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com/site/scientificrji
COMPARISON OF SHOULDER MUSCLE STRENGTHENING EXERCISES
WITH THE CONVENTIONAL TREATMENT OF MECHANICAL NECK
PAIN
*Dr. Deepak Raghav, **Dr. Sabiha, ***Dr. Monika, ****Dr. Tanvi
ABSTRACT
Background and Purpose: Although there have been previous researches reporting that scapula-thoracic
muscles such as the rhomboids, middle trapezius, and lower trapezius are thought to contribute to postural
stability of the cervical spine and reduce biomechanical loading of cervico-scapular musculature but
currently it is not known whether scapula-thoracic muscle strength is impaired in patients with chronic
neck pain compared to healthy individuals. Thereby this study is being conducted to see the effect of
shoulder muscles Strengthening on Mechanical neck pain. Methods: 30 patients who have been diagnosed
to have postural neck pain have been randomly assigned to one of the two treatment groups. Each group
consisted of 15 patients of both genders. Group A will be administered the traditional treatment protocol
with the addition of shoulder muscle strengthening exercises and Group B will be administered traditional
treatment . Both the groups will be administered 5 sessions per week for 3 weeks Visual analogue scale,
range of motion and neck disability index were the outcome measure and their scores for all groups were
taken prior ,at seventh week and after the training. Results: The pre and post treatments VAS (score) of two
groups showing that the mean VAS in both groups decreased (improved) after the treatments, and at final
evaluation, the decrease (improvement) was evident slightly higher in Group A than Group B. Comparison
between the 2 groups for extension ROM it showed that both the groups were equally effective. For side
flexion the comparison between the 2 groups proved equal effectiveness in both the groups. The pre and
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Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014
post treatments Neck Disability Index (NDI) scores of two groups showing that the mean NDI scores in
both groups decreased (improved) after the treatments and the decrease (improvement) was evident
comparatively higher in Group A (73.9%) than Group B (66.0%). Conclusion: The conclusion of the study
was that the Shoulder Muscle strengthening protocol was equally effective as the conventional treatment
protocol, in case of Mechanical neck pain
Keywords: Strengthening exercises, Mechanical neck pain, Visual analogue scale, Range of motion, Neck
disability index
INTRODUCTION Australian Acute Musculoskeletal Pain
guidelines group also recommended for neck
Neck pain is a common occurrence & some of
pain for no known cause the term Idiopathic
disability within the population with a lifetime
3 Neck Pain .The Neck Task Force proposed the
include as high as 54% .In the general
term Translatory neck pain instead of acute,
population up to 30%-50% of adults
short duration for sub-acute and long duration
experience neck pain at least once per year
for chronic neck pain 7.
(Martin Scherer et al., 2012) 4. Non-specific
According to several studies of patients, neck
neck pain has a postural or mechanical basis
pain may underlie impaired postural balance
and affects about two thirds of people at some
(Marie B. Jorgensen et al., 2011) 8. Most
stage, especially in middle age. Acute neck
patients who present with neck pain have non-
pain resolves within days or weeks but may
specific (simple) neck pain, where symptoms
become chronic in about 10% of people6.
have a postural or mechanical basis.
Bogduk & Mc Guirk et al also suggest that
Etiological factors are poorly understood and
neck pain maybe subdivided into upper
are usually multi-factorial, including poor
cervical spinal pain and lower cervical spinal
posture, anxiety, depression, neck strain, and
pain, above and below an imaginary transverse
sporting or occupational activities ( Haqberg
line through C4. From upper cervical
9,33
et al.,2000) . Aberrant activity within the
segments, pain can usually be referred to the
three portions of the trapezius muscle and
head whereas from the lower cervical
associated changes in scapular posture have
segments pain can be referred to the scapular
been identified as potential contributing
region, anterior chest wall, shoulder or upper
factors (Sally Wegner et al. 2010)1.
limb7.
Bad posture causes shortening of muscular
The Bone & Joint Decade 2000-2010 Task
fibers around articulation atlanto- occipitalis
Force on Neck Pain & its associated disorder
and overstretching of muscles around joints
describe neck pain as pain located in the
and thus possibly chronic neck pain. Chronic
anatomical region of the neck with or without
neck pain is often a widespread sensation with
radiation to head, trunk or upper limbs. The
29
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hyperalgesia in the ligaments and muscles SOURCE: Department of Physiotherapy
during both passive and active movements. It Santosh Medical & Dental College &
has also been stated that forward head posture Hospital, Ghaziabad.
may affect not only neck but also the thoracic Subjects who fulfilled the inclusion criteria
spine and shoulder blade, possibly causing and were ready to attend exercise program
overall imbalance in the musculoskeletal regularly were selected.
system (Jung-Ho Kang et al., 2012) .11 To participate subjects had to meet the
Neck pain causes considerable personal inclusion criteria: (i) Subjects with age of 20-
discomfort due to pain, disability, and 45 years. (ii) Subjects with history of
impaired quality of life, and may affect work. restriction of movement (iii) neck pain.
Studies have shown that physical training, (iv)forward head posture. (v) Unilateral
including specific exercises targeting the deep pain.32, 11,14
postural muscles of the cervical spine, is Exclusion Criteria for the subjects were: (i)
effective in reducing neck pain for patients Tumour. (ii) Infection. (iii) Non mechanical
with chronic neck pain. Exercise & vigorous neck pain. (iv) Herniated disc. (v) spinal
physical activities have a beautiful effect on fracture. (vi)Recent cervical surgery.
12
neck pain .
Technical information:
Jensin et al. found that strengthening &
A pre-post experimental design was used. The
fitness exercise is effective in reducing the
13 subjects were invited to participate in the
prevalence of neck pain . In addition to
study and were divided accordingly into two
gaining neck muscle strength, neck strength
groups. A detailed explanation of the
training has been shown to be effective in
procedure was given to the patients after
reducing neck pain & the disability associated
14 which they signed informed consent.
with it (Petri K. Salo et al.) . Stretching and
strengthening exercise reduces chronic neck 30 patients who have been diagnosed to
pain compared with usual care 6. groups traditional treatment of Hot Pack (20
minutes)88+ Cervical Isometrics+ Chin Tucks+
19,88
METOHDS Static Stretching (5 reptts,30 seconds)
exercises will be done. The treatment protocol
Selection and description of participants: was carried out for approximately 40-45
A sample of 50 subjects participated in the minutes including the application of Moist
study, out of which 20 subjects could not heat Pack for 20 minutes
complete the study. In Group A along with the traditional
treatment have postural neck pain have been
randomly assigned to one of the two treatment
30
Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014
groups. Each group consisted of 15 patients of slightly higher in Group A than Group B.
both genders. Group A will be administered Pre and post treatments Flexion levels
the traditional treatment protocol with the (Mean ± SD) of two groups
addition of shoulder muscle strengthening Pre and post treatments Flexion levels (Mean ±
exercises and Group B will be administered SD) of two groups showing an increase in the
traditional treatment . Both the groups will be Range of motion. The pre and post treatments
administered 5 sessions per week for 3 weeks. Flexion levels (degree) of two groups are
In both the, shoulder muscle strength training summarized in the table showing that the
will be done91 including the muscles- Serratus mean Flexion levels in both groups increased
Anterior, Supraspinatus, Infraspinatus & (improved) after the treatments, and at final
Upper Trapeziu evaluation, the increase (improvement) was
evident slightly higher in Group B (13.2%)
Statistics
than Group A (12.0%).
The data were summarized as Mean ± SD. The
Pre and post treatments Extention levels
groups were compared by repeated measures
mean ± ± SD) of two groups
analysis of variance (ANOVA) using general
Pre and post treatments Extension levels (Mean
linear models (GLM) and the significance of
± SD) of two groups depicting a similar scale
mean difference within and between the
of improvement in the range. The pre and post
groups was done by Tukey’s post hoc test
treatments Extension levels (degree) of two
after ascertaining normality by Shapiro-Wilk’s
groups are summarized in the table showed that
test and homogeneity of variances by
the mean Extension levels in both groups
Levene’s test. A two-sided (α=2) p<0.05 was
increased (improved) after the treatments, and
considered statistically significant. All
at final evaluation, the increase (improvement)
analyses were performed on STATISTICA
was evident slightly higher in Group B (12.2%)
(version 6.0) software.
than Group A (11.1%).
RESULTS
Pre and post treatments Side flexion levels
Pre and post treatments VAS score(Mean ±
(Mean ± SD) of two groups
SD) of two groups
Pre and post treatments Side flexion levels
Pre and post treatments VAS scores (Mean ±
(Mean ± SD) of two groups showing the
SD) of two groups showing a gradual decrease
effectiveness of both the protocols. The pre
in the score.The pre and post treatments VAS
and post treatments Side flexion levels
(score) of two groups showing that the mean
(degree) of two groups are summarized in the
VAS in both groups decreased (improved)
table showing that the mean Side flexion
after the treatments, and at final evaluation,
levels in both groups increased (improved)
the decrease (improvement) was evident
31
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after the treatments, and at final evaluation,
the increase (improvement) was evident
slightly higher in Group A (12.9%) than
Group B (11.4%).
Pre and post treatments Lateral rotation
levels (Mean ± SD) of two groups
Pre and post treatments Lateral rotation levels
(Mean ± SD) of two groups indicating an
increase in the ranges. The pre and post
treatments Lateral rotation levels (degree) of
two groups are summarized in the table
showing that the mean Lateral rotations in
both groups increased (improved) after the
treatments and the increase (improvement)
was evident slightly higher in Group B
(21.2%) than Group A (20.5%). Comparative mean Flexion levels between the
groups.
P Pre and post treatments NDI scores
(Mean ± SD) of two groups
Pre and post treatments NDI scores (Mean ±
SD) of two groups. The pre and post
treatments Neck Disability Index (NDI) scores
of two groups are summarized in the table
showing that the mean NDI scores in both
groups decreased (improved) after the
treatments and the decrease (improvement)
was evident comparatively higher in Group A Comparative mean Extension levels between
(73.9%) than Group B (66.0%). the groups.
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Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014
When the VAS score comparison was made
between the groups it showed similar decrease
indicating that both the groups are equally
effective for improving postural neck pain.
Comparing the two groups against each other
proved that both the groups were equally
effective. As we make comparison between
the 2 groups for extension ROM it showed
Comparative mean Side flexion levels within that both the groups were equally effective.
the groups For side flexion the comparison between the 2
groups proved equal effectiveness in both the
groups. Comparing Group A v/s Group B for
lateral rotation it was evident that both the
groups had similar improvement. When N.D.I.
scores were compared between the groups it
showed similar improvement in both the
groups.
The net results when observed clearly showed
that in terms of VAS Group A had more
Comparative mean NDI scores within the
effectiveness than Group B, while in Flexion
groups.
range of motion Group B proved to be better
than Group A. In case of Extension range of
motion Group B had better effectiveness but
as of Side Flexion range of motion Group A
proved better & for Lateral Rotation range of
motion Group B was marginally better than
Group A. As we talk of Neck Disability Index
Group A showed a marked better effect when
compared to Group B.
Comparative mean Lateral rotation levels This study was carried out for the reason that
within the groups. currently it is not known whether scapula-
DISCUSSION thoracic muscle strength is impaired in
patients with chronic neck pain compared to
The aim of the study was to compare the
healthy individuals. Katrina Maluf et al.
shoulder strengthening program with the
supports the shoulder muscle strengthening
conventional treatment of postural neck pain.
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protocol by stating that Scapulo-thoracic stabilizer muscle weakness. Physiotherapists
muscles such as the rhomboids, middle usually recommend using the chin-tuck
trapezius, and lower trapezius are thought to exercises to correct this faulty posture83.
contribute to postural stability of the cervical The neck retractions for proper posture by
spine and reduce biomechanical loading of moving the neck backward to a position over
1
cervico-scapular musculature . the shoulders, then a cranio-cervical flexion
Years ago, Gordon compared the effects of which is a nodding action to affect the deep
strength and endurance training on muscle flexors of the neck for which the terminology
proteins. Strength training adds to the portion is chin tucking exercise. These exercises have
of the muscle that generates tension, the shown an immediate pain reduction response.
contractile proteins. Connective tissue and These neck exercises also help reverse the ill
tendons grow in size and toughness when they effects of poor neck posture, neck related
are placed under tension. This increased headaches and the pain of arthritis. They are a
toughness in tendons may help quiet the simple and pro-active approach to improve the
inhibitory influence of the muscle receptor coordination and fitness of your neck muscles.
known as the tendon organ, a receptor These exercises target the deeper muscles
sensitive to stretching. The increase in which guide movements are important for
thickness of connective tissue contributes preventing injury and they often become weak
somewhat to the growth or hypertrophy of the when you are in pain and thus require specific
muscle43. therapeutic exercises to activate and train
The effects of conventional group cannot be them. Strength training results in muscle
overlooked. Moist heat therapy is known to hypertrophy, an increase in the cross-sectional
have effects on pain and spasm and thus can size of existing fibers. This is achieved by
attribute to pain relief and improved tissue increasing the number of myofibrils,
extensibility in both the groups88,89. sarcoplasmic volume, protein, supporting
Anna Sjors et al stated that neck shoulder pain connective tissue. Also strength training
remains a major problem in tasks with high programs increase the intramuscular stores
exposure to awkward working positions, such as adenosine tri-phosphate (ATP),
repetitive movements and movements with creatine phosphate (CP) and glycogen.
high precision demands. The reduction in the pain following static
Janda et al described a cervical upper crossed stretching can be explained on the basis of
syndrome to show the effect of a poking chin inhibitory effects of GTO (which causes a
posture on the muscles. Forward head posture dampening effect on the motor neuronal
(FHP) is one of the most common faulty discharges, thereby causing relaxation of the
postures to be accompanied by the deep neck musculotendinous unit by resetting its resting
34
Scientific Research Journal of India ● Volume: 3, Issue: 1, Year: 2014
length) and Pacinian corpuscle Also the comparison of other technique with
modification.These reflexes will allow proposed technique can be done in future.
relaxation in musculotendinous unit tension A larger sample size can be taken up for the
and decreased pain perception88. study.
The combination of stabilization exercises and
chin-tuck exercises provide not only the better LIMITATION OF STUDY
correction effect for Forward head posture in 1. The study has limited sample size and
neck pain patients, but could be provided a short period of intervention. Increasing the
83
more effective and stable corrected posture . sample size would have increased the
The variations in the results occur due to statistical power of the study.
difference in characteristics 2. Duration of the study was limited.
3. Electromyography could not be used due
FUTURE RESEARCH to unavailability.
This study has provided a positive outcome of 4. Less Trials.
the experimental method conducted in order to 5. Instrumental error could not be ruled out.
treat the proposed condition, still it provides
us with a chance to further modify the CONCLUSION
methodology and conduct a new study. The conclusion of the study was that the
Extending the duration of the study will make Shoulder Muscle strengthening protocol was
up for future prospects. equally effective as the conventional treatment
Future study can be done on another protocol, in case of Mechanical neck pain,
population. therefore the null hypothesis is rejected.
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CORRESPONDENCE
* MPT (Musculoskeletal), Principal, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh
** Student MPT (Musculoskeletal), Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh
39
ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji
*** MPT (Neurology), Assistant Professor, Santosh Medical College and Hospital, Ghaziabad, Uttar
Pradesh.
**** MPT (Musculoskeletal), Assistant Professor, Santosh Medical College and Hospital, Ghaziabad, Uttar
Pradesh.
40
