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Dere T, Alemdaroğlu-Gürbüz İ. Muscular endurance and its association with neck pain, disability, neck awareness, and kinesiophobia in patients with chronic neck pain. Somatosens Mot Res 2024; 41:134-141. [PMID: 36897182 DOI: 10.1080/08990220.2023.2186390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Recent studies revealed the connection between the endurance of neck muscles and pain, neck awareness, and fear of movement in patients with chronic neck pain in literature. OBJECTIVES To investigate the association between cervical, scapular, trunk, and upper extremity muscles' endurance and neck pain, disability, neck awareness, and kinesiophobia in patients with chronic neck pain. DESIGN Cross-sectional, observational study. METHODS Thirty-six patients with chronic neck pain (aged 18-65 years) were included in the study. Endurance tests were performed for 9 muscles/muscle groups in the cervical and scapular region, upper limb, and trunk. Pain severity, neck disability, neck awareness, and fear of movement were measured by Visual Analog Scale (VAS), Neck Disability Index (NDI), Fremantle Neck Awareness Questionnaire (FreNAQ), and Tampa Scale of Kinesiophobia (TSK), respectively. RESULTS Negative, weak-to-moderate relations were found between VAS (at rest and during activity) and the endurance of muscles evaluated in the cervical and scapular regions, upper extremity, and trunk as well as between NDI and endurance of the same muscles, similar to the relations between FreNAQ scores and the endurance of the cervical flexor, anterior trunk flexor, and upper extremity muscles (p < 0.05). No relation was found between the endurance of the muscles and TSK (p > 0.05). CONCLUSIONS Since the decrease in upper extremity, scapular region, and trunk muscles' endurance may contribute to neck pain and disability, and decrease neck awareness in patients with chronic neck pain; the evaluation of muscular endurance of upper body and trunk should also be considered. CLINICAL TRIALS NCT05121467.
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Affiliation(s)
- Tuğba Dere
- School of Sarıkaya Physical Therapy and Rehabilitation, Yozgat Bozok University, Yozgat, Turkey
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Tsai CS, Li HT, Yang WL, Jhan YT. The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial. Spinal Cord Ser Cases 2024; 10:27. [PMID: 38654004 DOI: 10.1038/s41394-024-00637-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. OBJECTIVE This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. SETTING Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. METHOD Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. RESULT The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). CONCLUSION The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. IRB TRIAL REGISTRATION TYGH108045. CLINICAL TRIAL REGISTRATION NCT04500223.
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Affiliation(s)
- Cheng Shin Tsai
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
| | - Hsin-Tzu Li
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wan-Li Yang
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yi-Ting Jhan
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
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Avaghade RR, Shinde SB, Dhane SB. Effectiveness of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: An experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:225. [PMID: 37727425 PMCID: PMC10506789 DOI: 10.4103/jehp.jehp_239_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND This study "Effectiveness of Mckenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: an experimental study" was conducted to study and find the effectiveness of Mckenzie approach and segmental spinal stabilization exercises on reduction of pain, correction of rounded shoulder, and disability. Pain, disability, and rounded shoulders are the major limiting factors as it affects the quality of life and reduces efficiency and social participation. MATERIALS AND METHODS The study was conducted among 120 individuals with cervical postural syndrome, and fulfilling the inclusion and exclusion criteria was included. The outcome measures were Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Vernier caliper to evaluate pain, functional disability, and rounded shoulder, respectively. Subjects were randomly divided into two groups, Group A and Group B, by using SPSS software. Interventional training was given for 6 weeks to the patients. Group A subjects were given spinal stabilization exercises. Group B subjects were given Mckenzie approach. The statistical analysis was performed using SPSS; pre-test and post-test were used to calculate the results, followed by data presentation and analysis. RESULT The result showed that at the end of the 6 weeks on comparison between pre- and post-intervention of Group A and Group B, both the techniques were effective, but group B was significantly effective than Group A. CONCLUSION It was noted that McKenzie approach and segmental spinal stabilization exercises were effective on neck pain in individuals with cervical postural syndrome, but on comparing both techniques, Mckenzie protocol is more beneficial than segmental spinal stabilization exercises. The study accepts the alternate hypothesis that there is significant effect of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome.
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Affiliation(s)
- Rutuja R. Avaghade
- Department of Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
| | - Sandeep B. Shinde
- Department of Musculoskeletal Sciences Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
| | - Sayalee B. Dhane
- Department of Musculoskeletal Sciences Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
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Chen Z, Falla D, Elgueta Cancino E, A Deane J. 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. BMJ Open 2023; 13:e074494. [PMID: 37429689 PMCID: PMC10335581 DOI: 10.1136/bmjopen-2023-074494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
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.
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Affiliation(s)
- Ziyan Chen
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Edith Elgueta Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
| | - Janet A Deane
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Yan ZW, Yang Z, Zhao FL, Gao Y, Wu ZK, Wang JL, Zhou M. Effect of sling exercise therapy on surface electromyography and muscle thickness of superficial cervical muscle groups in female patients with chronic neck pain. J Back Musculoskelet Rehabil 2022; 36:387-397. [PMID: 36278336 DOI: 10.3233/bmr-220030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients. OBJECTIVE To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain. METHODS Twenty-five patients with chronic neck pain were randomly assigned to the SET group (n= 12) or the control group (n= 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test. RESULTS At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p< 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p< 0.05). There were no within-group differences in the control group (p> 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p< 0.05). CONCLUSION 4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck.
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Affiliation(s)
- Zhi-Wei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China.,Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Zhen Yang
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK.,Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Feng-Long Zhao
- Institute of Ultrasonic Engineering in Medicine, Chongqing Key Laboratory of Ultrasound Medical Engineering, Department of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yan Gao
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Zhen-Kun Wu
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Jie-Long Wang
- School of Physical Education and Sports Science, Soochow University, Suzhou, China
| | - Mei Zhou
- Laboratory Management Center, Shenyang Sport University, Liaoning, China
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Investigation of the effectiveness of neck stabilization exercises in patients with chronic neck pain: A randomized, single-blind clinical, controlled study. Turk J Phys Med Rehabil 2022; 68:364-371. [DOI: 10.5606/tftrd.2022.8481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Effect of manual soft tissue therapy on the pain in patients with chronic neck pain: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 49:101619. [DOI: 10.1016/j.ctcp.2022.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
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Villanueva-Ruiz I, Falla D, Lascurain-Aguirrebeña I. Effectiveness of Specific Neck Exercise for Nonspecific Neck Pain; Usefulness of Strategies for Patient Selection and Tailored Exercise-A Systematic Review With Meta-Analysis. Phys Ther 2022; 102:6423600. [PMID: 34935963 DOI: 10.1093/ptj/pzab259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Specific neck exercises (SNE) targeting deep cervical flexors and extensors are commonly used for the treatment of nonspecific neck pain (NSNP). However, whether SNE are more effective than alternative exercise interventions (AEI) remains unclear. Furthermore, it has been postulated that SNE may be most effective when they are tailored and targeted to patients with evidence of motor control dysfunction, yet this notion also remains unproven. The objectives of this study were to compare the effectiveness of SNE with that of AEI for reducing pain and disability in people with NSNP and to assess whether the effectiveness of SNE is increased when the exercises are tailored and provided to patients with evidence of motor control dysfunction. METHODS For this systematic review with meta-analysis, Medline, Web of Science, Scopus, and Physiotherapy Evidence Database were searched. Eligibility criteria included randomized controlled trials evaluating the effectiveness of SNE against that of AEI in people with NSNP. Meta-analysis included subgroup analyses to determine the effect of exercise tailoring and participant selection criteria on the effectiveness of SNE. RESULTS Twelve studies were included. Meta-analysis revealed greater effectiveness of SNE in the short to medium term for reducing pain (pooled standardized mean difference [SMD] = -0.41; 95% CI = -0.76 to -0.06; P = .02) and disability (pooled SMD = -0.41; 95% CI = -0.78 to -0.04; P = .03) but no differences in the long term for pain (pooled SMD = -1.30; 95% CI = -3.35 to 0.75; P = .21) and disability (pooled SMD = -1.81; 95% CI = -4.29 to 0.67; P = .15), although evidence was limited for the latter. The effectiveness of SNE was not superior in studies that included only participants with motor control dysfunction or when exercises were tailored to each participant. Overall, the studies were of low quality. Grading of Recommendations Assessment, Development and Evaluation revealed low certainty, serious risk of bias, and inconsistency of findings for short- to medium-term effects and very low certainty, serious risk of bias, and very serious inconsistency for long-term effects. CONCLUSION The preferential use of SNE may be recommended to achieve better short- to medium-term outcomes, although the low quality of evidence affects the certainty of these findings. Currently used strategies for selecting patients and tailoring SNE are not supported by the evidence and therefore cannot be recommended for clinical practice. IMPACT SNE are more effective than AEI for reducing pain and disability in patients with NSNP in the short to medium term, but overall evidence is of low quality, affecting the certainty of the findings. Tests of muscle dysfunction (mostly the craniocervical flexion test) currently used in studies to select patients and tailor SNE do not result in greater effectiveness of these exercises. LAY SUMMARY Evidence suggests SNE are more effective than other forms of exercise, although evidence is overall of low quality. Use of the craniocervical flexion test in isolation to select participants and/or tailor SNE cannot be recommended.
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Affiliation(s)
- Iker Villanueva-Ruiz
- Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain.,Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences. College of Life and Environmental Sciences. University of Birmingham, Edgbaston, United Kingdom
| | - Ion Lascurain-Aguirrebeña
- Physiotherapy, Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain
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Pozsgai M, Szabo I, Nusser N, Varnai R, Sipeky C. Overview of Registered Clinical Trials on Manual Therapy: Possible Implications of Genetic Testing for Personalized Treatment. In Vivo 2022; 36:294-305. [PMID: 34972726 DOI: 10.21873/invivo.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Manual therapy (MT) is a frequently applied intervention offering individualized treatment in the clinic. In addition to the traditional approaches of MT, measuring molecular response to MT may offer better understanding of MT outcomes in order to provide specific personalized treatment. The aim of this study was to summarize MT-related registered clinical trials, as well as to search for any evidence on MT and genetics. PATIENTS AND METHODS A comprehensive search was conducted within the Clinical Trials database with predefined keywords mining for all types of MT-related clinical trials. RESULTS From the 47 trials, 20 had results and 27 had no results. MT alleviated pain and improved function almost in all trials. One registered clinical trial had investigated molecular outcomes of MT. CONCLUSION MT is an effective and individualized treatment offering option in the management of several conditions. Interestingly, a clinical trial was found investigating molecular genetics and MT pinpointing an already existing link between genetics and MT. Therefore, further clinical trials may focus on genetics and MT for providing specific personalized treatment in future.
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Affiliation(s)
- Miklos Pozsgai
- Medical School, University of Pécs, Pécs, Hungary; .,Harkány Termal Rehabilitation Centre, Harkány, Hungary
| | - Istvan Szabo
- Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary.,Faculty of Sciences, Doctoral School of Biology and Sportbiology, University of Pécs, Pécs, Hungary
| | - Nora Nusser
- Medical School, University of Pécs, Pécs, Hungary.,Harkány Termal Rehabilitation Centre, Harkány, Hungary
| | - Reka Varnai
- Department of Primary Health Care, Medical School, University of Pécs, Pécs, Hungary
| | - Csilla Sipeky
- Institute of Biomedicine and Cancer Research Laboratories, Western Cancer Centre FICAN West, University of Turku, Turku, Finland
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Toth E, Pesce A, Tartaglia G, Russo GM, Inghilleri M, Caruso R. The beneficial effect of physiotherapy on the cervical spine mobility of ACDF patients and healthy individuals: An original observational cohort comparison research protocol. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tsiringakis G, Dimitriadis Z, Triantafylloy E, McLean S. 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. Musculoskelet Sci Pract 2020; 50:102220. [PMID: 32827852 DOI: 10.1016/j.msksp.2020.102220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Georgios Tsiringakis
- Physiotherapy Department, Allied Health Professions Department, Sheffield Hallam University, UK.
| | - Zacharias Dimitriadis
- Health and Quality of Life Assessment Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Greece
| | - Evripidis Triantafylloy
- Physiotherapy Department, Allied Health Professions Department, Sheffield Hallam University, UK
| | - Sionnadh McLean
- Physiotherapy Department, Allied Health Professions Department, Sheffield Hallam University, UK
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de Zoete RM, Armfield NR, McAuley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Br J Sports Med 2020; 55:bjsports-2020-102664. [PMID: 33139256 DOI: 10.1136/bjsports-2020-102664] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain. DESIGN Systematic review and network meta-analysis. DATA SOURCES Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain. RESULTS The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges' g, pain -1.32, 95% CI: -1.99 to -0.65; disability -0.87, 95% CI: -1.45 o -0.29), yoga/Pilates/Tai Chi/Qigong (pain -1.25, 95% CI: -1.85 to -0.65; disability -1.16, 95% CI: -1.75 to -0.57) and strengthening (pain -1.21, 95% CI: -1.63 to -0.78; disability -0.75, 95% CI: -1.28 to -0.22). Other interventions, including range of motion (pain -0.98 CI: -2.51 to 0.56), balance (pain -0.38, 95% CI: -2.10 to 1.33) and multimodal (three or more exercises types combined) (pain -0.08, 95% CI: -1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. CONCLUSION There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain. PROSPERO REGISTRATION NUMBER CRD42019126523.
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Affiliation(s)
- Rutger Mj de Zoete
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel R Armfield
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
| | - James H McAuley
- Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenneth Chen
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
- Geriatric Education and Research Institute, Singapore
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
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The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain. Healthcare (Basel) 2020; 8:healthcare8040449. [PMID: 33139645 PMCID: PMC7712906 DOI: 10.3390/healthcare8040449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic neck pain (CNP) patients have weak deep neck flexors (DNF) and a hyperactive sternocleidomastoid (SCM). The cranio-cervical flexion test (CCFT) promotes activation of the DNF and decreases activity of the SCM, promoting pain recovery, but research suggests SCM activation increases with increasing gaze direction. We aimed to investigate how DNF and SCM activation varies according to gaze direction in the CCFT, and to prescribe the appropriate gaze direction for CNP. Twenty-eight CNP subjects had their maximum strength pressure level determined by CCFT for strength (20-~30 mmHg) and at each of the measured pressures, DNF and SCM thickness in each of four gaze directions (0°, 20°, 40°, and 60°) was measured by ultrasound imaging. The DNF to SCM ratio varied significantly according to gaze direction (p < 0.05), with gaze directions of 20° and 0° being significantly different from 40° (p < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation (p < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° (p < 0.05). In order to increase DNF activation efficiency during the CCFT, SCM activation should be controlled, and a gaze direction below 20° is the most efficient. This can inform DNF training of CNP patients in a clinical environment.
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Women with mechanical neck pain exhibit increased activation of their superficial neck extensors when performing the cranio-cervical flexion test. Musculoskelet Sci Pract 2020; 49:102222. [PMID: 32861371 DOI: 10.1016/j.msksp.2020.102222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
Several studies have analysed the activity of superficial neck flexors, but the activity of neck extensors has been less investigated in patients with neck pain OBJECTIVES: 1, to investigate the differences in the activation of superficial neck flexor and extensor musculature during the cranio-cervical flexion test (CCFT) in women with mechanical chronic neck pain when compared to asymptomatic women; 2, to investigate the correlation between neck muscle activity and the clinical features of neck pain DESIGN: Cross-sectional METHODS: Surface electromyography was recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles of 30 women with mechanical chronic neck pain and 30 asymptomatic women as they performed the CCFT. Comparisons of the normalized root mean square between both groups were conducted with 2x5 ANCOVA with task level as the within-subjects variable, group as the between-subjects variable, and pain related-disability as a co-variate RESULTS: Women with mechanical neck pain exhibited increased activity of superficial neck flexors (sternocleidomastoid: F = 14.448, P < 0.001; anterior scalene: F = 21.693, P < 0.001) and superficial neck extensors (splenius capitis: F = 4.692, P < 0.001; upper trapezius: F = 4.245, P < 0.001) as compared to asymptomatic women. Higher pain related-disability was associated with more electrical activity of the anterior scalene and upper trapezius muscles during the CCFT CONCLUSIONS: Women with mechanical chronic neck pain exhibit an increased activity of their superficial neck flexors and superficial neck extensors during a low-load task such as CCFT when compared to asymptomatic pain-free women. Our results should be considered when designing therapeutic exercise programs for this population.
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Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155430. [PMID: 32731521 PMCID: PMC7432242 DOI: 10.3390/ijerph17155430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.
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The Potential Role of the Cervical Spine in Sports-Related Concussion: Clinical Perspectives and Considerations for Risk Reduction. J Orthop Sports Phys Ther 2019; 49:202-208. [PMID: 30645949 PMCID: PMC7102493 DOI: 10.2519/jospt.2019.8582] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sports-related concussion (SRC) occurs due to biomechanical forces to the head or neck that can result in pathophysiological changes in the brain. The musculature of the cervical spine has been identified as one potential factor in reducing SRC risk as well as for underlying sex differences in SRC rates. Recent research has demonstrated that linear and rotational head acceleration, as well as the magnitude of force upon impact, is influenced by cervical spine biomechanics. Increased neck strength and girth are associated with reduced linear and rotational head acceleration during impact. Past work has also shown that overall neck strength and girth are reduced in athletes with SRC. Additionally, differences in cervical spine biomechanics are hypothesized as a critical factor underlying sex differences in SRC rates. Specifically, compared to males, females tend to have less neck strength and girth, which are associated with increased linear and rotational head acceleration. Although our ability to detect SRC has greatly improved, our ability to prevent SRC from occurring and decrease the severity of clinical outcomes postinjury is limited. However, we suggest, along with others, that cervical spine biomechanics may be a modifiable factor in reducing SRC risk. In this commentary, we review the role of the cervical spine in reducing SRC risk, and how this risk differs by sex. We discuss clinical considerations for the examination of the cervical spine and the potential clinical relevance for SRC prevention. Additionally, we provide suggestions for future research examining cervical spine properties as modifiable factors in reducing SRC risk. J Orthop Sports Phys Ther 2019;49(3):202-208. Epub 15 Jan 2019. doi:10.2519/jospt.2019.8582.
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Blomgren J, Strandell E, Jull G, Vikman I, Röijezon U. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord 2018; 19:415. [PMID: 30486819 PMCID: PMC6263552 DOI: 10.1186/s12891-018-2324-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Neck pain is a major health issue with high rates of recurrence. It presents with a variety of altered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods are used. Exercise is evaluated in most randomized controlled trials on its pain relieving effects. No review has assessed the effect of exercise on the altered physiological functions or determined if there are differential effects of particular training methods. This review investigated the effects of deep cervical flexor (DCF) training, a training method commonly used for patients with neck pain, and compared it to other training methods or no training on outcomes of cervical neuromuscular function, muscle size, kinematics and kinetics. Methods Web of Science, Scopus, CINAHL, PubMed were searched from inception until January 2018. Twelve randomized controlled trials were included that compared DCF training as sole intervention to other training or no interventions in persons with neck pain. The Cochrane Risk of Bias tool was used to assess the method quality. All outcome measures were analysed descriptively and meta-analyses were performed for measures evaluated in three or more studies. Results DCF training was compared to cervical endurance, strength, proprioception and mobility training, muscle stretching, and no intervention control groups. Physiological outcome measures included neuromuscular co-ordination (craniocervical flexion test), functional tasks, muscle fatigability, muscle size, kinematics (joint position sense, posture and range of motion) and kinetics (strength, endurance and contraction accuracy). Strong evidence was found for effectiveness of DCF training on neuromuscular coordination, but it had no or small effects on strength and endurance at higher loads. DCF training improved head and cervical posture, while evidence was limited or contradictory for other measures. Conclusions DCF training can successfully address impaired neuromuscular coordination, but not cervical flexor strength and endurance at higher contraction intensities. A multimodal training regime is proposed when the aim is to specifically address various impaired physiological functions associated with neck pain.
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Affiliation(s)
- Johannes Blomgren
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Erika Strandell
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Gwendolen Jull
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Irene Vikman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Ulrik Röijezon
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
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Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study. Spine (Phila Pa 1976) 2018; 43:E1174-E1183. [PMID: 29652778 DOI: 10.1097/brs.0000000000002663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study was a prospective, randomized, controlled study. OBJECTIVE The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood and quality of life for chronic neck pain (CNP). SUMMARY OF BACKGROUND DATA Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear. METHODS A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE, and third group had IFC and NSE. Pain levels [visual analogue scale (VAS)], limits of cervical range of motion (ROM), quality of life (short form-36), mood (Beck depression inventory), levels of disability (Neck Pain and Disability Index), and the need for analgesics of all patients were evaluated before treatment, at 6th and 12th week follow-up. Physical therapy modalities were applied for 15 sessions in all groups. All participants had group exercise accompanied by a physiotherapist for 3 weeks and an additional 3 weeks of home exercise program. RESULTS According to the intragroup assessment, the study achieved its purpose of pain reduction, ROM increase, improvement of disability, quality of life, mood and reduction in drug use in all three treatment groups (P < 0.05). However, clinical outcomes at 6th and 12 th week had no significant difference among the three groups (P > 0.05). CONCLUSION TENS and IFC therapies are effective in the treatment of CNP patients. However, they have no additional benefit or superiority over NSE. LEVEL OF EVIDENCE 2.
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Maicki T, Bilski J, Szczygieł E, Trąbka R. PNF and manual therapy treatment results of patients with cervical spine osteoarthritis. J Back Musculoskelet Rehabil 2017; 30:1095-1101. [PMID: 28946528 PMCID: PMC5814664 DOI: 10.3233/bmr-169718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of PNF and manual therapy methods in the treatment of patients with cervical spine osteoarthritis, especially their efficacy in reducing pain and improving functionality in everyday life. Long-term results were also compared in order to determine which method of treatment is more effective. SUBJECTS AND METHODS Eighty randomly selected females aged 45-65 were included in the study. They were randomly divided into two groups of 40 persons. One group received PNF treatment and the other received manual therapy (MAN.T). To evaluate functional capabilities, the Functional Rating Index was used. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used. RESULT The PNF group achieved a greater reduction in pain than the MAN.T group. The PNF group showed a greater improvement in performing daily activities such as sleeping, personal care, travelling, work, recreation, lifting, walking and standing as well as decreased intensity and frequency of pain compared to the MAN.T group. CONCLUSION The PNF method proved to be more effective in both short (after two weeks) and long (after three months) term.
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Affiliation(s)
- Tomasz Maicki
- Clinic of Rehabilitation, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland,Cracow Rehabilitation and Orthopedics Center, Krakow, Poland,Corresponding author: Tomasz Maicki, Clinic of Rehabilitation, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, ul. Przegorzalska 23, 30-252 Kraków, Poland. E-mail: .
| | - Jan Bilski
- Department of Ergonomics and Exercise Physiology, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Szczygieł
- Rehabilitation in Orthopaedics, Faculty of Rehabilitation, Department of Clinical Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Rafał Trąbka
- Clinic of Rehabilitation, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland,Cracow Rehabilitation and Orthopedics Center, Krakow, Poland
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Mani S, Sharma S, Omar B, Ahmad K, Muniandy Y, Singh DKA. Quantitative measurements of forward head posture in a clinical settings: a technical feasibility study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1296888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Suresh Mani
- Faculty of Health Sciences, School of Rehabilitation Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shobha Sharma
- Faculty of Health Sciences, School of Rehabilitation Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Baharuddin Omar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kartini Ahmad
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yughdtheswari Muniandy
- Faculty of Health Sciences, School of Rehabilitation Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, School of Rehabilitation Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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