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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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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

Neck pain is a common occurrence & some of disability within the population with a lifetime include as high as 54% population up to
3

guidelines group also recommended for neck pain for no known cause the term Idiopathic Neck Pain .The Neck Task Force proposed the term Translatory neck pain instead of acute, short duration for sub-acute and long duration for chronic neck pain 7. According to several studies of patients, neck pain may underlie impaired postural balance (Marie B. Jorgensen et al., 2011) 8. Most

.In the general of adults

30%-50%

experience neck pain at least once per year (Martin Scherer et al., 2012) 4. Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks but may become chronic in about 10% of people6. Bogduk & Mc Guirk et al also suggest that neck pain maybe subdivided into upper cervical spinal pain and lower cervical spinal pain, above and below an imaginary transverse line through C4. From upper cervical

patients who present with neck pain have nonspecific (simple) neck pain, where symptoms have a postural or mechanical basis.

Etiological factors are poorly understood and are usually multi-factorial, including poor posture, anxiety, depression, neck strain, and sporting or occupational activities ( Haqberg et al.,2000)
9,33

segments, pain can usually be referred to the head whereas from the lower cervical

. Aberrant activity within the

three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors (Sally Wegner et al. 2010)1. Bad posture causes shortening of muscular fibers around articulation atlanto- occipitalis and overstretching of muscles around joints and thus possibly chronic neck pain. Chronic neck pain is often a widespread sensation with

segments pain can be referred to the scapular region, anterior chest wall, shoulder or upper limb7. The Bone & Joint Decade 2000-2010 Task Force on Neck Pain & its associated disorder describe neck pain as pain located in the anatomical region of the neck with or without radiation to head, trunk or upper limbs. The
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hyperalgesia in the ligaments and muscles during both passive and active movements. It has also been stated that forward head posture may affect not only neck but also the thoracic spine and shoulder blade, possibly causing overall imbalance in the musculoskeletal system (Jung-Ho Kang et al., 2012) .11 Neck pain causes considerable personal discomfort due to pain, disability, and impaired quality of life, and may affect work. Studies have shown that physical training, including specific exercises targeting the deep postural muscles of the cervical spine, is effective in reducing neck pain for patients with chronic neck pain. Exercise & vigorous physical activities have a beautiful effect on neck pain . Jensin et al. found that strengthening &
13 12

SOURCE: Santosh

Department &

of Dental

Physiotherapy College &

Medical

Hospital, Ghaziabad. Subjects who fulfilled the inclusion criteria and were ready to attend exercise program regularly were selected. To participate subjects had to meet the inclusion criteria: (i) Subjects with age of 2045 years. (ii) Subjects with history of restriction of movement (iii) neck pain. (iv)forward head posture. (v) Unilateral pain.32, 11,14 Exclusion Criteria for the subjects were: (i) Tumour. (ii) Infection. (iii) Non mechanical neck pain. (iv) Herniated disc. (v) spinal fracture. (vi)Recent cervical surgery. Technical information: A pre-post experimental design was used. The subjects were invited to participate in the study and were divided accordingly into two groups. A detailed explanation of the

fitness exercise is effective in reducing the prevalence of neck pain . In addition to

gaining neck muscle strength, neck strength training has been shown to be effective in reducing neck pain & the disability associated with it (Petri K. Salo et al.)
14

procedure was given to the patients after which they signed informed consent. 30 patients who have been diagnosed to groups traditional treatment of Hot Pack (20 minutes)88+ Cervical Isometrics+ Chin Tucks+
19,88

. Stretching and

strengthening exercise reduces chronic neck pain compared with usual care 6.

METOHDS Selection and description of participants: A sample of 50 subjects participated in the study, out of which 20 subjects could not complete the study.

Static Stretching (5 reptts,30 seconds)

exercises will be done. The treatment protocol was carried out for approximately 40-45 minutes including the application of Moist heat Pack for 20 minutes In Group A along with the traditional treatment have postural neck pain have been randomly assigned to one of the two treatment

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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. In both the, shoulder muscle strength training will be done91 including the muscles- Serratus Anterior, Supraspinatus, Infraspinatus &

slightly higher in Group A than Group B. Pre and post treatments Flexion levels (Mean SD) of two groups Pre and post treatments Flexion levels (Mean SD) of two groups showing an increase in the Range of motion. The pre and post treatments Flexion levels (degree) of two groups are summarized in the table showing that the

mean Flexion levels in both groups increased (improved) after the treatments, and at final evaluation, the increase (improvement) was evident slightly higher in Group B (13.2%) than Group A (12.0%). Pre and post treatments Extention levels mean SD) of two groups

Upper Trapeziu Statistics The data were summarized as Mean SD. The groups were compared by repeated measures analysis of variance (ANOVA) using general linear models (GLM) and the significance of mean difference within and between the groups was done by Tukeys post hoc test after ascertaining normality by Shapiro-Wilks test and homogeneity of variances by

Pre and post treatments Extension levels (Mean SD) of two groups depicting a similar scale of improvement in the range. The pre and post treatments Extension levels (degree) of two groups are summarized in the table showed that the mean Extension levels in both groups increased (improved) after the treatments, and at final evaluation, the increase (improvement) was evident slightly higher in Group B (12.2%) than Group A (11.1%).

Levenes test. A two-sided (=2) p<0.05 was considered statistically significant. All

analyses were performed on STATISTICA (version 6.0) software.

RESULTS Pre and post treatments VAS score(Mean SD) of two groups

Pre and post treatments Side flexion levels (Mean SD) of two groups Pre and post treatments Side flexion levels (Mean SD) of two groups showing the effectiveness of both the protocols. The pre and post treatments Side flexion levels (degree) of two groups are summarized in the table showing that the mean Side flexion levels in both groups increased (improved)
31

Pre and post treatments VAS scores (Mean SD) of two groups showing a gradual decrease in the score.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

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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 (73.9%) than Group B (66.0%). Comparative mean Extension levels between the groups.

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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 the groups that both the groups were equally effective. 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 Comparative mean NDI scores within the groups. that in terms of VAS Group A had more effectiveness than Group B, while in Flexion 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 within the groups. DISCUSSION The aim of the study was to compare the shoulder strengthening program with the conventional treatment of postural neck pain.
33

This study was carried out for the reason that currently it is not known whether scapulathoracic muscle strength is impaired in patients with chronic neck pain compared to healthy individuals. Katrina Maluf et al. supports the shoulder muscle strengthening

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protocol by stating that Scapulo-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 . Years ago, Gordon compared the effects of strength and endurance training on muscle proteins. Strength training adds to the portion of the muscle that generates tension, the contractile proteins. Connective tissue and tendons grow in size and toughness when they are placed under tension. This increased toughness in tendons may help quiet the inhibitory influence of the muscle receptor known as the tendon organ, a receptor sensitive to stretching. The increase in thickness of connective tissue contributes somewhat to the growth or hypertrophy of the muscle43. The effects of conventional group cannot be overlooked. Moist heat therapy is known to have effects on pain and spasm and thus can attribute to pain relief and improved tissue extensibility in both the groups88,89. Anna Sjors et al stated that neck shoulder pain remains a major problem in tasks with high exposure to awkward working positions, repetitive movements and movements with high precision demands. Janda et al described a cervical upper crossed syndrome to show the effect of a poking chin posture on the muscles. Forward head posture (FHP) is one of the most common faulty postures to be accompanied by the deep neck
34
1

stabilizer muscle weakness. Physiotherapists usually recommend using the chin-tuck exercises to correct this faulty posture83. The neck retractions for proper posture by moving the neck backward to a position over the shoulders, then a cranio-cervical flexion which is a nodding action to affect the deep flexors of the neck for which the terminology is chin tucking exercise. These exercises have shown an immediate pain reduction response. These neck exercises also help reverse the ill effects of poor neck posture, neck related
headaches and the pain of arthritis. They are a

simple and pro-active approach to improve the coordination and fitness of your neck muscles. These exercises target the deeper muscles which guide movements are important for preventing injury and they often become weak when you are in pain and thus require specific therapeutic exercises to activate and train them. Strength training results in muscle
hypertrophy, an increase in the cross-sectional

size of existing fibers. This is achieved by increasing the number of myofibrils,

sarcoplasmic volume,

protein, supporting

connective tissue. Also strength training programs increase the intramuscular stores such as adenosine tri-phosphate (ATP),

creatine phosphate (CP) and glycogen. The reduction in the pain following static stretching can be explained on the basis of inhibitory effects of GTO (which causes a dampening effect on the motor neuronal discharges, thereby causing relaxation of the musculotendinous unit by resetting its resting

Scientific Research Journal of India Volume: 3, Issue: 1, Year: 2014

length)

and

Pacinian reflexes

corpuscle will allow

Also the comparison of other technique with proposed technique can be done in future. A larger sample size can be taken up for the study.

modification.These

relaxation in musculotendinous unit tension and decreased pain perception88. The combination of stabilization exercises and chin-tuck exercises provide not only the better correction effect for Forward head posture in neck pain patients, but could be provided a more effective and stable corrected posture . The variations in the results occur due to difference in characteristics
83

LIMITATION OF STUDY 1. The study has limited sample size and short period of intervention. Increasing the sample size would have increased the statistical power of the study. 2. Duration of the study was limited. 3. Electromyography could not be used due

FUTURE RESEARCH This study has provided a positive outcome of the experimental method conducted in order to treat the proposed condition, still it provides us with a chance to further modify the methodology and conduct a new study. Extending the duration of the study will make up for future prospects. Future study can be done on another population.

to unavailability. 4. Less Trials. 5. Instrumental error could not be ruled out.

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, 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
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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.

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