Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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Effects of Thoracic Mobility Exercise on Cervicothoracic Function, Posture and Pain in Individuals With Mechanical Neck Pain

등뼈 가동성 운동이 기계적 목통증 환자의 목등뼈부 기능 수준과 자세, 통증 수준에 미치는 영향

  • Lee, Hwa-jeong (Dept. of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Kim, Suhn-yeop (Dept. of Physical Therapy, College of Health & Medical Science, Daejeon University)
  • 이화정 (대전대학교 보건의료대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료학과)
  • Received : 2019.05.05
  • Accepted : 2019.06.17
  • Published : 2019.09.17
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Abstract

Background: Individuals with mechanical neck pain show biomechanical and neurophysiological changes, including cervical spine muscle weakness. As a result of deep muscle weakness, it causes stability disability and reduced upper thoracic spine mobility, which finally leads to functional movement restriction such as limited range of motion and dysfunction. Recent studies have shown that thoracic spine manipulation and mobilization could reduce symptoms of mechanical neck pain in patients. Objects: The purpose of this study was to investigate the effects of thoracic mobility exercise on cervicothoracic function, posture feature, and pain intensity in individuals with mechanical neck pain. Methods: The study subjects were 26 persons who were randomly assigned to the experimental (with thoracic mobility exercise) and control groups (without thoracic mobility exercise), with 13 subjects in each group. The cervicothoracic function (neck functional disability level and cervicothoracic range of motion), posture feature, and pain rating (using a quadrupled visual analogue scale [QVAS]) were measured before, after 3 weeks, and after 6 weeks. Results: Statistically significant group-by-time interactions were found with repeated analyses of variance for the Korean neck disability index (KNDI), all cervical range of motion (CROM), all thoracic range of motion (TROM), cranial rotation angle, sagittal shoulder posture (SSP), and QVAS (p<.05). All groups showed significant improvements from all times in all the evaluated methods. The KNDI, CROM, TROM of left rotation, and SSP in the experimental group showed significant improvements after 3 weeks, and the TROM of the right rotation and QVAS in the experimental group showed significant improvements after 6 weeks when compared with the control group. Conclusion: Thoracic mobility exercise during 6 weeks might be effective intervention to improve the functional level, posture feature, and QVAS pain rating for managing individuals with mechanical neck pain.

Keywords

References

  1. Ahn NU, Ahn UM, Ipsen B, et al. Mechanical neck pain and cervicogenic headache. Neurosurgery. 2007;60(1 Suppl_1):S1-21-S1-27. https://doi.org/10.1227/01.NEU.0000249258.94041.C6
  2. Audette I, Dumas JP, Cote JN, et al. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010;40(5):318-323. https://doi.org/10.2519/jospt.2010.3180
  3. Bialosky JE, Bishop MD, Price DD, et al. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Man Ther. 2009;14(5):531-538. https://doi.org/10.1016/j.math.2008.09.001
  4. Bogduk N, Aprill C. On the nature of neck pain, discography and cervical zygapophysial joint blocks. Pain. 1993;54(2):213-217. https://doi.org/10.1016/0304-3959(93)90211-7
  5. Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18(3):1-33. https://doi.org/10.1186/1746-1340-18-3
  6. Bucke J, Spencer S, Fawcett L, et al. Validity of the digital inclinometer and iphone when measuring thoracic spine rotation. J Athl Train. 2017;52(9):820-825. https://doi.org/10.4085/1062-6050-52.6.05.
  7. Chae YW. The measurement of forward head posture and pressure pain threshold in neck muscle. J Kor Phys Ther 2002:14(1):117-124.
  8. Childs JD, Cleland JA, Elliott JM, et al. Neck pain:Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34. https://doi.org/10.2519/jospt.2008.0303
  9. Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: A randomized clinical trial. BMC Musculoskelet Disord. 2017;18(1):525. https://doi.org/10.1186/s12891-017-1889-2
  10. Choi IS, Jang HJ, Kim SY. Regression analysis of the relationship among the level of pain and dysfunction and psychosocial factors in patients with chronic back pain. Phys Ther Korea. 2016;23(1):38-45. https://doi.org/10.12674/ptk.2016.23.1.038
  11. Choi YJ, Hwang R. Effect of cervical and thoracic stretching and strengthening exercise program on forward head posture. The Korea Contents Association. 2011;11(10):293-300. https://doi.org/10.5392/JKCA.2011.11.10.293
  12. Cleland JA, Childs JD, Whitman JM. Psychometric properties of the neck disability index and numeric pain rating scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008;89(1):69-74. https://doi.org/10.1016/j.apmr.2007.08.126
  13. Cleland JA, Glynn P, Whitman JM, et al. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: A randomized clinical trial. Phys Ther. 2007;87(4):431-440. https://doi.org/10.2522/ptj.20060217
  14. Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med. 2007;8(4):344-353. https://doi.org/10.1111/j.1526-4637.2006.00201.x
  15. Cross KM, Kuenze C, Grindstaff TL, et al. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: A systematic review. J Orthop Sports Phys Ther. 2011;41(9):633-642. https://doi.org/10.2519/jospt.2011.3670
  16. de Camargo VM, Alburquerque-Sendin F, Berzin F, et al. Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: A randomized controlled trial. J Manipulative Physiol Ther. 2011;34(4):211-220. https://doi.org/10.1016/j.jmpt.2011.02.002
  17. Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-A57. https://doi.org/10.2519/jospt.2012.42.4.A1
  18. Dishman JD, Ball KA, Burke J. First prize central motor excitability changes after spinal manipulation: A transcranial magnetic stimulation study. J Manipulative Physiol Ther. 2002;25(1):1-9. https://doi.org/10.1067/mmt.2002.120414
  19. D'Sylva J, Miller J, Gross A, et al. Manual therapy with or without physical medicine modalities for neck pain: A systematic review. Man Ther. 2010;15(5):415-433. https://doi.org/10.1016/j.math.2010.04.003
  20. Elliott J, Jull G, Noteboom JT, et al. MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD). Man Ther. 2008;13(3):258-265. http://doi.org/10.1016/j.math.2007.01.012
  21. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004;29(13):1436-1440. https://doi.org/10.1097/01.BRS.0000128759.02487.BF
  22. Falla D, O'Leary S, Fagan A, et al. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Man Ther. 2007;12(2):139-143. https://doi.org/10.1016/j.math.2006.06.003
  23. Fejer R, Kyvik KO, Hartvigsen J.. The prevalence of neck pain in the world population: A systematic critical review of the literature. Eur Spine J 2006;15(6):834-848. https://doi.org/10.1007/s00586-004-0864-4
  24. Fernandez-de-las-Penas C, Albert-Sanchis JC, Buil M, et al. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. J Orthop Sports Phys Ther. 2008;38(4):175-180. https://doi.org/10.2519/jospt.2008.2598
  25. Ganesh GS, Mohanty P, Pattnaik M, et al. Effectiveness of mobilization therapy and exercises in mechanical neck pain. Physiother Theory Pract. 2015;31(2):99-106. https://doi.org/10.3109/09593985.2014.963904
  26. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, et al. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(1):20-27. https://doi.org/10.2519/jospt.2009.2914
  27. Graham N, Gross AR, Carlesso LC, et al. An ICON Overview on physical modalities for neck pain and associated disorders. Open Orthop J. 2013;7:440-460. https://doi.org/10.2174/1874325001307010440
  28. Grimmer-Somers K, Milanese S, Louw Q. Measurement of cervical posture in the sagittal plane. J Manipulative Physiol Ther. 2008;31(7):509-517. https://doi.org/10.1016/j.jmpt.2008.08.005
  29. Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1:CD004250. https://doi.org/10.1002/14651858.CD004250.pub5
  30. Gross A, Miller J, D'Sylva J, et al. Manipulation or mobilisation for neck pain: A Cochrane Review. Man Ther. 2010;15(4):315-333. https://doi.org/10.1016/j.math.2010.04.002
  31. Gross AR, Goldsmith C, Hoving JL, et al. Conservative management of mechanical neck disorders: A systematic review. J Rheumatol. 2007;34(5):1083-1102.
  32. Ha NR, Shin HM, Kim MC, et al. Effects of abdominal breathing and thoracic expansion exercises on head position and shoulder posture in patients with rotator cuff injury. J Korean Soc Phys Med, 2016;11(4):1-9. https://doi.org/10.13066/kspm.2016.11.4.1
  33. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol. 2012;22(5):768-776. https://doi.org/10.1016/j.jelekin.2012.02.012
  34. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52(4):424-427. https://doi.org/10.1097/JOM.0b013e3181d44f3b
  35. Hengeveld E, Banks K. Maitland's vertebral manipulation. 8th ed. Churchill Livingstone;2013:5-13,157.
  36. Horton SJ, Johnson GM, Skinner MA. Changes in head and neck posture using an office chair with and without lumbar roll support. Spine. 2010;35(12):E542-E548. https://doi.org/10.1097/BRS.0b013e3181cb8f82
  37. Huisman PA, Speksnijder CM, de Wijer A. The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: A systematic review. Disabil Rehabil. 2013; 35(20):1677-1685. https://doi.org/10.3109/09638288.2012.750689
  38. Hwang DG, Lee JH, Moon SY, et al. The reliability of the nonradiologic measures of thoracic spine rotation in healthy adults. Phys Ther Rehabil Sci. 2017;6(2):65-70. https://doi.org/10.14474/ptrs.2017.6.2.65
  39. Jull G, Trott P, Potter H, et. al. Randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835-1843. https://doi.org/10.1097/00007632-200209010-00004
  40. Jull G. Management of cervical headache. Man Ther. 1997;2(4):182-190. https://doi.org/10.1054/math.1997.0298
  41. Katzman WB, Vittinghoff E, Kado DM et al. Study of hyperkyphosis, exercise and function (sheaf) protocol of a randomized controlled trial of multimodal spine-strengthening exercise in older adults with hyperkyphosis. Phys Ther. 2016;96(3):371-381. https://doi.org/10.2522/ptj.20150171
  42. Kim BB, Lee JH, Jeong HJ et al. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol. 2016;30:31-37. http://doi.org/10.1016/j.jelekin.2016.05.007
  43. Lee BK, Yang JM, Kang KH. Comparison of between upper thoracic manipulation and cervical stability training on range of motion and neck disability in patients with chronic mechanical neck pain. J Korean Soc Phys Med, 2015;10(2):35-45. https://doi.org/10.13066/kspm.2015.10.2.35
  44. MacDermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: A systematic review. J Orthop Sports Phys Ther. 2009;39(5):400-417. https://doi.org/10.2519/jospt.2009.2930.
  45. Manchukonda R, Manchikanti KN, Cash KA, et al. Facet joint pain in chronic spinal pain: An evaluation of prevalence and false-positive rate of diagnostic blocks. J Spinal Disord Tech. 2007;20(7):539-545. https://doi.org/10.1097/BSD.0b013e3180577812
  46. Martinez-Segura R, De-la-Llave-Rincon AI, Ortega-Santiago R, et al. Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2012;42(9):806-814. https://doi.org/10.2519/jospt.2012.4151
  47. Masaracchio M, Cleland JA, Hellman M, et al. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(3):118-127. https://doi.org/10.2519/jospt.2013.4221
  48. Masaracchio M, Kirker K, States R, et al. Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis. PLoS One. 2019;14(2):e0211877. https://doi.org/10.1371/journal.pone.0211877
  49. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: A critical review. Psychol Med. 1988;18(4):1007-1019. https://doi.org/10.1017/S0033291700009934
  50. Miller J, Gross A, D'Sylva J, et al. Manual therapy and exercise for neck pain: A systematic review. Man Ther. 2010;15(4):334-354. https://doi.org/10.1016/j.math.2010.02.007
  51. O'Leary S, Falla D, Jull G. The relationship between superficial muscle activity during the cranio-cervical flexion test and clinical features in patients with chronic neck pain. Man Ther. 2011;16(5):452-455. https://doi.org/10.1016/j.math.2011.02.008
  52. Puentedura EJ, March J, Anders J, et al. Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports. J Man Manip Ther. 2012;20(2):66-74. https://doi.org/10.1179/2042618611Y.0000000022
  53. Redcord AS. ExerciseManual_Neurac 2 Upper Body_V1. Redcord(R). 2016;57-59.
  54. Saavedra-Hernandez M, Castro-Sanchez AM, Fernandez-de-Las-Penas C, et al. Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine. J Manipulative Physiol Ther. 2011;34(3):144-152. https://doi.org/10.1016/j.jmpt.2011.02.011
  55. Song KJ, Choi BW, Kim SJ, et al. Cross-cultural adaptation and validation of the korean version of the neck disability index. J Korean Orthop Assoc. 2009;44(3):350-359. https://doi.org/10.4055/jkoa.2009.44.3.350
  56. Suter E, McMorland G. Decrease in elbow flexor inhibition after cervical spine manipulation in patients with chronic neck pain. Clin Biomech. 2002;17(7):541-544. https://doi.org/10.1016/S0268-0033(02)00025-6
  57. Thigpen CA, Padua DA, Michener LA, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20(4):701-709. https://doi.org/10.1016/j.jelekin.2009.12.003
  58. Von Korff M, Ormel J, Keefe FJ, et al. Grading the severity of chronic pain. Pain. 1992;50(2):133-149. https://doi.org/10.1016/0304-3959(92)90154-4
  59. Wagner DR, Tatsugawa K, Parker D, et al. Reliability and utility of a visual analog scale for the assessment of acute mountain sickness. High Alt Med Biol. 2007;8(1):27-31. https://doi.org/10.1089/ham.2006.0814
  60. Walser RF, Meserve BB, Boucher TR. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: A systematic review and meta-analysis of randomized clinical trials. J Man Manip Ther. 2009;17(4):237-246. https://doi.org/10.1179/106698109791352085
  61. Wilke HJ, Wolf S, Claes LE, et al. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine. 1995;20(2):192-198. https://doi.org/10.1097/00007632-199501150-00011
  62. Young IA, Cleland JA, Michener LA, et al. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil. 2010;89(10):831-839. https://doi.org/10.1097/PHM.0b013e3181ec98e6