Cervical Stabilization Exercises on Respiratory Strength in Chronic Neck Pain

Neck Pain Clinical Trial

Official title:

Effects of Cervical Stabilization Exercises on Respiratory Strength in Chronic Neck Pain Patients With Forward Head Posture

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04674891
• Other study ID #: REC/LHR/20/1048 Tooba Arif
• Status: Completed
• Phase: N/A
• Start date: March 30, 2020
• Est. completion date: January 30, 2021

Study information

• Verified date: March 2021
• Source: Riphah International University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This project was a Randomized control trial conducted to check the effects of Cervical Stabilization Exercises on Respiratory Strength in Chronic Neck Pain Patients with Forward Head Posture, duration of study was of 6 months, convenient sampling was done, subject following eligibility criteria from Jinnah Hospital Lahore, were randomly allocated in two groups via lottery method, baseline assessment was done, Group A participants were given baseline treatment protocol for 4 weeks which included 3 sessions per week. Heating Pad applied for 15 min and TENS (Transcutaneous Electric Nerve Stimulation) for 10 min. After that Cervical isometric exercises performed in sitting (10sec hold, 10 to 15 reps). Group B was experimental group and participants were given baseline treatment in addition to Cervical Stabilization exercises for 4 weeks which included 3 sessions per week. The baseline measurement was taken on day one for Numeric Pain Rating Scale (NRPS) and Neck Disability Index (NDI). Forward head posture assessed by measuring Cranio Vertebral Angle (CVA). Respiratory muscle strengths measured by Spirometer and SBC (single breath count). All the measurements repeated at the end of fourth week. Data was analyzed by using SPSS version 20.

Description:

Extensive usage of electronic gadgets in today's life leads to the musculoskeletal problems among which neck pain is the most common problem reported to physicians, orthopedics and physical therapists. Even before reporting to clinics there is long history of using over the counter pain killers. Pain avoidance behaviors let the cervical spine stiff so much that a clinician help is sought. There is huge literature regarding the management of chronic neck pain and yet after the decades of research there are gaps in treatment options. In modern age of health care, it is common goal of every healthcare to make patient self-sufficient as early as possible. The self-care models have tremendous advantages. The current study has compared the effects of cervical stabilization exercises and isometric exercises. The current study was novel in a way that there is limited literature about treating Chronic Neck Pain Patients with effects of physiotherapy on respiratory strength in improving forward head posture. All the methods were employed to see if they improve ranges along with accompanying pain and disability.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 44
• Est. completion date: January 30, 2021
• Est. primary completion date: December 30, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Patients with chronic neck pain for more than 3 months.
• Mild neck disability (NDI score 5-15)

Exclusion Criteria:

• Neck pain secondary to trauma
• Deformities of thoracic region or vertebral column
• History of any thoracic or vertebral column surgery.
• History of smoking
• Patients with any other serious pathology/red flags

Related Conditions & MeSH terms

• Neck Pain

Intervention

Other:
• baseline physical therapy treatment
Group A was control group and the patients received Conventional treatment protocol for 4 weeks which included 3 sessions per week. Patients received hot pack for 15 min and TENS (Transcutaneous Electric Nerve Stimulation) for 10 min. After that Cervical isometric exercises will be performed in sitting (10sec hold,10 to 15 reps)
• Cervical Stabilization exercises
Group B was experimental group and received baseline physiotherapy treatment in addition to Cervical Stabilization exercises. Pillow was placed beneath cervical spine in supine position and guided patients to nod head as though they said 'yes' and asked them to hold for 10 seconds. 10 repetitions were done before progressing to the next target level. 4 weeks (3 sessions per week) Hot pack: 10 min TENS: 10 min Cervical isometric exercises in sitting (10sec hold,10 to 15 reps) Cervical Stabilization exercises (10 sec hold, 10 reps) On eligible participants baseline assessment was taken on day 1, post intervention assessment was taken at the end of 4th week.

Locations

Country	Name	City	State
Pakistan	Jinnah Hospital	Lahore	Punjab

Sponsors (1)

Lead Sponsor	Collaborator
Riphah International University

Country where clinical trial is conducted

Pakistan, 

References & Publications (16)

Alsultan F, De Nunzio AM, Rushton A, Heneghan NR, Falla D. Variability of neck and trunk movement during single- and dual-task gait in people with chronic neck pain. Clin Biomech (Bristol, Avon). 2020 Feb;72:31-36. doi: 10.1016/j.clinbiomech.2019.11.019. Epub 2019 Nov 28. — View Citation

Gurudut P, Welling A, Chodankar A. Effect of self-care exercises in forward head posture on craniovertebral angle and craniocervical flexion endurance: A pilot study. Indian Journal of Physical Therapy and Research. 2020;2(1):25.

Herman PM, Vernon H, Hurwitz EL, Shekelle PG, Whitley MD, Coulter ID. Clinical Scenarios for Which Cervical Mobilization and Manipulation Are Considered by an Expert Panel to Be Appropriate (and Inappropriate) for Patients With Chronic Neck Pain. Clin J Pain. 2020 Apr;36(4):273-280. doi: 10.1097/AJP.0000000000000800. — View Citation

Kalita J, Kumar M, Misra UK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome. J Clin Neurosci. 2020 Feb;72:50-56. doi: 10.1016/j.jocn.2020.01.032. Epub 2020 Jan 22. — View Citation

Kim G-C, HwangBo P-N. Effects of cervical stabilization exercise using pressure biofeedback on neck pain, forward head posture and acoustic characteristics of chronic neck pain patients with forward head posture. Korean Society of Physical Medicine. 2019;14(1):121-9.

Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effect of forward head posture on thoracic shape and respiratory function. J Phys Ther Sci. 2019 Jan;31(1):63-68. doi: 10.1589/jpts.31.63. Epub 2019 Jan 10. — View Citation

Lee H-j, Park H-s, Park J-m. The Effects of Cervical Stabilization Exercise on Neck Pain, Range of Motion, and Deep Cervical Muscle Strength in Patients With Chronic Neck Pain. The Journal of Korean Academy of Orthopedic Manual Physical Therapy. 2019;25(1):9-19

Lee MH, Jang SH. The effects of the neck stabilization exercise on the muscle activity of trunk respiratory muscles and maximum voluntary ventilation of chronic stroke patients. J Back Musculoskelet Rehabil. 2019;32(6):863-868. doi: 10.3233/BMR-170839. — View Citation

Mathur H, Khan SA, Siddiqui ZA. Effect of forward head posture on swallowing: Review of Literature. 2019

Migliarese S, White E. Review of Forward-Head Posture and Vestibular Deficits in Older Adults. Current Geriatrics Reports. 2019;8(3):194-201.

Miranda IF, Wagner Neto ES, Dhein W, Brodt GA, Loss JF. Individuals With Chronic Neck Pain Have Lower Neck Strength Than Healthy Controls: A Systematic Review With Meta-Analysis. J Manipulative Physiol Ther. 2019 Oct;42(8):608-622. doi: 10.1016/j.jmpt.2018.12.008. Epub 2019 Nov 23. — View Citation

Pawaria S, SuDhan DS, Kalra S. Effectiveness of Cervical Stabilisation Exercises on Respiratory Strength in Chronic Neck Pain Patients with Forward Head Posture-A Pilot Study. Journal of Clinical and Diagnostic Research. 2019;13(4).

Son K-k, Cynn H-S, Lee J-H, Park D-H, Kim B-B. Effects of Deep Cervical Flexor Exercise with Visual Guide on Muscle Activity and Craniovertebral Angle in Subjects with Forward Head Posture. Korean Society of Physical Medicine. 2019;14(2):53-61.

Storto CJ, Garcez AS, Suzuki H, Cusmanich KG, Elkenawy I, Moon W, Suzuki SS. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion. Angle Orthod. 2019 Sep;89(5):713-720. doi: 10.2319/070518-504.1. Epub 2019 Mar 21. — View Citation

Uysal SC, Tüzün EH, Eker L, Angin E. Effectiveness of the muscle energy technique on respiratory muscle strength and endurance in patients with fibromyalgia. J Back Musculoskelet Rehabil. 2019;32(3):411-419. doi: 10.3233/BMR-181287. — View Citation

Young IA PT, DSc, Dunning J PT, DPT, Butts R PT, PhD, Mourad F PT, DPT, Cleland JA PT, PhD. Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract. 2019 Dec;35(12):1328-1335. doi: 10.1080/09593985.2018.1471763. Epub 2018 Jun 1. — View Citation

* Note: There are 16 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Spirometer	A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. The spirogram will identify two different types of abnormal ventilation patterns, obstructive and restrictive	4th Week
Other	Single Breath Count( SBC)	To perform, ask patient to count out loud after maximal inspiration. Ability to reach 50 indicates normal respiratory function. Single breath count of less than 15 typically correlates with low forced vital capacity (FVC) and respiratory muscle weakness	4th Week
Primary	Numeric Pain rating scale	The NPRS is the segmented numeric version of visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of pain. The common format is a horizontal bar or line. Similar to VAS, the NPRS is anchored by terms describing pain severity extremes.	4th week
Secondary	Neck disability Index	Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, questionnaire 10-item scaled entitled the Neck Disability Index (NDI)	4th Week