The Effects of Soft Tissue Release of Superficial Neck Muscles on the Motor Control Ability in Patients with Neck Pain

A physiotherapist will administer each aspect of the intervention. The soft-tissue release group First, patients will be positioned comfortably in supine lying with the knees bent and the position of the head will be standardized by placing the craniocervical and cervical spines in a mid-position. An air-filled pressure sensor (Pressure Biofeedback Unit, Chattanooga Group, Hixon, TN) will be placed suboccipitally behind the neck of the patient and inflated to a pressure of 20 mm Hg. Patients will be instructed in the action of craniocervical flexion and practiced progressive targeting of five incremental levels (increment, 2 mm Hg) between 22 and 30 mm Hg. Substitution strategies such as neck retraction will be identified visually and discouraged. Recordings of EMG activity from the sternal head of sternocleidomastoid (SCM) and the anterior scalene muscles will be made bilaterally with Ag/AgCl surface electrodes following careful skin preparation and using previously published guidelines for electrode placement. EMG data will be collected for 10 seconds during a standardized maneuver for normalization of the EMG amplitude. The task will involve a combined movement of craniocervical and cervical flexion to lift the head up and hold up isometrically for 10 seconds. Patients will perform the five incremental stages (22-24-26-28-30 mm Hg) of the craniocervical flexion test to the best of their abilities, maintaining the pressure steady on each target for 10 seconds. Thirty seconds rest will be allowed between trials. After establishing the baseline EMG data, subjects in the soft-tissue release group will receive a session of kneading, rolling and transverse friction massage therapy for 15 minutes. The massage therapy/sham therapy will be applied to the bilateral sternocleidomastoid and anterior scalene muscles. Then, a posttest with the same testing procedure as the pretest will be conducted immediately after the treatment. The sham therapy group The pretest and posttest procedure will be the same as the soft-tissue release group. Subjects in the sham therapy group will receive a 15-minute session of superficial stroking massage with light pressure on the anterior neck muscles. Two interventions will be applied to all subjects. The duration of the wash-out period will be 1 week between interventions.