Effects of Dynamic Balance Exercise on Pain, Functional level, and Psychosocial Level in Patients with Non-specific Chronic Neck Pain

비특이성 만성 경부통 환자에게 적용한 동적 균형 운동이 통증과 기능적 수준, 심리사회적 수준에 미치는 효과

  • Yu-hui Kwon (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Suhn-yeop Kim (Dept. of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 권유희 (대전대학교 일반대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료과)
  • Received : 2023.11.11
  • Accepted : 2023.11.29
  • Published : 2023.12.29

Abstract

Background: Patients with neck pain develop instability due to muscle imbalance, decreased proprioception, and balance disorders. Studies have examined various exercise methods as treatment methods, but few studies have compared the effects of cervical stabilization exercise and dynamic balance exercise. The purpose of this study was to investigate the effects of dynamic balance exercise on pain, functional level, and psychosocial level in patients with non-specific chronic neck pain. Methods: Thirty-four non-specific chronic neck pain patients were randomly assigned to the experimental group (EG, n=17) and control group (CG, n=17); the cervical stabilization exercise and dynamic balance exercise program were applied to the EG; and only the cervical stabilization exercise program was applied to the CG. The intervention was conducted twice a week, for six weeks. Assessment items evaluated pain, dysfunction (Korean version neck disability index), range of motion, craniocervical flexion test, cervical deep flexor endurance test, and psychosocial level. Data analysis was performed using intention-to-treat analysis as assigned. To analyze differences in the items assessed in the two groups, we used a repeated measures analysis of variance with an interaction between group (EG, CG) and time point (baseline, 6 weeks, 12 weeks). Results: The endurance of the cervical flexor muscles between the group and the measurement point after intervention (p<.05). Both groups showed significantly improved endurance between time points after the intervention (p<.05), with the EG showing a greater change than the CG. None of the other measurement items differed in the pattern of change between measurement points. Conclusion: In conclusion, the EG applying a cervical stabilization exercise and a dynamic balance exercise experienced a significant difference in muscle endurance improvement compared to the CG. We propose an exercise intervention program that includes stabilization exercises and dynamic balance exercises for patients with chronic cervical pain who lack muscle endurance.

Keywords

References

  1. Choi TS, Ryu BH, Lee SB. Effects of cervical mobilization and craniocervical flexion exercise on the dynamic balance and gait variability in chronic neck pain patients: Randomized Controlled Trial. J Korean Soc Phys Med. 2020;15(2):31-38. https://doi.org/10.13066/kspm.2020.15.2.31
  2. Cleland JA, Childs MJD, McRae M, et al. Immediate effects of thoracic manipulation in patients with neck pain: A randomized clinical trial. Man Ther. 2005;10(2):127-135. https://doi.org/10.1016/j.math.2004.08.005
  3. 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):633-42. https://doi.org/10.2519/jospt.2011.3670
  4. Domenech MA, Sizer PS, Dedrick GS, et al. The deep neck flexor endurance test: Normative data scores in healthy adults. PM R. 2011;3(2):105-110. https://doi.org/10.1016/j.pmrj.2010.10.023
  5. Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res. 2004;157:43-48. https://doi.org/10.1007/s00221-003-1814-9.
  6. Fredin K, Loras H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain-A systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;31:62-71. https://doi.org/10.1016/ j.msksp.2017.07.005
  7. Gross AR, Hoving JL, Haines TA, et al. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine. 2004;29(14):1541-8. https://doi.org/10.1097/01.BRS.0000131218.35875.ED
  8. Guzman J, Hurwitz EL, Carragee EJ, et al. Treatment of neck pain: Noninvasive interventions: Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009;32(2):S141-S175. https://doi.org/10.1016/j.jmpt.2008.11.017
  9. Harris KD, Heer DM, Roy TC, et al. Reliability of a measurement of neck flexor muscle endurance. Phys Ther. 2005;85(12):1349-1355. https://doi.org/10.1093/ptj/85.12.1349
  10. Hogg-Johnon S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther 2008;17:39-51. https://doi.org/10.1016/j.jmpt.2008.11.010
  11. Hoy DG, Protani M, De R, et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010;24(6):783-792. https://doi.org/10.1016/j.berh.2011.01.019
  12. Hudswell S, Von Mengersen M, Lucas N. The craniocervical flexion test using pressure biofeedback: A useful measure of cervical dysfunction in the clinical setting? Int J Osteopath Med. 2005;8(3):98-105. https://doi.org/10.1016/j.ijosm.2005.07.003
  13. Joo M. The Effects of Stabilization Exercise on Chronic Neck Pain Patients. Daejeon University. Master Thesis, 2009. 
  14. Jordan A, Bendix T, Nielsen H, et al. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: A prospective, single-blinded, randomized clinical trial. Spine, 1998;23(3):311-318. https://doi.org/10.1097/00007632-199802010-00005
  15. Jull G, Sterling M, Falla D, et al. Whiplash, Head Ache, and Neck Pain: Research-based Directions for Physical Therapies. Elsevier Health Sciences. Amsterdam. 2008.
  16. Jull GA, O'Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: The craniocervical flexion test. J Manipulative Physiol Ther. 2008;31(7):525-533. https://doi.rg/10.1016/j.jmpt.2008.08.003
  17. Jung JH, Baik SW. The effect of pedalo vestibular integrated training in low back pain middle age women's lumbar muscle. The Korean Journal of Physical Education. 2021;60(1):507-522. https://doi.org/10.23949/kjpe.2021.1.60.1.36
  18. Kim JC, Yi CH, Kwon OY, et al. Strength and en durance of the deep neck flexors of industrial workers with and without neck pain. Journal of the Ergonomics Society of Korea. 2007;26(4):25-31. https://doi.org/10.5143/JESK.2007.26.4.025
  19. Kim SJ, Kim SY, Lee MJ. The effects of thoracic spine self-mobilization exercise using a tool on pain, range of motion, and dysfunction of chronic neck pain patients. Phys Ther Korea. 2020;27(1):1-10. https://doi.org/10.12674/ptk.2020.27.1.1
  20. Lee JU, Han JT. Comparison of the thickness of the neck flexor between open and closed kinetic chain exercises during chin-in movement. PNF & Mov. 2020;18(3):333-341. https://doi.org/10.21598/JKPNFA.2020.18.3.333
  21. Lee NY. A comparison of the effects of manual therapy plus stabilization exercise with manual therapy alone in patients with chronic mechanical neck pain. J Korean Soc Phys Med. 2022;17(1):63-74. https://doi.org/10.13066/kspm.2022.17.1.63
  22. 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
  23. Misailidou V, Malliou P, Beneka A, et al. Assessment of patients with neck pain: A review of definitions, selection criteria, and measurement tools. J Chiropr Med. 2010;9(2):49-59. https://doi.org/10.1016/j.jcm.2010.03.002
  24. Nam CH, Choi YJ, Cho JN. The effect that the application of myofascial release has on neck pain of adults and joint range of motion. Archives of Orthopedic and Sports Physical Therapy 2019;15(2):117-126. https://doi.org/10.24332/aospt.2019.15.2.15
  25. Park JH, Jeon HS, Kim JH, et al. Effects of biofeedback based deep neck flexion exercise on neck pain: Meta-analysis. Physical Therapy Korea. 2021;28(1):18-26. https://doi.org/10.12674/ptk.2021.28.1.18
  26. Radanov BP, Sturzenegger M, Di Stefano G. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine, 1995;74(5):281-297. https://doi.org/10.1097/00005792-199509000-00005
  27. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther. 2003;8(1):10-20. https://doi.org/10.1054/math.2002.0480
  28. Schroeder J, Kaplan L, Fischer DJ, et al. The outcomes of manipulation or mobilization therapy compared with physical therapy or exercise for neck pain: A systematic review. Evid Based Spine Care J. 2013;4:30-41. https://doi.org/10.1055/s-0033-1341605
  29. Song KJ, Choi BW, Choi BR, et al. Cross cultural adaptation and validation of the Korean version of the neck disability index. Spine. 2010;35:E1045-E1049. https://doi.org/10.1097/BRS.0b013e3181df78e9
  30. Sremakaew M, Jull G, Treleaven J, et al. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: Protocol for a randomized controlled trial. BMC musculoskelet disord. 2018;19(1):1-12. https://doi.org/10.1186/s12891-018-1964-3
  31. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther. 2008;13(1):2-11. https://doi.org/10.1016/j.math.2007.06.003
  32. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain. 2000;85(3):317-332. https://doi.org/10.1016/S0304-3959(99)00242-0
  33. Watson DH, Trott PH. Cervical headache: An investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia. 1993;13(4):272-284. https://doi.org/10.1046/j.1468-2982.1993.1304272.
  34. Wing Chiu TT, Hung Law EY, Fai Chiu TH. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005;35(9):567-571. https://doi.org/10.2519/jospt.2005.35.9.567