Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Biofeedback Based Deep Neck Flexion Exercise on Neck Pain: Meta-analysis

바이오피드백을 이용한 심부목굽힘근운동이 목 질환에 미치는 영향: 메타분석

  • Park, Joo-Hee (Department of Physical Therapy, College of Health Science, Yonsei University) ;
  • Jeon, Hye-Seon (Department of Physical Therapy, College of Health Science, Yonsei University) ;
  • Kim, Ji-hyun (Department of Physical Therapy, The Graduate School, Yonsei University) ;
  • Kim, Ye Jin (Department of Physical Therapy, The Graduate School, Yonsei University) ;
  • Moon, Gyeong Ah (Department of Physical Therapy, The Graduate School, Yonsei University) ;
  • Lim, One-bin (Department of Physical Therapy, College of Health Science, Yonsei University)
  • 박주희 (연세대학교 보건과학대학 물리치료학과) ;
  • 전혜선 (연세대학교 보건과학대학 물리치료학과) ;
  • 김지현 (연세대학교 일반대학원 물리치료학과) ;
  • 김예진 (연세대학교 일반대학원 물리치료학과) ;
  • 문경아 (연세대학교 일반대학원 물리치료학과) ;
  • 임원빈 (연세대학교 보건과학대학 물리치료학과)
  • Received : 2020.12.29
  • Accepted : 2021.01.14
  • Published : 2021.02.20
Download PDF
⟨ Previous Next ⟩

Abstract

Previous studies have reported that deep neck flexor (DNF) exercise can improve neck problems, including neck pain, forward head posture, and headache, by targeting the deep and superficial muscles of the neck. Despite the prevailing opinion across studies, the benefits of DNF can vary according to the type of neck problems and the outcome measures adopted, ranging from positive outcomes to non-significant benefits. A meta-analysis was conducted in this study to assess conclusive evidence of the impact of DNF exercise on individuals with neck problems. We used PUBMED, MEDLINE, NDSL, EMBASE, and Web of Science to search for primary studies and the key terms used in these searches were "forward head posture (FHP)," "biofeedback," "pressure biofeedback unit," "stabilizer," "headache," and "neck pain." Twenty-four eligible studies were included in this meta-analysis and were coded according to the type of neck problems and outcome measures described, such as pain, endurance, involvement of neck muscle, craniovertebral angle (CVA), neck disability index (NDI), cervical range of motion (CROM), radiographs of the neck, posture, strength, endurance, and headache disability index. The overall effect size of the DNF exercise was 0.489. The effect sizes of the neck problems were 0.556 (neck pain), -1.278 (FHP), 0.176 (headache), and 1.850 (mix). The effect sizes of outcome measures were 1.045 (pain), 0.966 (endurance), 0.894 (deep neck flexor), 0.608 (superficial neck flexor), 0.487 (CVA), 0.409 (NDI), and 0.252 (CROM). According to the results of this study, DNF exercise can effectively reduce neck pain. Thus, DNF exercise is highly recommend as an effective exercise method for individuals suffering from neck pain.

Keywords

References

  1. Health Insurance Review & Assessment Service, National Health Insurance Service. National health insurance statistical yearbook. Wonju: Health Insurance Review & Assessment Service; 2016.
  2. Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther 2004;9(3):125-33. https://doi.org/10.1016/j.math.2004.05.003
  3. Jull GA, Soderlund A, Stemper BD, Kenardy J, Gross AR, Cote P, et al. Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5. Spine (Phila Pa 1976) 2011;36(25 Suppl):S335-42. https://doi.org/10.1097/BRS.0b013e3182388449
  4. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther 2017;47(7):A1-83.
  5. O'Leary S, Jull G, Kim M, Uthaikhup S, Vicenzino B. Training mode-dependent changes in motor performance in neck pain. Arch Phys Med Rehabil 2012;93(7):1225-33. https://doi.org/10.1016/j.apmr.2012.02.018
  6. Kristjansson E, Leivseth G, Brinckmann P, Frobin W. Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: a case-control study using a new measurement protocol. Spine (Phila Pa 1976) 2003;28(19):2215-21. https://doi.org/10.1097/01.BRS.0000089525.59684.49
  7. Mayoux-Benhamou MA, Wybier M, Revel M. Strength and cross-sectional area of the dorsal neck muscles. Ergonomics 1989;32(5):513-8. https://doi.org/10.1080/00140138908966121
  8. 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 (Phila Pa 1976) 2004;29(13):1436-40. https://doi.org/10.1097/01.BRS.0000128759.02487.BF
  9. Hayashi N, Masumoto T, Abe O, Aoki S, Ohtomo K, Tajiri Y. Accuracy of abnormal paraspinal muscle findings on contrastenhanced MR images as indirect signs of unilateral cervical root-avulsion injury. Radiology 2002;223(2):397-402. https://doi.org/10.1148/radiol.2232010857
  10. Javanshir K, Amiri M, Mohseni-Bandpei MA, Rezasoltani A, Fernandez-de-las-Penas C. Ultrasonography of the cervical muscles: a critical review of the literature. J Manipulative Physiol Ther 2010;33(8):630-7. https://doi.org/10.1016/j.jmpt.2010.08.016
  11. Blomgren J, Strandell E, Jull G, Vikman I, Roijezon U. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review. BMC Musculoskelet Disord 2018;19(1):415. https://doi.org/10.1186/s12891-018-2324-z
  12. Martin-Gomez C, Sestelo-Diaz R, Carrillo-Sanjuan V, Navarro-Santana MJ, Bardon-Romero J, Plaza-Manzano G. Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: a systematic review and meta-analysis. Musculoskelet Sci Pract 2019;42:52-9. https://doi.org/10.1016/j.msksp.2019.04.010
  13. Cho J, Lee E, Lee S. Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: a randomized clinical trial investigating their effectiveness. J Back Musculoskelet Rehabil 2019;32(4):595-602. https://doi.org/10.3233/BMR-181228
  14. Anarte E, Ferreira Carvalho G, Schwarz A, Luedtke K, Falla D. Can physical testing be used to distinguish between migraine and cervicogenic headache sufferers? A protocol for a systematic review. BMJ Open 2019;9(11):e031587. https://doi.org/10.1136/bmjopen-2019-031587
  15. Fernandez-de-las-Penas C, Perez-de-Heredia M, Molero-Sanchez A, Miangolarra-Page JC. Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study. J Orthop Sports Phys Ther 2007;37(2):33-9. https://doi.org/10.2519/jospt.2007.2401
  16. National Heart, Lung, and Blood Institute. Study quality assessment tools [Internet]. Bethesda [cited 2020 Oct 28]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
  17. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Abingdon-on-Thames: Routledge; 2013;377-86.
  18. Lluch E, Arguisuelas MD, Coloma PS, Palma F, Rey A, Falla D. Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain. J Manipulative Physiol Ther 2013;36(9):604-11. https://doi.org/10.1016/j.jmpt.2013.08.004
  19. Mohamed SS, Hagag AA, Shendy MA, El-Batanony MM. Ventilatory function response to training of cervical muscles in mechanical neck pain: a randomized controlled study. IJRAMR 2019;6(2):4617-22.
  20. Karthi M, Gopalswami AD, Aseer AL. Efficacy of endurance training on deep cervical flexor muscles using pressure feedback in mechanical neck pain. Int J Physiother 2019;6(3):95-101.
  21. Lee ES. The effect of SNAGs and biofeedback training on the integrative propriocepcion and function of the patients with cervical disorder. J Korea Acad Ind Soc 2020;21(1):284-90.
  22. Deepa A, Dabholkar TY, Yardi S. Comparison of the efficacy of Maitland thoracic mobilization and deep neck flexor endurance training versus only deep neck flexor endurance training in patients with mechanical neck pain. Indian J Physiother Occup Ther 2014;8(3):77-82. https://doi.org/10.5958/0973-5674.2014.00360.8
  23. Kim GC, HwangBo PN. 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. J Korean Soc Phys Med 2019;14(1):121-9. https://doi.org/10.13066/kspm.2019.14.1.121
  24. Kim Y. The effect of the deep neck flexor exercise for the proprioception in the neck. J Korean Acad Orthop Man Ther 2013;19(2):23-9.
  25. Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: a randomized controlled trial. J Back Musculoskelet Rehabil 2017;30(2):211-9. https://doi.org/10.3233/BMR-160735
  26. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: a randomized controlled trial. Physiother Theory Pract 2018;34(12):916-25. https://doi.org/10.1080/09593985.2018.1430876
  27. Chung SH, Her JG, Ko T, You YY, Lee JS. Effects of exercise on deep cervical flexors in patients with chronic neck pain. J Phys Ther Sci 2012;24(7):629-32. https://doi.org/10.1589/jpts.24.629
  28. Gallego Izquierdo T, Pecos-Martin D, Lluch Girbes E, Plaza-Manzano G, Rodriguez Caldentey R, Mayor Melus R, et al. Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: a randomized controlled clinical trial. J Rehabil Med 2016;48(1):48-55. https://doi.org/10.2340/16501977-2034
  29. Kim JY, Kwag KI. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain. J Phys Ther Sci 2016;28(1):269-73. https://doi.org/10.1589/jpts.28.269
  30. Javanshir K, Amiri M, Mohseni Bandpei MA, De las Penas CF, Rezasoltani A. The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain. J Back Musculoskelet Rehabil 2015;28(4):833-40. https://doi.org/10.3233/BMR-150593
  31. Kang H, Yang H. The effects of modified chin tuck exercise on the cervical curvature, the strength and endurance of the deep cervical flexor muscles in subjects with forward head posture. J Korean Soc Integr Med 2019;7(2):189-95. https://doi.org/10.15268/KSIM.2019.7.2.189
  32. Kim Y, Lee S, Jeon B, Jeong S, Kim B. The effects of shoulder stabilization and thoracic extensor exercises combined with deep neck flexor exercise on posture and pressure pain threshold of physical therapist and occupational therapist with turtle neck syndrome. J Korean Acad Orthop Man Ther 2017;23(1):45-53.
  33. Islam R, Quddus N, Miraj M, Anwer S. Efficacy of deep cervical flexor strength training versus conventional treatment in cervicogenic headache. IJCRR 2013;5(8):84-90.
  34. Nambi SG, Pancholi DP, Trivedi PS, Momin SM, Patel S. Comparative effect between C1-C2 self-sustained natural apophyseal glide (SNAG) and deep cervical flexors strength training in the management of cervicogenic headache. Int J Pharmacol Screen Methods 2014;4(2):69-73.
  35. Park S, Yoon J. Effects of neck stabilizing exercise on muscle characteristics, muscle activity and posture in patients with cervicogenic headache. J Korean Soc Integr Med 2019;7(4):301-9. https://doi.org/10.15268/KSIM.2019.7.4.301
  36. Park SK, Yang DJ, Kim JH, Heo JW, Park SH, Uhm YH, et al. Effects of cranio-cervical flexion with transcranial direct current stimulation on muscle activity and neck functions in patients with cervicogenic headache. J Phys Ther Sci 2019;31(1):24-8. https://doi.org/10.1589/jpts.31.24
  37. Park SK, Yang DJ, Kim JH, Kang DH, Park SH, Yoon JH. Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. J Phys Ther Sci 2017;29(10):1836-40. https://doi.org/10.1589/jpts.29.1836
  38. Karthikeyan T, Anupam G, Bhadri Narayan V. Efficacy of craniocervical flexor training on sitting neck posture in patients with chronic non specific neck pain among athletes-single group experimental study. Int J Med Health Sci 2017;3(11):1-11.
  39. Kim CK, Lee ES. The changes of in headache due to postural improvement in patients with tension headache with forward head posture. Neurotherapy 2016;20(3):27-32.
  40. Min D, Baek S, Park HW, Lee SA, Moon J, Yang JE, et al. Prevalence and characteristics of musculoskeletal pain in Korean farmers. Ann Rehabil Med 2016;40(1):1-13. https://doi.org/10.5535/arm.2016.40.1.1
  41. Ris I, Sogaard K, Gram B, Agerbo K, Boyle E, Juul-Kristensen B. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up. Man Ther 2016;26:132-40. https://doi.org/10.1016/j.math.2016.08.004
  42. Hoffman J, Gabel P. Expanding Panjabi's stability model to express movement: a theoretical model. Med Hypotheses 2013;80(6):692-7. https://doi.org/10.1016/j.mehy.2013.02.006
  43. Beer A, Treleaven J, Jull G. Can a functional postural exercise improve performance in the cranio-cervical flexion test?--a preliminary study. Man Ther 2012;17(3):219-24. https://doi.org/10.1016/j.math.2011.12.005
  44. Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther 2009;14(6):696-701. https://doi.org/10.1016/j.math.2009.05.004
  45. Park J, Kang S, Cynn H, Jeon H. Effect of tactile feedback on trunk posture and EMG activity in people with postural kyphosis during VDT work. Phys Ther Korea 2016;23(3):48-56. https://doi.org/10.12674/ptk.2016.23.3.048
  46. Park JH, Kang SY, Lee SG, Jeon HS. The effects of smart phone gaming duration on muscle activation and spinal posture: pilot study. Physiother Theory Pract 2017;33(8):661-9. https://doi.org/10.1080/09593985.2017.1328716
  47. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2010.