Chronic Mechanical Neck Pain
Conditions
Keywords
Bruegger's Relief Exercise, Chronic Mechanical Neck Pain, Forward Head Posture, Craniovertebral Angle, Neck Disability
Brief summary
The aim of this randomized controlled trial is to determine the effect of Bruegger's Relief Exercise combined with conventional physical therapy on pain intensity, functional disability, cervical range of motion, and craniovertebral angle in patients with chronic mechanical neck pain
Detailed description
Neck pain is the second most prevalent musculoskeletal disorder worldwide. Neck pain persisting for more than three months is classified as chronic neck pain (CNP). Individuals with chronic mechanical neck pain (CMNP) exhibit distinct neuromuscular and epidemiological characteristics This imbalance contributes to impaired cervical stability and altered movement control.According to the Global Burden of Disease 2019 report, the global age-standardized prevalence of neck pain was approximately 2,696.5 per 100,000 population (≈2.7%), with an incidence rate of 579.1 per 100,000 population (≈0.58%). In Pakistan, musculoskeletal pain among young adults has been reported to range between 55-60%, with neck pain representing a major complaint Forward head posture (FHP) is a common postural deviation associated with chronic mechanical neck pain. It is highly prevalent, affecting approximately 62% of young adults in Pakistan and nearly 64% globally. FHP is characterized by anterior translation of the head, lower cervical flexion, and often increased upper cervical extension. The craniovertebral angle (CVA), defined as the angle formed between a horizontal line through the C7 spinous process and a line connecting the tragus of the ear to C7, is commonly used to quantify forward head posture. A reduced CVA indicates greater forward head translation and has been associated with increased pain intensity and reduced endurance of the deep cervical flexor muscles. Postural deviation and neuromuscular imbalance contribute to mechanical stress on cervical structures, functional limitations, and persistent symptoms in individuals with CMNP. Given the high prevalence of forward head posture and its association with chronic mechanical neck pain, interventions targeting postural correction and neuromuscular re-education may be clinically beneficial. This randomized controlled trial aims to evaluate the effect of Bruegger's Relief Exercise combined with conventional physical therapy on pain intensity, functional disability, cervical range of motion, and craniovertebral angle in individuals with chronic mechanical neck pain.
Interventions
OTHERBruegger's Relief Exercise + Conventional Physical Therapy
Bruegger's Relief Exercise. High sitting neutral posture with feet flat on the floor and a light resistance band held across the thighs. 1A gentle chin tuck is performed to maintain cervical alignment. The movement includes 2 shoulder abduction and external rotation 3. Elbow extension 4. Forearm supination 5. Wrist extension 6. Finger and thumb abduction, coordinated with diaphragmatic breathing. (Hold duration: 10-30 seconds with progression of 2 seconds per session). 12 repetitions per session with 30-second rest interval between holds. Total duration is 3 sessions per week for 4 consecutive weeks.
OTHERConventional Treatment
Conventional PT including 1- Cervical ROM exercises (flexion, extension, rotation, lateral flexion) 2- Stretching of upper trapezius and levator scapulae (30 sec hold × 3 repetitions) 3- Cervical isometric strengthening in all directions 4- Scapular stabilization exercises (elevation-depression, protraction-retraction) (Dosage: 2-3 sets of 10-15 repetitions). Total duration is 3 sessions per week for 4 consecutive weeks.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* • Participants falling in this category would be recruited into the study. * Age 20-50 years * Diagnosis of chronic mechanical neck pain (\>3 months) * Pain intensity ≥ 3/10 on NPRS * Neck Disability Index score ≥ 10/50 * Willing to participate and provide informed consent
Exclusion criteria
* • Participants falling in this category would be excluded from the study. * History of cervical spine fracture or surgery * Systemic musculoskeletal or neurological disease * Recent whiplash injury (within 6 months) * Botulinum toxin injection within previous 6 months * Severe structural deformity (e.g., torticollis, severe scoliosis) * Red flag signs (fever, unexplained weight loss, progressive neurological deficit) * Positive cervical instability tests (Sharp-Purser or Alar ligament test) * Clinical signs of cervical radiculopathy (positive Spurling's/ULTT/distraction test)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale | Baseline, Week 2, Week 4 | An 11-point scale (0-10) used to assess pain intensity. 0 indicates no pain and 10 indicates worst imaginable pain. Participants verbally report their pain score |
| Neck Disability Index | Baseline, Week 2, Week 4 | The NDI is a 10-item questionnaire assessing functional disability related to neck pain. Each item is scored 0-5 with total score range 0-50. Higher scores indicate greater disability. |
| Cervical Range of Motion | Baseline, Week 2, Week 4 | A universal goniometer will be used to measure cervical flexion, extension, lateral flexion, and rotation |
| Craniovertebral Angle | Baseline, Week 2, Week | CVA will be measured using the Angle - Video Goniometer mobile application via lateral photographic analysis. A smaller angle indicates greater forward head posture. |
Countries
Pakistan
Contacts
CONTACTKINZA ANWAR, MS-OMPT
PRINCIPAL_INVESTIGATORKINZA ANWAR, MS-OMPT
Riphah International University
Outcome results
None listed