of PPTs of the C1/C2 and C5/C6 articular pillar bilaterally and large effect size (Cohen's d > 0.8, p < 0.05). Moreover, VR was more effective in decreasing JPSE (Cohen's d > 0.08; mean difference changes between -2.91 and -1.24, %95 CI -4.47 to 0.80) and functional limitation (ProFitMap-Neck) (Cohen's d = 0.7, mean difference 8.27, %95 CI 0.20 to 16.35). The results of T-Tests demonstrated that neither intervention was superior in terms of pain intensity, muscle performance, symptoms (ProFitMap-Neck), HADS, or SF-36 (Cohen's d < 0.5).

CONCLUSIONS

VR can be applied for improving proprioception and for decreasing cervical articular pain in CNP patients. In addition, VR may be more effective for decreasing functional limitations in patients. Clinicians can choose MC exercises with or without VR for improving pain, muscle performance, symptoms, anxiety/depression, and quality of life.

Comparison of time-dependent resistance isometric exercise and active range of motion exercise in alleviating the sensitization of postoperative axial pain after cervical laminoplasty

BACKGROUND

Postoperative axial pain (PAP) is a significant complication after cervical laminoplasty.

OBJECTIVE

To investigate pain sensitization in PAP patients and effects of time-dependent resistance isometric exercise compared to active range-of-motion exercise on PAP.

STUDY DESIGN

Retrospective cohort analysis.

METHODS

211 patients undergoing postoperative 12-week exercises were evaluated for pressure pain threshold (PPT), temporal summation (TS) and both cross-sectional area and fatty infiltration of paraspinal muscles preoperatively and 3 months postoperatively. There patients underwent Numeric rating pain scale (NRS) and neck disability index (NDI) 3 and 6 months postoperatively.

RESULTS

At postoperative 3-month assessments, fewer patients undergoing isometric exercise showed PAP compared to range-of-motion exercise group (14/98 vs. 34/113; P = 0.006), and pain-related assessments in the former were lower than the latter (NRS at rest: 0.3 ± 0.8 vs. 0.7 ± 1.4, P = 0.014; NRS with movements: 0.4 ± 1.0 vs. 1.0 ± 1.7, P = 0.015; NDI: 2.4 ± 6.3 vs. 6.7 ± 10.9, P = 0.002). Postoperative cross-sectional area was smaller in isometric exercise group (603.5 ± 190.2) than in range-of-motion exercise group (678.7 ± 215.5) (P = 0.033), and the former showed higher local-area PPT and lower TS than the latter (PPT: 3.9 ± 1.8 vs. 3.1 ± 1.6, P = 0.002; TS: 1.8 ± 0.9 vs. 2.2 ± 1.0, P = 0.003). PAP patients showed lower local-area PPT and greater TS than those without PAP in both isometric (PPT: 2.8 ± 0.7 vs. 4.0 ± 1.9, P = 0.019; TS: 2.4 ± 0.6 vs. 1.7 ± 0.9, P = 0.011) and range-of-motion (PPT: 2.2 ± 0.9 vs. 3.6 ± 1.7, P < 0.001; TS: 2.8 ± 0.8 vs. 1.9 ± 0.9, P < 0.001) exercise groups.

CONCLUSIONS

Both peripheral and central sensitization are involved in PAP. Time-dependent isometric exercise has more positive effects on PAP than range-of-motion exercise because of its advantages in improving pain sensitization.

Efeitos da fisioterapia na cefaleia do tipo tensional

Introdução: A Cefaleia do Tipo Tensional (CTT) é a mais frequente dentro do grupo das cefaleias primárias, sendo responsável por gerar um alto impacto socioeconômico para a sociedade, além de prejudicar as relações sociais, profissionais e familiares. Objetivos: Analisar os efeitos de um protocolo de intervenção fisioterapêutica, incluindo técnicas de terapia manual, alongamentos e fortalecimento muscular sobre a funcionalidade, dor e incapacidade em pacientes com CTT. Métodos: Trata-se de um estudo de caráter intervencionista, exploratório-descritivo com abordagem quantitativa, realizado com cinco indivíduos com quadro sintomático de CTT. A dor foi avaliada através da Escala Analógica Visual (EVA); a incapacidade pelo Neck Disability Index (NDI) e o impacto da cefaléia em atividades de vida diária (AVD) mediante aplicação do Headache Impact Test (HIT-6) antes e após intervenção. Foram realizadas seis sessões de fisioterapia, uma vez por semana, durante seis semanas. Resultados: Houve redução no padrão de dor pós-intervenção (4,2 ± 2,28 x 0,2 ± 0,45; p=0,0189). No quesito incapacidade, houve diferença entre os períodos pré e pós-intervenção (11,4 ± 1,54 x 6,6 ± 2,30; p=0,0220). Além disso, após a intervenção, houve redução nos níveis do HIT-6 quando comparado ao período pré-intervenção (51 ± 7,45 x 59,6 ± 3,91; p=0,0381). Conclusão: O protocolo de intervenção fisioterapêutica mostrou-se eficaz na redução do padrão de dor, incapacidade e impacto da cefaleia nas AVD de pacientes com CTT.

The Effect of Fu’s Subcutaneous Needling Combined with Reperfusion Approach on Surface Electromyography Signals in Patients with Cervical Spondylosis and Neck Pain: A Clinical Trial Protocol

Background

Neck pain is one of the most common musculoskeletal diseases. Fu's subcutaneous needling therapy is a special acupuncture method that targets muscle trigger points. It has been proven to have a positive effect on the treatment of neck pain. The access to its curative effect may be related to the improvement of muscle and soft tissue condition. The purpose of this study is to evaluate the outcome of Fu's subcutaneous needling therapy for patients with neck pain by collecting changes in the sEMG of the patient's neck muscles and related data from evaluation scales and explore the feasibility and safety of Fu's subcutaneous needling therapy for neck pain.

Methods

72 patients meeting the inclusion criteria were randomly divided into FSN group and acupuncture group for corresponding treatment. FSN group was treated once every other day for 5 consecutive treatments; the acupuncture group was treated once a day for 10 consecutive treatments.

Result

Outcome indicators were measured at baseline, after the first treatment and the end of the treatment. Primary outcome indicators: average EMG (AEMG) and (mean power frequency) MPF of sternocleidomastoid muscle and superior trapezius muscle. Secondary outcome indicators: Mc Gill pain questionnaire (MPQ), neck disability index (NDI), and adverse reactions.

Conclusions

This study will explore the efficacy, safety, and possible mechanism of Fu's subcutaneous needling therapy for patients with neck pain, thus to provide more evidence support for clinical decision-making. This trial is registered with Chinese Clinical Trial Register Center (registration number ChiCTR2100043529).

Investigation of the effectiveness of neck stabilization exercises in patients with chronic neck pain: A randomized, single-blind clinical, controlled study

Objectives: This study aims to compare the efficacy of neck stabilization exercises versus a conventional exercise program on pain, range of motion, disability, and depression in patients with chronic neck pain.

Patients and methods: This prospective, single-blind, randomized controlled study included 60 patients with chronic neck pain, 58 (21 males, 37 females; mean age: 36.7±8.5 years; range, 18 to 55 years) of whom completed the study. The patients were randomized into two groups. Patients in one group were given neck stabilization exercises, while the patients in the other group were given conventional neck exercises. Neck pain due to activities of daily living (Visual Analog Scale), neck range of motion in sagittal, transverse, and frontal planes, disability (Neck Disability Index), and depression (Beck Depression Inventory) were evaluated at the beginning, at the end of the treatment, and at the first and third months after the end of treatment.

Results: Significant improvement was achieved in both groups in terms of Visual Analog Scale, Neck Disability Index, neck range of motion in the sagittal, transverse, and frontal planes, and Beck Depression Inventory compared to the beginning of treatment (p<0.05). In the stabilization exercise group, statistically significant improvement was found in the range of motion of the neck in the transverse plane (p<0.05).

Conclusion: Stabilization exercise programs, which show their effect by maintaining segmental stabilization, postural control, and balance between the superficial and deep muscles of the neck region, contribute to reduced pain in daily activities and improved function similar to conventional exercise programs.

A Single-Center Study Comparing the Effects of Thoracic Spine Manipulation vs Mobility Exercises in 26 Office Workers with Chronic Neck Pain: A Randomized Controlled Clinical Study

Background

Neck pain is associated with computer work, poor posture, imbalanced neck muscles, and fatigue, particularly in office workers. This study from a single center aimed to compare the effects of thoracic spine mobility exercise and thoracic spine manipulation to improve cervical spine range of motion in 26 office workers who had chronic neck pain for more than 12 weeks.

Material/Methods

The participants were 26 office workers with neck pain lasting >12 weeks. These participants were randomly assigned to undergo TSME (n=13) or TSM (n=13). Both groups underwent cervical joint mobilization and deep cervical flexor muscle exercises for 25 min a day, twice weekly, for 6 weeks. The TSME group additionally performed TSME 15 min a day, twice a week, for 6 weeks, while the TSM group received TSM 2 times a day, twice a week, for 6 weeks. Cervical and thoracic spine ROM, numeric pain rating scale (NPRS), and neck disability index (NDI) were measured before and after interventions. The ROM of cervical and thoracic spine was measured using a dual inclinometer.

Results

Both groups showed significant changes in cervical spine ROM, thoracic spine ROM, NPRS, and NDI after intervention compared to before intervention (P<0.05). Cervical spine right lateral flexion and right rotation differed significantly between the groups (P<0.05), while thoracic spine ROM, NPRS, and NDI did not.

Conclusions

TSME and TSM have similar effects in improving pain and disability in office workers with non-specific chronic neck pain.

Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial

Background

Neck pain and disability is a significant public health problem with only very few evidence-based treatment option. The aim of this study was to evaluate the effect of isometric exercise on pain and disability of cervical spondylosis.

Methods

Twenty four patients with cervical osteoarthritis and neck pain (22 females and 2 males; mean age, 46.70 ± 13.71 years) were recruited and randomly allocated into 2 arms: neck isometric exercises (n = 12) and conservative management without exercise (n = 12). The Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPAD) were used to assess participants at baseline and after 4 weeks.

Results

Basic characteristics, NDI score and NPAD score were not significantly different between groups at baseline. The exercise arm demonstrated significantly lower scores regarding NDI (mean, 17.41 vs. 25.58; P-value = 0.035) and NPAD (mean, 25.33 vs. 66.67; P < 0.001), compared to the control arm after 4 weeks. The exercise arm also showed significant within group reduction considering NDI and NPAD scores after 4 weeks (Both, P < 0.001).

Conclusion

Our findings suggested that isometric exercises might be a beneficial treatment for improving pain and disability caused by cervical spondylosis.

Trial registration This study was registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N1, 07.05.2022, retrospectively registered.

Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial

Neck pain and forward head posture (FHP) are typical in prolonged smartphone users and need to be targeted for treatment. We aimed to compare the effect of a routine therapeutic program with and without respiratory exercises on smartphone users with FHP and non-specific chronic neck pain (NSCNP). Sixty patients (aged 24.7 ± 2.1 years) with FHP and NSCNP were randomly assigned to the routine therapeutic program (n = 20), combined respiratory exercises with a routine therapeutic program (n = 20), or control (n = 20) groups. At baseline, there was no difference among groups at all variables. Each programme was implemented three times a week for eight weeks. Primary Outcome was pain measured by visual analogue scale (VAS), and secondary ones were forward head angle, the activity of specific muscles, and respiratory patterns, measured by photogrammetry, electromyography and manual, respectively. All outcomes were measured at baseline and eight weeks post-treatment. We used the repeated measures analysis of variance to examine the interaction between time and group, paired t-test for intragroup comparison, one-way analysis of variance for intergroup comparison, and Tukey post hoc test at a significant level 95% was used. There were significant differences in the combined group compared with the routine therapeutic group (P = 0.03) for diaphragm muscle activation, respiratory balance (P = 0.01), and the number of breaths (P = 0.02). There were significant within-group changes from baseline to post-treatment in the combined group for all outcomes above, but no changes in the therapeutic exercise routine group. Despite respiratory pattern, none of the secondary outcomes proved to be superior in the combination group compared to the routine therapeutic program in smartphone users with FHP and NSCNP. Future studies with longer follow-up assessments could strengthen these results.

Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20200212046469N1 “Prospectively registered” at 04/03/2020.

Effect of pompage on pain, disability and craniocervical position of female teachers - Randomized clinical trial

Abstract Introduction: Education professionals are one of the most important occupational groups and represents one of the main parts of the economy of modern society. The vocal demands most mentioned by the teachers are talking while standing up, talking a lot and in a closed environment, which corresponds to the most frequent situations encountered in teaching. In addition, remaining in the standing position for a prolonged period may have repercussions on other systems and generate postural deviations, pain and reduced functionality. Objective: To verify changes in pressure pain threshold, in disability index and in craniocervical posture of female teachers with vocal and musculoskeletal complaints, and with normal larynx, after myofascial release - pompage. Methods: This study was a controlled and randomized clinical trial. The following procedures were performed: anamnesis, videolaryngoscopy, hearing screening, clinical and photogrammetric postural assessment using the SAPo® protocol, completion of the neck pain self-assessment protocol Neck Disability Index, and pain threshold in the cervical muscles using the Pain Pressure Threshold. Myofascial therapy with pompage had a total of 24 sessions of 40 min each, three times a week, in 28 teachers assigned to the study group (SG), and 28 to the control group (CG). Afterwards, the groups were reassessed. Results: The SG presented a significant improvement in the pain threshold of all the muscles evaluated, in the posture of most of the body segments evaluated, and in the cervical disability. In the CG there was a significant improvement in angle A2 after therapy. Conclusion: After myofascial release therapy with pompage, the subjects presented a reduction in cervical pain and in functional disability, an increase in pain threshold, and posture improvement.

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

Focus on the Scapular Region in the Rehabilitation of Chronic Neck Pain Is Effective in Improving the Symptoms: A Randomized Controlled Trial

Chronic neck pain is a common human health problem. Changes in scapular posture and alteration of muscle activation patterns of scapulothoracic muscles are cited as potential risk factors for neck pain. The purpose of this study was to compare the effects of neck exercise training (NET) with and without scapular stabilization training (SST) on pain intensity, the scapula downward rotation index (SDRI), forward head angle (FHA) and neck range of motion (ROM) in patients with chronic neck pain and scapular dyskinesia. A total of sixty-six subjects with chronic neck pain and scapular dyskinesia were randomly divided into three groups: neck exercise training, n = 24, combined training (NET + SST), n = 24 and a control group, n = 24. Pain intensity, SDRI, FHA and ROM were measured by the numerical rating scale, caliper, photogrammetry and IMU sensor, respectively. When the combined intervention group consisting of NET and SST was compared with NET alone at six weeks, there was a statistically significant difference in pain intensity, SDRI, FHA and cervical ROM for flexion and extension (p ≤ 0.05). Adding scapular exercises to neck exercises had a more significant effect in decreasing pain intensity, SDRI, FHA and increased cervical ROM than neck exercises alone in patients with chronic neck pain. These findings indicate that focus on the scapular posture in the rehabilitation of chronic neck pain effectively improves the symptoms.

The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient’s functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient’s postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expression. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.

Additive effect of "Brahma Mudra" on pain, proprioception and functional abilities in non-specific mechanical neck pain

OBJECTIVE

Being the second highest musculoskeletal problem irrespective of age, gender and occupation, the etiology of neck pain is predominantly mechanical in nature. This can lead to dysfunction with time and recurrence. Altered joint position sense (JPS) from soft tissues can alter the cervical biomechanics by compromising the cephalo spatial orientation, which depends on the visual, vestibular and proprioceptive cues. This study was done to observe the additive effect of "Brahma mudra" (BM) a yogic tool on non-specific mechanical neck pain and its clinical implication on pain, proprioception and functional abilities.

METHODS

It was a quasi-experimental pre -post study design involving 30 individuals from a software firm between the age group of 18-45 years. The conventional treatment group received standard physiotherapy regime and in the BM group BM was incorporated in addition to standard physiotherapy regime. Independent sample student t-test/Mann Whitney test were used to compare continuous variables between two groups. Paired sample test/Wilcoxon signed rank test were used for within groups.

RESULTS

There was a significant reduction in pain, improved functional abilities and proprioception in BM group when compared to conventional treatment group with 0.01 level of statistical significance.

CONCLUSION

It may be concluded that practice of BM had an added effect to conventional standard physiotherapy regime in reduction of pain, improvement of proprioception and functional abilities among individuals with chronic non-specific mechanical neck pain.

Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial

Background: Flexion-rotation test predominantly measures rotation in C1-2 segment. Restriction in flexion-rotation may be due to direct limitation in C1-2, but also to a premature tightening of the alar ligament as a result of lack of movement in C0-1 or C2-3. The aim of this study was to compare the effect of a 20-min single cervical exercise session, with or without manual therapy of C0-1 and C2-3 segment in flexion-rotation test, in patients with chronic neck pain and positive flexion-rotation test. Methods: Randomized controlled clinical trial in 48 subjects (24 manual therapy+exercise/24 exercise). Range of motion and pain during flexion-rotation test, neck pain intensity and active cervical range of motion were measured before and after the intervention. Results: Significant differences were found in favour of the manual therapy group in the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); pain during the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); neck pain intensity: (p < 0.001); cervical flexion (p < 0.038), extension (p < 0.010), right side-bending (p < 0.035), left side-bending (p < 0.002), right rotation (p < 0.001), and left rotation (p < 0.006). Conclusions: Addition of one C0-C1 and C2-C3 manual therapy session to cervical exercise can immediately improve flexion-rotation test and cervical range of motion and reduce pain intensity.

Clinical and radiological outcomes of kinesiotaping in patients with chronic neck pain: A double-blinded, randomized, placebo-controlled study

Objectives

In this study, we aimed to evaluate the efficacy of kinesiotaping (KT) in patients with chronic non-specific neck pain (NSNP) in terms of pain, disability, cervical range of motion (ROM), and cervical lordosis.

Patients and methods

Between October 2013 and March 2014, a total of 50 patients (10 males, 40 females; mean age 35.1±9.9 years; range, 17 to 62 years) with chronic NSNP were randomized into the KT (n=25) or the sham KT intervention (n=25) groups. Both groups were additionally given a therapeutic exercise (TE) program. The Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores and ROM measurements were recorded at baseline, at the end of treatment, and at one month. Lateral cervical digital radiographs were analyzed by the Cobb, posterior tangent and effective lordosis methods at baseline and at one month after the treatment.

Results

There was a statistically significant decrease in the VAS scores compared to baseline in the KT group. The NDI scores significantly decreased in both groups. The patients in the KT group experienced a significant increase in all planes of cervical ROM after the treatment. Cervical radiographs revealed a significant increase in the Cobb and posterior tangent angles only in the KT group.

Conclusion

Our study results suggest that KT significantly improves VAS, NDI scores, ROM and cervical lordosis angles. The combination of TE and KT is useful in reducing pain and disability and improving ROM and cervical lordosis loss in patients with chronic NSNP.

Motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain: A systematic review and meta-analysis

BACKGROUND

The effects of motor control training with pressure biofeedback on neck pain and disability of patients with neck pain is a field that has drawn a lot of research interest. Therefore, the aim of this study was to conduct, for the first time, a systematic review and meta-analysis for examining whether motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain.

METHODS

The systematic review and meta-analysis were performed according to PRISMA guidelines. The databases PubMED, MEDLINE, EBSCOhost, Google scholar, SportDiscus, COCHRANE and EMBASE were searched for studies related to the research question. PEDro scale was used for examining methodological quality. A random effects model was used for data meta-analysis.

RESULTS

Seventeen studies were included for qualitative synthesis and 10 were selected for further quantitative synthesis. Motor control training of deep neck flexors with pressure biofeedback was found to have equal or better effectiveness on neck pain intensity and disability in comparison to other control interventions. The meta-analyses show that motor control training of deep neck flexors with pressure biofeedback is more effective than strength-endurance training of cervical muscles for improving pain (Hedges' g = 0.323, 95% CI 0.04-0.60, I² = 50.94%) and disability (Hedges g = 0.401, 95% CI 0.12-0.68, I² = 53.44%) in patients with neck pain.

CONCLUSIONS

Motor control training of deep neck flexors with pressure biofeedback is an effective intervention for improving pain intensity and disability in patients with neck pain and preferable to strength-endurance training of cervical muscles.

Effect of adding motor imagery training to neck stabilization exercises on pain, disability and kinesiophobia in patients with chronic neck pain

PURPOSE

The investigation of this study was to compare the effect of adding motor imagery training to neck stabilization exercises on pain, disability, and kinesiophobia in patients with chronic neck pain.

MATERIAL AND METHODS

After screening, seventy-two volunteers with chronic neck pain were randomly allocated to 3 groups: neck stabilization exercises alone, n = 24, combined ( neck stabilization exercises + motor imagery training), n = 24, and a control group, n = 24. Pain intensity, disability, and kinesiophobia before and after the intervention exercises were measured by the Visual Analog Scale, Neck Disability Index, and the Tampa Scale of Kinesiophobia , respectively.

RESULTS

Statistically significant differences in pain intensity, the neck disability index, and kinesiophobia were found when a combined intervention group including neck stabilization and motor imagery training was compared with neck stabilization training alone at 6 weeks ) p ≤ 0.005). Also, there were significant between-group differences favoring experimental groups versus control for all outcomes (p ≤ 0.001).

CONCLUSION

neck stabilization exercises in combination with motor imagery training was superior to neck stabilization exercises alone in decreasing pain, disability, and kinesiophobia in patients with chronic neck pain.

Measurement Properties of the Craniocervical Flexion Test: A Systematic Review

OBJECTIVE

Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles.

METHODS

The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence.

RESULTS

Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included.

CONCLUSIONS

The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.

Effectiveness and optimal dosage of exercise training for chronic non-specific neck pain: A systematic review with a narrative synthesis

BACKGROUND

Clinical guidelines make vague recommendations as to exercise training (ET) type and dosage to manage chronic non-specific neck pain (CNSNP).

OBJECTIVE

To synthesise evidence on the effectiveness of different ET programmes to reduce CNSNP and associated disability, and whether dosage affects outcomes.

METHODS

A systematic review and data synthesis was conducted according to a published registered protocol (PROSPERO CRD42018096187). A sensitive topic-based search was conducted of CINAHL, MEDLINE, EMBASE, PEDro, grey literature sources and key journals from inception to 6th January 2020 for randomised controlled trials, investigating ET for CNSNP or disability. Two reviewers independently completed eligibility screening, data extraction, risk of bias assessment (Cochrane Risk of Bias Tool) and rated the overall strength of evidence using Grading of Recommendations Assessment, Development and Evaluation. Data was tabulated for narrative synthesis and grouped by intervention, outcome and time point to compare across studies.

RESULTS

Twenty-six trials from 3990 citations (n = 2288 participants) investigated fifteen ET programmes. High RoB and low sample sizes reduced evidence quality. Clinical heterogeneity prevented meta-analyses. A range of ET programmes reduce pain/disability in the short term (low to moderate evidence). Pillar exercises reduce pain/disability in the intermediate term (low level evidence). Moderate to very large pain reduction is found with ET packages that include motor control + segmental exercises (low to moderate evidence). No high-quality trials investigated long term outcomes. Increased frequency of motor control exercises and progressively increased load of pillar exercise may improve effectiveness.

CONCLUSIONS

Motor control + segmental exercises are the most effective ET to reduce short term pain/disability, but long-term outcomes have not been investigated. Optimal motor control + segmental exercise variables and dosage is unknown and requires clarification. An adequately powered, low RoB trial is needed to evaluate the effectiveness and optimal dosage of motor control + segmental on long term outcomes.

TRIAL REGISTRATION

PROSPERO CRD42018096187.

Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial

OBJECTIVE

The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP).

DESIGN

Randomized controlled trial.

SETTING

Outpatient care units.

SUBJECTS

Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups.

INTERVENTIONS

Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy.

MAIN MEASURES

The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up.

RESULTS

Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P₂₅-P₇₅): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P₂₅-P₇₅): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group.

CONCLUSION

This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.

Four-year pain relief after coblation combined with active exercise for cervical discogenic pain: Case report

RATIONALE

Coblation of intervertebral disc is an effective and safe minimally invasive technology for treating discogenic pain. The inactivation of neural ingrowth around annulus and tissue ablation and coagulation are currently considered to be the major causes for success of this treatment. However, it has been found by clinical researchers that its long-term clinical outcome is not optimistic. This report has given us favorable information that this situation can be improved with multimodal therapy.

PATIENT CONCERNS

A 61-year-old man presented with right severe neck and shoulder pain in 2014 which could not be relieved by medications.

DIAGNOSES

According to his symptoms and signs, this patient was diagnosed with cervical discogenic pain. And discography confirmed the diagnosis.

INTERVENTIONS

The patient underwent coblation of cervical intervertebral disc 4-5 (C4-5) and got apparently pain relief after surgery. After 1 month, he began to perform active exercise at least 30 min every day.

OUTCOMES

The right neck and shoulder pain completely relieved for 4 years. The cervical lordosis of this patient was restored in 2018 which was confirmed by MRI compared in 2014 and NDI (neck disability index) decreased from 58 to 10%.

LESSONS

This report demonstrated that it was important and essential for clinicians to educate patients with discogenic pain to perform active exercise after minimally invasive surgery.