Article

Efficacy of deep neck flexor exercise for neck pain: A randomized controlled study

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Abstract

Objectives: This study aims to investigate the efficacy of deep neck flexor exercises in the management of neck pain. Patients and methods: Sixty patients with non-specific neck pain of at least six-week duration were randomized into one of three groups: group 1 - physical therapy agents including transcutaneous electrical nerve stimulation, continuous ultrasound and infra-red irradiation; group 2 - physical therapy agents + isometric, stretching, and scapulothoracic exercises; and group 3 - physical therapy agents + deep neck flexor exercise. The patients were evaluated with a visual analog scale (VAS), Neck Disability Index (NDI), and the range of motion in the three planes at baseline and after one month of treatment, and at three-month follow-up period. Results: Compared to baseline, all groups showed a significant decrease in VAS scores at one month. However, this improvement was achieved only in group 3 at three months indicating a significant difference among the groups (p<0.05). During the study, the improvement in disability was significant in group 3, as assessed by the NDI and range of motion (p<0.05). Conclusion: This study demonstrates the superiority of the deep neck flexor exercise, which offers several advantages in pain, disability, and range of motion outcomes, compared to isometric, stretching, and scapulothoracic exercises in combination with physical therapy agents for the management of neck pain. © 2016 by Turkish Society of Physical Medicine and Rehabilitation.

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... Sel lek s, et K T Fh-d soor itada kor rek tselt, tuleb järgida mõningaid metoodilisi aspekte. KTFh õppimist võiks alustada selili asendis, tehes aeglaselt ja rahulikult noog utusliig utuse, nii et kaelalordoos lameneb (21). Liigutus peaks sarnanema pigem sagitaaltasapinnalise rotatsiooni kui kaela retraktsiooniga (23). ...
... Tuleb jälgida, et rinnaku-rangluu-nibujätke lihas ja eesmine astriklihas ei kontraheeruks. Fleksiooni asendit hoitakse 10 sekundit (16,18,(20)(21)(22)(23), osas uuringutes kuni 20 sekundit (25). Enamasti tehakse 10 kuni 15 kordust (11, 16, 18-22, 24, 25). ...
... KTFh ja isomeetriliste kaelaharjutuste mõju kaelavalule (11,17,21,23,25), kaela funktsioonile (11,17,21,23,25), kaela painutajalihaste vastupidavusele (23), kaela liikuvusele (17,23), kaela pikklihase ristlõikepindalale (25), pea ja õlgade asendile (11), patsiendi meeleolule (17) on võrreldud viies uuringus. Tuginedes ühe hea (23) ja nelja kehvema (11,17,21,25) kvaliteediga uuringu samasuunalistele tulemustele, võib väita, et on olemas mõõdukas tõendus, et eelistada kroonilise kaelavalu vähendamisel ja kaela funktsiooni parandamisel KTFh-d tavapärastele isomeetrilistele harjutustele, isegi kui viimastele on lisatud näiteks dünaamilised harjutused, kaela liikuvust suurendavad harjutused või venitused. ...
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Craniocervical flexion training is addressed to activate deep neck flexors, allowing correction of neck position and reduction in chronic neck pain. The PEDro scale as a measure of methodological quality of clinical trials and best-evidence synthesis was used to answer the question whether craniocervical flexion exercise is helpful in chronic neck pain and whether it is superior than other exercise types. Use of craniocervical flexion training in reducing chronic neck pain and improving neck function in comparison with conventional isometric neck exercises was supported by moderate evidence. There is insufficient evidence to confirm or refute the efficacy of craniocervical flexion training compared to cervical flexion or extension training, considering quality issues and inconsistencies in results. Considering the limited number of studies, it is not possible to draw conclusions about the effectiveness of craniocervical flexion over the rest of exercise types (neck school or head-neck proprioceptive training). Finally, relatively small sample sizes could have caused underestimation of the efficacy of interventions.
... The pressure biofeedback unit was centered just below the occiput between the plinth and the back of the neck and inflated to a baseline of 20 mmHg. Each subject was asked to gently and slowly execute the head nodding action (as if they said yes) at five different levels of pressure (22,24,26, 28 and 30 mmHg) and to maintain each level for 10 seconds There was a 30-second rest period between each level. The test protocol ended when the subject was unable to hold the same pressure level for 10 sec or reached a peak level of 30mmHg. ...
... Superiority of the deep neck flexor exercise in pain outcome compared to isometric, stretching, and scapulothoracic exercises has been established in another randomized clinical trial. 22 So, the existing literature support our current study findings in terms of effectiveness of DCF endurance training with pressure biofeedback as compared to conventional therapeutic exercise approaches. It is evident from literature that poor endurance of neck muscles is considered a risk factor for mechanical neck pain. ...
Article
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Objective: To compare the effects of Cranio cervical flexion training with and without pressure biofeedback on deep cervical muscular endurance in patients with mechanical chronic neck pain. Methods: A randomized control trial was conducted at Railway General Hospital Rawalpindi, from May to December 2019. It consisted of thirty participants with the age ranging from 25 to 40 years, and having chronic mechanical neck pain. The participants were randomly allocated into two groups Group-A received Craniocervical flexion training with pressure biofeedback and Group-B received Craniocervical flexion training without pressure biofeedback. The intervention was applied for four weeks (3 sessions per week). Assessments were taken at Pre, Post intervention and after six weeks of follow up. Data analysis was done using SPSS-21 version. Results: The mean age of Group-A and Group-B was 29.40±3.08 and 31.33±4.95 respectively. Between-group analyses has shown statistically and clinically significant improvement in Group-A regarding deep neck muscles endurance (p<0.05). Whereas within group analysis of both groups A & B showed a statistical and clinically significant difference (p=0.00) for deep neck muscles endurance. Conclusions: Cranio-cervical flexion training with Pressure Biofeedback has proven to be more effective in improving endurance of deep cervical flexors in patients with mechanical neck pain.
... Patients with Chronic Neck Pain have reported muscle weakness, weariness, and morphological abnormalities [2] . Certain muscles in the cervical spine have been discovered to weaken as a result of neck pain, the most prevalent of which are the deep and anterior cervical flexors [3] . ...
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Background: Neck pain is a common musculoskeletal problem and reported to be a major health problem worldwide that affects the quality of life. Neck pain is a common phenomenon related to Muscle deterioration and scapular dys-function with higher prevalence in females than males.
... 6 To improve a patient's functional status and quality of life, it is important to understand which structures are capable of producing pain and disability before treatment. 7 Muscle weakness around the spine was related to most neck pain. Weakening of Deep Cervical Flexors (DCFs) causes lack of ability to control cervical vertebra after the onset of pain. ...
Article
Objective: Neck pain is a common cause of disability and costly problem, especially in the working population. However, there is a paucity of studies examining the efficacy of pressure-biofeedback guided craniocervical flexion exercise (CCFE) in neck pain. Therefore, this study aims to find out the efficacy of Pressure-Biofeedback guided CCFE on the treatment of neck pain. Methods: This randomized controlled trial included 60 participants with neck pain who were randomly assigned to the experimental group (n=30) and control group (n=30). The experimental group received pressure-biofeedback guided CCFE for four times per week for four weeks, whereas the control group received physical therapy agents (PTA) (radiant heat and transcutaneous electrical nerve stimulation). Outcome measures included the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Results: The baseline demographics and outcome measurements were not significantly different between the two groups. More significant reduction in VAS of the experimental group was found in comparison with control group at week 2 and week 4, respectively (p<0.05). Regarding the NDI, there was a more significant reduction in the experimental group than the control group at week 4 (p<0.05). Conclusion: Pressure-biofeedback guided CCFE was useful for improving pain and functional disability of neck for the management of neck pain.
... Thus, the improvement in cervical posture created through DCF exercise may have long-term benefits in reducing recurrent episodes of neck pain. 13 In this study, no side effects were recorded during or after the intervention either reported by the study subjects or found at the time of examination by the investigators, such as increased pain after exercise, headache, and stiffness in the neck. This is in accordance with the research of Kim et al who also showed that giving deep cervical flexor exercise did not cause any side effects and was proven to be safe to do. ...
Article
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Background: Mechanical neck pain is defined as neck pain due to biomechanical dysfunction in the neck or upper back. Exercise can reduce muscle tension and strengthen deep cervical flexor (DCF) muscles by helping to relieve pain. The prevalence of neck pain is considered high in helicopter crews compared to the general population. Aim: To investigate the effectiveness of DCF exercise on neck functional scores (study of helicopter crews with mechanical neck pain).Material and Methods: Experimental one pre and post-test group design. The samples were 14 squadron-31/serbu helicopter crew performing conventional DCF muscle exercise 12 times for 4 weeks with a frequency of 3 times each week. Neck function was assessed using the Neck Outcome Score (NOOS) which consists of domains of mobility, stiffness, symptoms, sleep disturbances, everyday activity and pain, participating in everyday life, and quality of life.Results: This study showed that the mean NOOS score before intervention was 30.64 (SD: 9.44) and the mean NOOS score after intervention was 8.57 (SD: 5.33). There was a significant difference in the NOOS score before and after deep cervical flexor exercise (p = 0.001).Conclusion: DCF exercises are effective for improving neck functionality in helicopter crew with mechanical neck pain.
... To identify whether the subject had lower-limb length discrepancies, first the distance between upper margin of greater trochanter and lower margin of lateral malleolus was measured [28] (Figure 2, A), and thereafter we measured the distance between ASIS and lower margin of lateral malleolus by measuring tape (Figure 2, B) [9,36,24]. [1,2,4,6,8,20,22,30,31] (Table 1), and integrating the corrected posture into daily activities [22,39]. During the first week exercises were performed 3-4 times a week and in the following 2-5 weeks were progressed to 6 times a week, thereafter step-by-step in a decreasing manner 5 times a week in 6-10 weeks, 3 times a week in 11-22 weeks and finally 2 times a week in 23-40 weeks. ...
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The participant of this study was a 40-year-old female, who mainly complained of middle thoracic stiffness and pain in extension at the mid thoracic level with hyperkyphosis, forward head and mild thoracic dextroscoliosis. The subject participated in multimodal home-based physiotherapy program with the duration of 9 months, consisting of posture exercises, soft tissue massage therapy and thoracic manipulations. Comparison of initial and final evaluation revealed the improvement in all evaluated variables, including the reduction of thoracic hyperkyphosis, forward head posture and thoracic dextroscoliosis, freer and less painful thoracic spine extension mobility, no pain in the sacroiliac joint, and increased satisfaction with the posture. There was also notable improvement in the algometry of the paraspinal muscles, equalization of functional lower-leg length and rib-pelvic distance of both sides of body. In conclusion, the proposed physiotherapy protocol can be beneficial in addressing postural faults such as thoracic hyperkyphosis, forward head and scoliosis. However, further research is needed with a larger sample.
... This finding did not conform to the report of Strunk and Hondras (25) who revealed that the pain of the studied participants worsened in the MET group. Abdel-Aziem and Draz (26), concluded in their study that neck flexor exercises improved pain and physical disability in patients with neck pain. The mechanism by which stabilization exercises cause reduction of pain in patients with NSCNP is that the exercise may increase the movement in the neural pathways, thus causing a restrictive effect on pain centers in the central nervous system leading to contraction of muscle and tension on different tendons and ligaments as well as stimulation of the mechanoreceptors and enhancement of the activity of the sensory nerve; consequently, results in the inhibition of the mediating pain pathways (13). ...
... Exercise is the most appropriate tool in the process of rehabilitation for cervical pain patients, as they help in improving the neuromuscular control, and the flexibility which is required for soft tissue proliferation and to improve daily activities [6]. Neck pain management exercises are affected by many factors including intensity, frequency, and types of exercise. ...
Article
Background: Cervical spondylosis (CS) is a degenerative disease for zygapophysial (facet) joints of the vertebra. Pain, stiffness, and dysfunction are the most common symptoms. Study design: A randomized controlled trial was conducted which included 30 female patients with cervical spondylosis. Objectives: Comparing the effect of dynamic and isometric neck exercise under the supervision and without supervision (home-based). Methods: Total 30 female patients with cervical spondylosis were assigned equally into two groups: Group A (n=15) and Group B (n=15). Neck exercises were performed under the supervision of the physiotherapist for Group A and home-based exercises for Group B, respectively. T-test and paired t-test were used for comparison of the outcome measurements which included pain, neck disability index (NDI) and range of motion (ROM). Results: Patients after 8-weeks of cervical strengthening program (supervised or unsupervised) had a significant reduction in the average cervical pain, dysfunction and improvement of ROM within the group of patients. However, the results of Group A were more significant as compared to Group B for pain reduction, flexion, extension and right rotation ROM, but no difference in other parameters for NDI, right and left lateral flexion as well as left rotation ROM. Conclusion: Supervised exercises have proved to be more effective than unsupervised neck exercises in the treatment of patients with chronic neck pain due to cervical spondylosis in spite of all outcomes has improved within the groups.
... Exercise is the most appropriate tool in the process of rehabilitation for cervical pain patients, as they help in improving the neuromuscular control, and the flexibility which is required for soft tissue proliferation and to improve daily activities [6]. Neck pain management exercises are affected by many factors including intensity, frequency, and types of exercise. ...
Article
Full-text available
Background: Cervical spondylosis (CS) is a degenerative disease for zygapophysial (facet) joints of the vertebra. Pain, stiffness, and dysfunction are the most common symptoms. Study design: A randomized controlled trial was conducted which included 30 female patients with cervical spondylosis. Objectives: Comparing the effect of dynamic and isometric neck exercise under the supervision and without supervision (home-based). Methods: Total 30 female patients with cervical spondylosis were assigned equally into two groups: Group A (n=15) and Group B (n=15). Neck exercises were performed under the supervision of the physiotherapist for Group A and home-based exercises for Group B, respectively. T-test and paired t-test were used for comparison of the outcome measurements which included pain, neck disability index (NDI) and range of motion (ROM). Results: Patients after 8-weeks of cervical strengthening program (supervised or unsupervised) had a significant reduction in the average cervical pain, dysfunction and improvement of ROM within the group of patients. However, the results of Group A were more significant as compared to Group B for pain reduction, flexion, extension and right rotation ROM, but no difference in other parameters for NDI, right and left lateral flexion as well as left rotation ROM. Conclusion: Supervised exercises have proved to be more effective than unsupervised neck exercises in the treatment of patients with chronic neck pain due to cervical spondylosis in spite of all outcomes has improved within the groups. Keywords: Cervical spondylosis, Neck pain, Supervised exercises, Unsupervised exercises
... This finding did not conform to the report of Strunk and Hondras (25) who revealed that the pain of the studied participants worsened in the MET group. Abdel-Aziem and Draz (26), concluded in their study that neck flexor exercises improved pain and physical disability in patients with neck pain. The mechanism by which stabilization exercises cause reduction of pain in patients with NSCNP is that the exercise may increase the movement in the neural pathways, thus causes a restrictive effect on pain centers in the central nervous system leading to contraction of muscle and tension on different tendons and ligaments as well as stimulation of the mechanoreceptors and enhancement of the activity of the sensory nerve; consequently, results in the inhibition of the mediating pain pathways (13). ...
Article
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 shows 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.
Chapter
The burden of musculoskeletal problems among musicians is high, and it affects performance and activities of daily living. Several injury prevention programs with the aim of adjusting instrument interface as well as conditioning the musician to the demands of performance have been developed. Despite these interventions, the occurrence of musculoskeletal problems is still a problem. Therefore, the aim of this study was to develop an instrument-specific exercise-based injury prevention program for violinists.
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Research background. During the rapid development of science and technology in the world, number of people suffering from pain in the neck-shoulder complex is increasing. Musculoskeletal disorders are influenced by non-ergonomic adaptation of the workplace, rapid decline in physical activity and other factors. The research aim was to evaluate the effect of stretching and strengthening exercises on work related neck/shoulder pain, muscle strength, range of motion in female blue-collar workers. Methods. The study involved 16 participants with neck-shoulders complex pain. The women were aged between 35–55 years. Participants rated their worst neck-shoulder pain during the previous week on a numerical rating scale from 0 to 10. Participants’ active range of motion of neck and humerus movements were measured with a goniometer, latent trigger point pain thresholds was measured with an algometer and muscle strength of upper trapezius, scalenus and sternocleidomastoideus muscles was evaluated with a dynamometer. The frst group (stretching exercise group) consisted of 9 participants, the second group (strengthening exercise group) – of 7 participants. Results. After 5 weeks stretching and strengthening exercise programs, the changes were statistically signifcant in both groups. Comparing pain intensity and muscle strength between groups, statistically signifcant changes were found in muscle strengthening group. Statistically signifcant latent trigger point pain threshold and range of motion changes were found in both groups (p < 0.05). Before the study, differences were found between the groups that could have had an effect on the results. Conclusion. Muscle strengthening exercises are more effective for blue – collar workers reducing muscular pain, increasing muscle strength and functional ability. Muscle strengthening exercise had a greater influence of pain intensity and muscle strength then stretching exercises. Keywords: neck-shoulder pain, stretching exercise, strengthening exercise.
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Case report. Immobilization and chronic neck pain may cause a transformation of muscle tissue fibers. These changes affect the ability to effectively control 3-D movement of the cervical spine. This case report describes the effect of specific deep cervical flexor (DCF) musculature training in a patient with chronic neck pain and dizziness. A 19-year-old woman presented with a 24-month history of neck pain and dizziness. Symptoms started during a 2-month immobilization period while in the intensive care unit for the treatment of brainstem encephalitis. Outcome measures included pain level, limitations in activities, fear avoidance, range of motion, dizziness, and function of the DCFs. Treatment was aimed at restoring altered motor control of the neck muscles using DCF training integrated with functional activities for 10 treatment sessions over 12 weeks. At the time of discharge, the patient reported full recovery and no restriction in her daily activities. Her score on the Neck Disability Index had improved by 28 points, active range of motion had increased, and her symptoms of dizziness were resolved. These results were maintained at 6-month follow-up. This patient responded positively to DCF training, resulting in an increase in cervical spine range of motion and a reduction of dizziness, pain, and limitations in activities. Therapy, level 4.J Orthop Sports Phys Ther 2012;42(10):853-860, Epub 26 July 2012. doi:10.2519/jospt.2012.4056.
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Prolonged static posture has been identified as a major risk factor for work-related neck and upper limb disorders (WRNULD) in computer users. Previous research has mainly examined working postures in healthy pain-free individuals. The present study examined whether symptomatic subjects exhibited the same kinematic patterns as asymptomatic controls during a prolonged computer task. In a Case-Control comparison, female office workers performed the same computer task using the same adjustable computer workstation for 1h. Three-dimensional (3D) kinematics were measured in the head-neck, thorax and shoulder (upper arm) segments. Case Group subjects (n=21) displayed trends for increased head-neck flexion angles and greater ranges of movements than the Control Group (n=17). There were also small but significant differences between groups in side flexion and rotation angles of the head-neck region. The shoulder joints displayed significantly greater flexion and abduction angles on the right in both groups, although no group differences were observed. The increased neck flexion angles were associated with significantly higher activity in the upper trapezius muscle and with neck and shoulder discomfort. The individual differences in postural habits appeared to be independent of the physical environment. These results suggest motor control changes are associated with the presence of WRNULD.
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Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study had 2 purposes: (1) to compare change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and (2) to compare the effects of 2 different neck exercise regimens on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task. Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study. Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task. Subjects with neck pain demonstrated a change in cervical angle across the duration of the task (mean=4.4 degrees ; 95% confidence interval [CI]=3.3-5.4), consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects (mean=2.2 degrees ; 95% CI=1.0-3.4). Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task. This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.
Article
This study aimed to evaluate the effects of an exercise programme focusing on muscle stretching and endurance training on the 12-month incidence of neck pain in office workers. A 12-month prospective cluster-randomised controlled trial was conducted in healthy office workers with lower-than-normal neck flexion movement or neck flexor endurance. Participants were recruited from 12 large-scale enterprises. A total of 567 healthy office workers were randomly assigned at the cluster level into either intervention (n=285) or control (n=282) groups. Participants in the intervention group received an exercise programme that included daily stretching exercise and twice-a-week muscle endurance training. Those in the control group received no intervention. The primary outcome measure was the 12-month incidence of neck pain, and the secondary outcome measures were pain intensity, disability level, and quality of life and health status. Analyses were performed using the Cox proportional hazard models. Over the 12-month follow-up, 12.1% of participants in the intervention group and 26.7% in the control group developed incident neck pain. Hazard rate ratios showed a protective effect of the exercise programme for neck pain (HR=0.45, 95% CI 0.28 to 0.71) after adjusting for biopsychosocial factors. There was no significant difference in pain intensity, disability and quality of life and health status between those who reported incident neck pain in the intervention and control groups. The exercise programme reduced incident neck pain and increased neck flexion movement for office workers with lower-than-normal neck flexion movement.
Article
The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain. Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period. After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs. Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles.
Article
Background: Although exercise can be effective for relief of neck pain, little is known about the effect of exercise on the neural control of neck muscles. Methods: A randomized controlled trial was conducted on 46 women with chronic neck pain to investigate the immediate effectiveness of an 8-week exercise programme on pain and directional specificity of neck muscle activity. At baseline, the patients completed questionnaires including the neck disability index (NDI) and performed a circular contraction of their head in the horizontal plane at 15 N force, with continuous change in force direction in the range 0-360°. Electromyography (EMG) was recorded from the sternocleidomastoid (SCM) and splenius capitis (SCap) muscles. Tuning curves of the EMG amplitude were computed, which depicts muscle activity over a range of force directions. The mean point of the tuning curves defined a directional vector, which determined the specificity of muscle activity. Patients were randomly assigned either to a training or control group. Results: A significant between-group difference in the change in NDI was observed. A reduction in NDI was observed following training (pre: 18.2 ± 7.4; post: 14.1 ± 6.5; p < 0.01) but not for the control group (pre: 17.5 ± 6.3; post: 16.6 ± 7.4). The training group showed higher specificity of muscle activity post-intervention (pre: 18.6 ± 9.8%, post: 24.7 ± 14.3%; p < 0.05), whereas no change occurred for the control group (pre: 19.4 ± 11.9%, post: 18.2 ± 10.1%). Conclusion: An exercise programme that aims to enhance motor control of the cervical spine improves the specificity of neck muscle activity and reduces pain and disability in patients with neck pain.
Article
Altered activation of the deep cervical flexors (longus colli and longus capitis) has been found in individuals with neck pain disorders but the response to training has been variable. Therefore, this study investigated the relationship between change in deep cervical flexor muscle activity and symptoms in response to specific training. Fourteen women with chronic neck pain undertook a 6-week program of specific training that consisted of a craniocervical flexion exercise performed twice per day (10 to 20 min) for the duration of the trial. The exercise targets the deep flexor muscles of the upper cervical region. At baseline and follow-up, measures were taken of neck pain intensity (visual analogue scale, 0 to 10), perceived disability (Neck Disability Index, 0 to 50) and electromyography (EMG) of the deep cervical flexors (by a nasopharyngeal electrode suctioned over the posterior oropharyngeal wall) during performance of craniocervical flexion. After training, the activation of the deep cervical flexors increased (P<0.0001) with the greatest change occurring in patients with the lowest values of deep cervical flexor EMG amplitude at baseline (R(2)=0.68; P<0.001). There was a significant relationship between initial pain intensity, change in pain level with training, and change in EMG amplitude for the deep cervical flexors during craniocervical flexion (R(2)=0.34; P<0.05). Specific training of the deep cervical flexor muscles in women with chronic neck pain reduces pain and improves the activation of these muscles, especially in those with the least activation of their deep cervical flexors before training. This finding suggests that the selection of exercise based on a precise assessment of the patients' neuromuscular control and targeted exercise interventions based on this assessment are likely to be the most beneficial to patients with neck pain.
Article
The Neck Disability Index (NDI) and Cervical Ranges of Motion (CROM) are measurement tools that are used for neck pain patients. To review the literature to determine how the NDI is associated with neck pain and CROM outcomes. Computer based searches of 5 databases were performed and supplemented by internet and hand searching of article references and "related citations." The search yielded 23 studies that met the inclusion and exclusion criteria and these were summarized into four categories: NDI, NDI and other questionnaires, whiplash and NDI and cervical range of motion and NDI. The NDI was shown to be a well validated and reliable self-reported questionnaire, especially when compared to other questionnaires, in both neck pain and whiplash (WAD) patients. There are very few studies that discuss the NDI and cervical range of motion. This review outlines the strength of the NDI as a self-reported neck disability questionnaire, but also demonstrates a need for further research to explore the association between the NDI, neck pain and cervical ranges of motion.
Article
Deep cervical flexor muscle (DCF) activation is impaired with neck pain. This study investigated the effects of low load cranio-cervical flexion (C-CF) and neck flexor strengthening exercises on spatial and temporal characteristics of DCF activation during a neck movement task and a task challenging the neck's postural stability. Forty-six chronic neck pain subjects were randomly assigned to an exercise group and undertook a 6-week training program. Electromyographic (EMG) activity was recorded from the DCF, sternocleidomastoid (SCM) and anterior scalene (AS) muscles pre and post intervention during the cranio-cervical flexion test (CCFT) and during perturbations induced by rapid, unilateral shoulder flexion and extension. C-CF training increased DCF EMG amplitude and decreased SCM and AS EMG amplitude across all stages of the CCFT (all P<0.05). No change occurred in DCF EMG amplitude following strength training. There was no significant between group difference in pre-post intervention change in relative latency of DCF but a greater proportion of the C-CF group shortened the relative latency between the activation of the deltoid and the DCF during rapid arm movement compared to the strength group (P<0.05). Specific low load C-CF exercise changes spatial and temporal characteristics of DCF activation which may partially explain its efficacy in rehabilitation.
Article
Although weakness of anterior cervical muscles is postulated to contribute to persistent neck pain in patients with mechanical neck pain, quantitation of weakness has never been reported. We compared anterior cervical muscle strength in 30 subjects with mechanical neck pain and in 30 asymptomatic control subjects. Testing was performed with the subject supine, chin retracted, and neck flexed. Assessment was made using a hand-held dynamometer with head held at the midline and with rotation left and right within a pain-free range. Analysis with Wilcoxon scores showed that patients with neck pain had significantly less (p less than .05) strength (N.Kg-1) in all three positions than controls (1.16 +/- 0.49 vs 1.71 +/- 0.42, sagittally; 1.01 +/- 0.52 vs 1.47 +/- 0.41, rotation left; .99 +/- 0.46 vs 1.43 +/- 0.43 rotation right; neck pain vs control, respectively.) This weakness and its role in persistent neck pain should be recognized. The efficiency and effect of cervical muscle strengthening in treatment of chronic neck pain should be further defined.
Article
To determine reliabilities within and between persons measuring cervical active range of motion (AROM) three methods were examined: use of a cervical-range-of-motion (CROM) instrument, use of a universal goniometer (UG), and visual estimation (VE). Measurements were made on 60 patients with orthopedic disorders of the cervical spine who were divided into three groups of 20 subjects each. All subjects were tested in a standardized seated position using operationally defined goniometric placements and nongoniometric estimation techniques. Cervical flexion and extension, lateral flexion, and rotation were measured. Intraclass correlation coefficients (ICCs) were used to quantify within-tester and between-tester reliability. We found that goniometric measurements of AROM of the cervical spine made by the same physical therapist had ICCs greater than .80 when made with the CROM device or the UG. When different physical therapist measured the same patient's cervical AROM, the CROM device had ICCs greater than .80, whereas the UG and VE generally had ICCs less than .80.
Article
Acute whiplash injuries are a common cause of soft tissue trauma for which the standard treatment is rest and initial immobilisation with a soft cervical collar. Because the efficacy of this treatment is unknown a randomised study in 61 patients was carried out comparing the standard treatment with an alternative regimen of early active mobilisation. Results showed that eight weeks after the accident the degree of improvement seen in the actively treated group compared with the group given standard treatment was significantly greater for both cervical movement (p less than 0.05) and intensity of pain (p less than 0.0125).
Article
Sustained joint load in extreme positions (namely maximally flexed or extended positions) has been described as causing pain. The aim of the present study is to analyse eight different sitting work postures with respect to extreme positions, and to assess the mechanical load and the levels of muscular activity arising in defined extreme positions of the cervical spine. Ten healthy female workers from an electronics plant took part in laboratory experiments. For seven of these, levels of neck and shoulder muscular activity in sitting postures with the cervical spine in different manually-adjusted extreme positions were recorded using surface electrodes. Loading moments of force about the bilateral motion axis of the atlanto-occipital joint (Occ-C1) and the spinal cervico-thoractc motion segments (C7-T1) were calculated. Extreme or almost extreme positions occurred in sitting postures with the thoracolumbar back inclined slightly backwards or with the whole spine flexed. Electromyographic (EMG) activity levels were very low in the manually-adjusted extreme positions. The load moment for the Occ-Cl joint when the whole neck was flexed was only 1·2 times the value for the neutral position of the head, but for C7-T1 it increased to 3·6 times. It is concluded that extreme positions of the cervical spine do occur in sitting work postures, and that the levels of muscular activity in such positions are low. Thus, recordings of muscle activity and calculations of load moment alone are not a sufficient basis for evaluating work postures: thorough recordings of spine positions should be included.
Article
The visual analogue scale (VAS) is a simple and frequently used method for the assessment of variations in intensity of pain. In clinical practice the percentage of pain relief, assessed by VAS, is often considered as a measure of the efficacy of treatment. However, as illustrated in the present study, the validity of VAS estimates performed by patients with chronic pain may be unsatisfactory. Two types of VAS, an absolute and a comparative scale, were compared with respect to factors influencing the reliability and validity of pain estimates. As shown in this study the absolute type of VAS seems to be less sensitive to bias than the comparative one and is therefore preferable for general clinical use. Moreover, the patients appear to differ considerably in their ability to use the VAS reliably. When assessing efficacy of treatment attention should therefore be paid to several complementary indices of pain relief as well as to the individual's tendency to bias his estimates.
Article
Fresh lumbar vertebral columns from nine male subjects aged from six to 61 years were tested for creep deformation and hysteresis. The standard test applied a load of 3.5 kg for one hour through a weight and pulley circuit. Additional tests used 1 kg and 5.5 kg for varying periods of time. The four oldest columns showed a pronounced decrease in the range of flexion movement but a consistent increase in the flexion creep deformation. Hysteresis recovery on load removal was more prolonged and less complete in the older lumbar columns than in the young.
Article
A randomized cross-sectional questionnaire was used to determine the prevalence of neck pain in Norwegian adults. The frequency and duration of neck pain were assessed. Reliable epidemiologic studies on the prevalence of neck pain in the general population have been sparse. A questionnaire that inquired about neck pain within the last year was sent to a random sample of 10,000 adult Norwegians. Overall, 34.4% of the responders had experienced neck pain within the last year. A total of 13.8% reported neck pain that lasted for more than 6 months. Chronic neck pain is a frequent symptom in the general population, particularly in women. Although reservations have to be taken as to the interpretation, the reported prevalence of persisting pain after whiplash injuries is of the same magnitude as the prevalence of chronic neck pain in the general population.
Article
Median frequency parameters of myoelectric signals were studied in 25 patients with osteoarthritis of the cervical spine and in 25 normal subjects. The median frequency parameters included initial median frequency and slope of the median frequency during 20%, 50%, 80%, and 100% of maximum voluntary contractions (MVC). The subjects performed sustained, isometric constant-force contractions of forward and backward bend of the cervical spine. The median frequency signals were obtained from the anterior (sternocleidomastoid) and posterior (upper trapezius) neck muscles. The results showed that at moderate and high forces (i.e., 50%, 80%, and 100% MVC) the anterior neck muscles in patients with osteoarthritis of the cervical spine fatigued faster than those of normal subjects. The posterior neck muscles in patients fatigued faster compared to normal subjects at high force levels (i.e., 80% and 100% MVC). This indicates a higher fatigue of the anterior and posterior neck muscles associated with arthritic changes of the cervical spine. Rehabilitation programs must consider these muscular changes to obtain optimal outcomes.
Article
Muscle use evoked by exercise was determined by quantifying shifts in signal relaxation times of T2-weighted magnetic resonance images. Images were collected at rest and after exercise at each of two intensities (moderate and intense) for each of four head movements: 1) extension, 2) flexion, 3) rotation, and 4) lateral flexion. This study examined the intensity and pattern of neck muscle use evoked by various movements of the head. The results will help elucidate the pathophysiology, and thus methods for treating disorders of the cervical musculoskeletal system. Exercise-induced contrast shifts in T2 has been shown to indicate muscle use during the activity. The noninvasive nature of magnetic resonance imaging appears to make it an ideal approach for studying the function of the complex neuromuscular system of the neck. The extent of T2 increase was examined to gauge how intensely nine different neck muscles or muscle pairs were used in seven subjects. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation was assessed to infer the pattern of use among and within individual neck muscles or muscle pairs. Signal relaxation increased with exercise intensity for each head movement. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation also increased with exercise load. Neck muscles or muscle pairs extensively used to perform each head movement were: extension--semispinalis capitis and cervicis and splenius capitis; flexion--sternocleidomastoid and longus capitis and colli; rotation--splenius capitis, levator scapulae, scalenus, semispinalis capitis ipsilateral to the rotation, and sternocleidomastoid contralateral; and lateral flexion--sternocleidomastoid The results of this study, in part, agree with the purported functions of neck muscles derived from anatomic location. This also was true for the few selected muscles that have been examined in human electromyographic studies. Neck muscle function and morphology can be studied at a detailed level using exercise-induced shifts in magnetic resonance images.
Article
Low back pain may affect up to 80% of all adults and is the second leading reason for physician visits in ambulatory medicine. Estimates for the annual direct medical costs for treating patients with back pain approach $25 million, despite the fact that it is a self-limited condition in at least 90% of patients with recovery occurring within 6 to 12 weeks. Recent scrutiny of health care delivery has produced numerous observations documenting a high variability in use of resources for medical conditions including low back pain, but few studies have attempted to examine the medical appropriateness of diagnostic and therapeutic decisions.
Article
Although muscles are assumed to be capable of stabilizing the spinal column in vivo, they have only rarely been simulated in vitro. Their effect might be of particular importance in unstable segments. The present study therefore tests the hypothesis that mechanically simulated muscle forces stabilize intact and injured cervical spine specimens. In the first step, six human occipito-cervical spine specimens were loaded intact in a spine tester with pure moments in lateral bending (+/- 1.5 N m), flexion-extension (+/- 1.5 N m) and axial rotation (+/- 0.5 N m). In the second step, identical flexibility tests were carried out during constant traction of three mechanically simulated muscle pairs: splenius capitits (5 N), semispinalis capitis (5 N) and longus colli (15 N). Both steps were repeated after unilateral and bilateral transection of the alar ligaments. The muscle forces strongly stabilized C0-C2 in all loading and injury states. This was most obvious in axial rotation, where a reduction of range of motion (ROM) and neutral zone to <50% (without muscles=100%) was observed. With increasing injury the normalized ROM (intact condition=100%) increased with and without muscles approximately to the same extend. With bilateral injury this increase was 125-132% in lateral bending, 112%-119% in flexion-extension and 103-116% in axial rotation. Mechanically simulated cervical spine muscles strongly stabilized intact and injured cervical spine specimens. Nevertheless, it could be shown that in vitro flexibility tests without muscle force simulation do not necessarily lead to an overestimation of spinal instability if the results are normalized to the intact state.
Article
Tissue blocks comprising muscle and bone from C5 to C7 segments were harvested at autopsy from 16 individuals ranging in age from 4 to 77 years. The prevertebral longus colli and postvertebral multifidus muscle pairs from one side in each individual were randomly selected for this study of muscle spindles. To determine muscle spindle distribution, morphology, and density for the longus colli and multifidus in caudal segments of the human cervical spine, and to assess whether changes are evident from infancy to old age. Age-related changes to the osteoligamentous framework of the cervical spine have been well documented. Postural modification accompanies these structural alterations, but there have been limited attempts to document whether muscle sustains a comparable level of morphologic alteration. Previous studies have examined muscle spindles in the neck muscles of various animal models and in a variety of isolated human muscles. However, most of these studies incurred bias through sampling and methodologic assumptions. The longus colli and multifidus were resected between C5 and C7, and between left and right pairs selected randomly for spindle analysis. These vertebral segments were selected deliberately because they form the apex of the cervical lordosis and the site at which the greatest age-related modification occurs. The tissue was processed in paraffin, sectioned, and then stained by Masson's trichrome. Spindle characteristics were examined using light microscopy and analyzed by unbiased stereologic methods. A one-sample paired t test was used to ascertain whether the differences in spindle density between the two muscles were statistically significant. The longus colli has a high density of muscle spindles, which appear clustered and concentrated anterolaterally, away from the vertebral body. The multifidus has a low density of muscle spindles, which are found predominantly as single units concentrated closely to the vertebral lamina. No change in spindle distribution, morphology, and density were observed with age. The current study examined spindle characteristics for an intrinsic neck muscle pair whose coactivation contributes to segmental stability of the cervical spine. The distribution and morphology of muscle spindles differ between the longus colli and the multifidus. In addition, these muscles have significant differences in terms of mean spindle density. Spindle characteristics represent one of many factors that govern proprioceptive regulation in skeletal muscle, and in neck muscles, the central connectivity of these receptors remains undefined. Therefore, although there are anatomic differences between the neck flexor and extensor, the functional implications of these differences are not clear. It is also of interest that spindle characteristics remain unchanged in these intrinsic muscles whose underlying segments are subject to age-related osteoligamentous changes.
Article
To examine the test-retest reliability and construct validity of cervical active range of motion and isometric neck muscle strength as measured by the Multi Cervical Rehabilitation Unit (Hanoun Medical Inc., Ontario). A cross-sectional study. Institutional practice. Twenty-one patients with neck pain and 25 healthy volunteers. After a trial-run session, active range of motion (AROM) was measured in the subsequent two sessions, with 2-3 days in between. During each session, three measurements were taken for each direction (flexion, extension, lateral flexions and rotations). The measurement of isometric strength was after a 15-minute break following completion of the measurement of AROM. Three measurements were made for each of the six directions (flexion, extension, lateral flexions, protraction and retraction). The software of the Multi Cervical Rehabilitation Unit automatically recorded and calculated the maximum AROM and isometric strength. There was a good to high level of reliability in the measurement of AROM for both groups of subjects, with intraclass correlation coefficients (ICCs) ranging from 0.81 to 0.96. Results also demonstrated very good to excellent reliability in isometric strength measurement (ICCs ranged from 0.92 to 0.99). Moreover, there was a significant difference in isometric neck muscle strength (p = 0.001) and in AROM (p = 0.034) between the two groups. The Multi Cervical Rehabilitation Unit was found to be reliable and valid for testing the cervical active range of motion and isometric neck muscle strength for both normal and patient subjects.
Article
Case report. To describe the use of manual therapy and muscle re-education for an individual with suspected cervicogenic headache. Background: This patient was a 27-year-old woman with complaint of headache. She was functionally limited with prolonged postures and lifting. She also demonstrated impairments in cervical mobility and muscular performance. This patient was treated 8 times over an 8-week period. Intervention included manual upper cervical spine mobilization techniques, muscle re-education for the deep neck flexor muscles, and scapular stabilization exercises. Following treatment, the patient demonstrated an increase in cervical mobility, improved muscular performance, a decrease in headaches, and complete resolution of functional limitations. The combination of manual therapy and muscle re-education was successful in relieving headaches and improving function in this patient.
Article
The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid (SCM) and anterior scalene (AS) muscles. While standing, subjects flexed and extended the right arm in response to a visual stimulus. For the control group, activation of DCF, SCM and AS muscles occurred less than 50 ms after the onset of deltoid activity, which is consistent with feedforward control of the neck during arm flexion and extension. When subjects with a history of neck pain flexed the arm, the onsets of DCF and contralateral SCM and AS muscles were significantly delayed ( p<0.05). It is concluded that the delay in neck muscle activity associated with movement of the arm in patients with neck pain indicates a significant deficit in the automatic feedforward control of the cervical spine. As the deep cervical muscles are fundamentally important for support of the cervical lordosis and the cervical joints, change in the feedforward response may leave the cervical spine vulnerable to reactive forces from arm movement.
Article
Cross-sectional study. This study compared neck muscle activation patterns during and after a repetitive upper limb task between patients with idiopathic neck pain, whiplash-associated disorders, and controls. Previous studies have identified altered motor control of the upper trapezius during functional tasks in patients with neck pain. Whether the cervical flexor muscles demonstrate altered motor control during functional activities is unknown. Electromyographic activity was recorded from the sternocleidomastoid, anterior scalenes, and upper trapezius muscles. Root mean square electromyographic amplitude was calculated during and on completion of a functional task. A general trend was evident to suggest greatest electromyograph amplitude in the sternocleidomastoid, anterior scalenes, and left upper trapezius muscles for the whiplash-associated disorders group, followed by the idiopathic group, with lowest electromyographic amplitude recorded for the control group. A reverse effect was apparent for the right upper trapezius muscle. The level of perceived disability (Neck Disability Index score) had a significant effect on the electromyographic amplitude recorded between neck pain patients. Patients with neck pain demonstrated greater activation of accessory neck muscles during a repetitive upper limb task compared to asymptomatic controls. Greater activation of the cervical muscles in patients with neck pain may represent an altered pattern of motor control to compensate for reduced activation of painful muscles. Greater perceived disability among patients with neck pain accounted for the greater electromyographic amplitude of the superficial cervical muscles during performance of the functional task.
Article
Cross-sectional study. The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. Individuals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested. Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles (sternocleidomastoid and anterior scalene). Root mean square electromyographic amplitude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine. There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain (P = 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task (P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain. These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain.
Article
A randomized controlled trial with single-blind outcome assessments. To evaluate the efficacy of a neck exercise program in patients with chronic neck pain. The effect of exercise for patients with chronic neck pain has been investigated in a number of studies. The efficacy is, however, questionable. A total of 145 patients were randomly allocated into an exercise (n = 67) and a nonexercise (control) group (n = 78). Patients in the control group were given infrared irradiation and neck care advice. In addition to infrared irradiation and advice, patients in the exercise group had undergone an exercise program with activation of the deep neck muscles and dynamic strengthening of the neck muscles for 6 weeks. Subjective pain and disability and isometric neck muscle strength were measured at baseline, 6 weeks, and 6 months. Analysis was by intention-to-treat. At week 6, the exercise group had a significantly better improvement in disability score (P = 0.03), subjective report of pain (P = 0.01), and in isometric neck muscle strength (P = 0.57-0.00) in most of the directions than the control group. However, significant differences between the two groups were found only in the subjective report of pain and patient satisfaction at the 6-month follow-up. At week 6, patients with chronic neck pain can benefit from the neck exercise program with significant improvement in disability, pain, and isometric neck muscle strength in different directions. However, the effect of exercise was less favorable at 6 months.
Article
This study compared the effects of conventional proprioceptive training and craniocervical flexion (C-CF) training on cervical joint position error (JPE) in people with persistent neck pain. The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise, which has been shown to be effective in reducing neck pain. This may help to differentiate the mechanisms of effect of such interventions. Sixty-four female subjects with persistent neck pain and deficits in JPE were randomized into two exercise groups: proprioceptive training or C-CF training. Exercise regimes were conducted over a 6-week period, and all patients received personal instruction by an experienced physiotherapist once per week. A significant pre- to postintervention decrease in JPE, neck pain intensity, and perceived disability was identified for both the proprioceptive training group (p < 0.001) and the C-CF training group (p < 0.05). Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group (p < 0.05). No other significant differences were observed between the two groups. The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE in people with neck pain, with marginally more benefit gained from proprioceptive training. The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense.
Article
The Neck Disability Index, the Northwick Park Pain Questionnaire, the Copenhagen Neck Functional Disability Scale and the Neck Pain and Disability Scale are widely used scales for assessing neck pain or disability. The aim of this study was to determine the most suitable scale for Turkish patients with neck pain. All scales were translated into Turkish, administered to 102 patients with neck pain, then compared with regard to their construct validity, reliability, responsiveness, acceptability and usefulness. The scales were similar in their high validity, reliability standards and sensitivity to change, but differed in their acceptability and usefulness. The item about driving in the Neck Disability Index and the Northwick Park Pain Questionnaire was omitted by 69.6% of patients for reasons other than a neck problem. All scales were reliable, valid and sensitive instruments, with similar psychometric properties. The scale that most adequately reflects the patient should be chosen.
Article
Both low-load and high-load training of the cervical muscles have been shown to reduce neck pain and change parameters of muscle function directly related to the exercise performed. The purpose of this study was to investigate whether either training regime changes muscle activation during a functional task which is known to be affected in people with neck pain and is not directly related to either exercise protocol. Fifty-eight female patients with chronic neck pain were randomised into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or low-load training of the cranio-cervical flexor muscles. The primary outcome was a change in electromyographic (EMG) amplitude of the sternocleidomastoid (SCM) muscle during a functional, repetitive upper limb task. At the 7th week follow-up assessment both intervention groups demonstrated a reduction in their average intensity of pain (P<0.05). However, neither training group demonstrated a change in SCM EMG amplitude during the functional task (P>0.05). The results demonstrate that training the cervical muscles with a prescribed motor task may not automatically result in improved muscle activation during a functional activity, despite a reduction in neck pain.
Article
The prevalence of neck muscle pain has steadily increased and especially pain from the descending part of the trapezius muscle has been associated with monotonous work tasks such as computer work. Physical exercise is generally recommended as treatment, but it is unclear which type of training is most effective. Our objective was to determine the effectiveness of specific strength training of the painful muscle versus general fitness training without direct involvement of the painful muscle (leg bicycling) on work-related neck muscle pain. We conducted a randomized controlled trial and recruited subjects from 7 workplaces characterized by monotonous jobs (e.g., computer-intensive work). Forty-eight employed women with chronic neck muscle pain (defined as a clinical diagnosis of trapezius myalgia) were randomly assigned to 10 weeks of specific strength training locally for the affected muscle, general fitness training performed as leg bicycling with relaxed shoulders, or a reference intervention without physical activity. The main outcome measure was an acute and prolonged change in intensity of neck muscle pain (100-mm visual analog scale [VAS]). A decrease of 35 mm (approximately 79%; P<0.001) in the worst VAS pain score over a 10-week period was seen with specific strength training, whereas an acute and transient decrease in pain (5 mm; P<0.05) was found with general fitness training. Specific strength training had high clinical relevance and led to marked prolonged relief in neck muscle pain. General fitness training showed only a small yet statistically significant acute pain reduction.
Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity
  • Tt Chiu
  • Kl Sing
Chiu TT, Sing KL. Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity. Clin Rehabil 2002;16:851-8.
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