Chronic Mechanical Neck Pain, Neck Pain
Conditions
Keywords
Chronic Mechanical Neck Pain, Physiotherapy, Randomized Controlled Trial, Cervical Motor Control, Pressure Biofeedback, Deep Cervical Flexor Training, Neck Disability, Pain, Cervical Range of Motion, Rehabilitation
Brief summary
Persistent pain, functional disability, cervical motor control deficit, and abnormal posture are associated with chronic mechanical neck pain. This study aimed to evaluate the efficacy of an integrated physiotherapy program of cervical motor control training, lumbopelvic stabilization, diaphragmatic breathing exercises, and pressure biofeedback versus conventional cervical physiotherapy in patients with chronic mechanical neck pain through a randomized controlled trial. 40 eligible participants were randomly assigned to the experimental or control group. The two groups were all given supervised physiotherapy three times a week for 6 weeks plus a standardized home exercise program. The main aim was to investigate the efficacy of the interventions on pain intensity and neck related disability. Secondary outcomes were CROM, DCFE, head position, and patient perceived recovery. Outcome measures were conducted at both baseline and the end of the six-week intervention.
Detailed description
Chronic mechanical neck pain is one of the most prevalent musculoskeletal conditions and is related to ongoing pain, diminished cervical movement, poor neck muscle control, poor posture, and diminished functional ability. Conventional physiotherapy emphasizes the mobility, strengthening, stretching and postural correction of the cervical region. Recent research indicates that cervical motor control, trunk stabilization and respiratory training may be beneficial when integrated into a rehabilitation program, as multiple aspects of spinal stability and motor control can be targeted. The study was designed as a single center, parallel-group, assessor-blinded randomized controlled trial, to compare the effectiveness of integrated physiotherapy program to conventional cervical physiotherapy in subjects with chronic mechanical neck pain. Participants were recruited from the outpatient physiotherapy department of Thumbay Physical Therapy and Rehabilitation Hospital, Ajman, UAE, where they met the inclusion criteria for having mechanical neck pain with a duration of at least three months. After obtaining informed consent, participants were allocated by a computer-generated random sequence in a 1:1 ratio to either the experimental or control group, with allocation concealed. The experimental group received an integrated rehabilitation program that included cervical motor control training with pressure biofeedback, lumbopelvic stabilization exercises, diaphragmatic breathing exercises and traditional physiotherapy interventions as clinically needed. The control group received conventional cervical physiotherapy which included cervical range of motion exercises, isometric strengthening, stretching, scapulothoracic strengthening, proprioceptive training, postural exercises, and other standard physiotherapy treatment. Both groups underwent supervised treatment three times a week for six weeks and an identical home exercise program during the intervention. The primary outcome measures included intensity of pain (Numeric Pain Rating Scale \[NPRS\]) and neck-related disability (Neck Disability Index \[NDI\]). Secondary outcome measures were the cervical range of motion, deep cervical flexor endurance, craniovertebral angle for head posture and the Global Rating of Change (GROC). Assessment of outcomes was conducted at baseline and at the end of the six-week interventions by an assessor who was not aware of the allocation of the interventions. This study aimed to evaluate the effectiveness of an integrated physiotherapy approach including cervical motor control training, lumbopelvic stabilization, diaphragmatic breathing exercises, and pressure biofeedback in comparison to a conventional cervical physiotherapy approach for reduction of pain, disability, and cervical function and postural control in patients with chronic mechanical neck pain.
Interventions
BEHAVIORALIntegrated Physiotherapy
Participants were given an integrated physiotherapy program which comprised motor control training for the cervical spine with pressure biofeedback, lumbopelvic stabilization exercises, diaphragmatic breathing exercises, and a standardized home exercise program. Three treatment sessions per week for six weeks were conducted under supervision.
BEHAVIORALConventional Physiotherapy
Conventional cervical physiotherapy included cervical range-of-motion exercises, isometric strengthening, stretching, scapulothoracic strengthening, proprioceptive training, postural exercises, and a standardized home exercise program. Supervised treatment was provided three times per week for six weeks.
Sponsors
Gulf Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
This is a single-blind randomized control trial. An independent assessor, blinded to treatment allocation, conducted outcome assessments. Due to the type of intervention (exercises), participants and physiotherapists were not blinded.
Intervention model description
The participants were randomly assigned in a 1:1 ratio to two parallel study arms. The integrated physiotherapy program for the experimental group included cervical motor control training, lumbopelvic stabilization, diaphragmatic breathing exercises, and pressure biofeedback. Conventional cervical physiotherapy was given to the control group. Each group received three supervised treatments per week for 6 weeks and a standard home exercise program.
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age in the range 18-60 years. * CNMP (lasting more than 3 months). * NPRS score ≥ 3. * Head Impact Test (HIT-6) score \< 50. * Absence of clinical signs of cervical radiculopathy. * Capacity to comprehend study procedures, follow directions for exercising and sign informed consent in writing. * Diaphragmatic function impairment by the DNS diaphragm test with asymmetric or inadequate rib expansion laterally, high elevation of upper chest or shoulder girdle and diminished truncal stabilization during inhalation.
Exclusion criteria
* Participants were excluded if they had cervical radiculopathy, cervical myelopathy, previous cervical spine surgery, spinal fracture, inflammatory arthritis, malignancy, neurological disorders, pregnancy, or any other serious spinal pathology that would make it difficult for the participant to participate in the rehabilitation programme. People with cognitive deficits or any medical condition which hampered their safe involvement in the exercise programme were also excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neck Disability | Baseline and 6 weeks | Neck-related disability will be assessed using the NDI. Higher scores indicate greater disability. |
| Pain Intensity | Baseline and 6 weeks | Pain intensity will be assessed using the NPRS. The NPRS is an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). Lower scores indicate reduced pain intensity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cervical Range of Motion | Baseline and 6 weeks | Cervical range of motion will be measured in flexion, extension, rotation, and lateral flexion using standard clinical assessment procedures. |
| Deep Cervical Flexor Endurance | Baseline and 6 weeks | Deep cervical flexor muscle endurance will be assessed using a standardized endurance test. |
| Head Posture | Baseline and 6 weeks | Forward head posture will be assessed by measuring the craniovertebral angle. |
| Global Rating of Change | 6 weeks | Participant-perceived overall improvement will be assessed using the GROC scale. |
Countries
United Arab Emirates
Outcome results
None listed