Effects of Cervico-Thoracic Mobilization Technique and Therapeutic Exercise on Muscle Activity, Functional Disability, Craniovertebral angle in Patient with Neck Pain

목 통증 환자에게 목-등뼈 가동술과 치료적 운동이 근활성도, 기능장애, 머리척추각에 미치는 영향

  • Je-ho Kim (Dept. of Physical Therapy, Daegu Health Collage) ;
  • Jong-uk Choi (Dept. of Physical Therapy, Yeong Am Hankook Hospital) ;
  • Yoon-hwan Kim (Dept. of Physical Therapy, KunJang University College) ;
  • Hyun-seung Song (Dept. of Physical Therapy, Chumdan Wooam Hospital Rehab Center) ;
  • Yong-sik Jeong (Dept. of Physical Therapy, Mokpo rehebilitation nursing Care Hospital)
  • Received : 2022.12.15
  • Accepted : 2023.01.27
  • Published : 2023.04.28

Abstract

Purpose: This study aimed to determine the effects of cervico-thoracic (C-T) mobilization technique and therapeutic exercise on muscle activity, craniovertebral angle (CVA), and neck disability index (NDI) in patients with neck pain. Methods: : A total of 30 patients with neck pain were included and divided into C-T mobilization combined with Pilates group (Experimental group; EG) and thoracic mobilization and self-exercise (Control group; CG) group; each group consisted of 15 patients. The exercises were performed by patients in both groups three times a week, for four weeks. NDI was used to measure functional disability and sEMG was used to measure muscle activity. Results: The EG participants showed significant improvement in the CVA and NDI after the intervention than the CG (p<.05). While both groups presented after intervention decreased muscle activity(upper trapezius), there were no statistically significant differences between the groups (p>.05). Conclusion: The findings of this study suggest that thoracic mobilization technique combined with Pilates exercise may have beneficial effects on CVA and NDI in patients with neck pain and forward head posture.

Keywords

References

  1. Ahearn EL, Greene A, Lasner A. Some effects of supplemental Pilates training on the posture, strength, and flexibility of dancers 17 to 22 years of age. J Dance Med Sci. 2018;22(4):192-202. https://doi.org/10.12678/1089-313X.22.4.192
  2. Alghadir AH, Iqbal ZA. Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study. Biomed Res Int. 2021. https://doi.org/10.1155/2021/5588580
  3. Andersen CH, Andersen LL, Mortensen OS, et al. Protocol for shoulder function training reducing musculoskeletal pain in shoulder and neck: A randomized controlled trial. BMC Musculoskelet Disord. 2011;12(1):1-5. https://doi.org/10.1186/1471-2474-12-14
  4. Bonney RA, Corlett EN. Head posture and loading of the cervical spine. Appl Ergon. 2002;33(5):415-417. https://doi.org/10.1016/S0003-6870(02)00036-4
  5. Cho HR. Change of craniovertebral angle (CVA) and respiration on application correction method of posture and breathing accessory muscle exercise in forward head posture (FHP). J The Korean Soc Integr Med. 2015;3:89-94. https://doi.org/10.15268/ksim.2015.3.3.089
  6. Choi YJ, Hwang R. Effect of cervical and thoracic stretching and strengthening exercise program on forward head posture. The Journal of the Korea Contents Association. 2011;11(10):293-300. https://doi.org/10.5392/JKCA.2011.11.10.293
  7. Cleland JA, Childs JD, Fritz JM, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: Use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007;87(1):9-23. https://doi.org/10.2522/ptj.20060155
  8. Cruz-ferreira A, Fernandes J, Kuo YL, et al. Does Pilates-based exercise improve postural alignment in adult women?. Women Health. 2013;53(6):597-611. https://doi.org/10.1080/03630242.2013.817505
  9. De Araujo Cazotti L, Anamaria J, Diego RS, et al. Effectiveness of the Pilates method in the treatment of chronic mechanical neck pain: A randomized controlled trial. Arch Phys Med Rehabil. 2018;99(9):1740-1746. https://doi.org/10.1016/j.apmr.2018.04.018
  10. DI Lorenzo, Christine E. Pilates: what is it? Should it be used in rehabilitation?. Sports health. 2011;3(4):352-361. https://doi.org/10.1177/194173811141028
  11. Dunleavy K, Kava K, Goldberg A, et al. Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: Quasi-randomised parallel controlled study. Physiotherapy. 2016;102(3):236-242. https://doi.org/10.1016/j.physio.2015.06.002
  12. Dusunceli Y, Ozturk C, Atamaz F, et al. Efficacy of neck stabilization exercises for neck pain: A randomized controlled study. J Rehabil Med. 2009;41(8):626. https://doi.org/10.2340/16501977-0392
  13. Ekstrom RA, Soderberg GL, Donatelli RA. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. J Electromyogr Kinesiol. 2005;15(4):418-428. https://doi.org/10.1016/j.jelekin.2004.09.006
  14. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: A six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):1-8. https://doi.org/10.1186/s12891-019-2438-y
  15. 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
  16. Gustafsson E, Thomee S, Grimby EA, et al. Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study. Appl Ergon. 2017;58:208-214. https://doi.org/10.1016/j.apergo.2016.06.012
  17. Guzman J, Haldeman S, Carroll L, et al. Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Eur Spine J. 2008;17(1):199-213. https://doi.org/10.1007/s00586-008-0637-6
  18. Hackney J, Bade D, Clawson A. Relationship between forward head posture and diagnosed internal derangement of the temporo-mandibular joint. J Orofac Pain. 1993;7(4). https://pubmed.ncbi.nlm.nih.gov/8118442
  19. Harrison DE, Harrison DD, Betz JJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther. 2003;26(3):139-151. https://doi.org/10.1016/S0161-4754(02)54106-3
  20. Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: A randomized, controlled 10-week trial. J Man Manip Ther. 2005;13(3):163-176. https://doi.org/10.1179/106698105790824888
  21. Hoving JL, de Vet HCW, Twisk JWR, et al. Prognostic factors for neck pain in general practice. Pain. 2004;110(3):639-645. https://doi.org/10.1016/j.pain.2004.05.002
  22. Ishida H, Suehiro T, Kurozumi C, et al. Correlation between neck slope angle and deep cervical flexor muscle thickness in healthy participants. J Bodyw Mov Ther. 2015;19(4):717-721. https://doi.org/10.1016/j.jbmt.2015.04.001
  23. Jull GA. Deep cervical flexor muscle dysfunction in whiplash. J Musculoskeletal Pain. 2008(1-2):143-154. https://doi.org/10.1300/J094v08n01_12
  24. Kang JH, Park RY, Lee SJ, et al. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012;36(1):98-104. https://doi.org/10.5535/arm.2012.36.1.98
  25. Kang NY, Im SC, Kim K. Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(3):291. https://doi.org/10.5606/tftrd.2021.6397
  26. Kang JI, Jeong DK, Park SK, et al. Effect of Self-Stretching Exercises on Postural Improvement in Patients with Chronic Neck Pain Caused by Forward Head Posture. Korean J Intern Med. 2020;15(3):51-59. https://doi.org/10.13066/kspm.2020.15.3.51
  27. Khan A, Khan Z, Bhati P. Influence of forward head posture on cervicocephalic kinesthesia and electromyographic activity of neck musculature in asymptomatic individuals. J Chiropr Med. 2020;19(4):230-240. https://doi.org/10.1016/j.jcm.2020.07.002
  28. Kim DH, Kim SY. Comparison of immediate effects of sling-based manual therapy on specific spine levels in subjects with neck pain and forward head posture: A randomized clinical trial. Disabil Rehabil Assist Technol. 2020;42(19):2735-2742. https://doi.org/10.1080/09638288.2019.1571638
  29. Kim EJ, Kim JW, Park BR. Effects of sling exercise program on muscle activity and cervical spine curvature of forward head posture. Korean J Intern Med. 2011;11(11):213-220. https://doi.org/10.5392/JKCA.2011.11.11.213
  30. Kim HJ, Lee ES. Eunsang. efficacy of forward head posture treatment on neck function and quality of life. Phys Ther Rehabil Sci 2021;10(3):337-342. https://doi.org/10.14474/ptrs.2021.10.3.337
  31. Kim KC, Kwon BA. Effects of somatic techniques applied to adults with turtle neck symptoms on the improvement of craniovertebral angle and thoracic kyphotic angle. Korea Society for Wellness. 2020;15(1):447-456. https://doi.org/10.21097/ksw.2020.02.15.1.447
  32. Kim SY, An CM, Cha YS, et al. Effects of sling-based manual therapy on cervico-thoracic junction in patients with neck pain and forward head posture: A randomized clinical trial. J Bodyw Mov Ther. 2021;27: 447-454. https://doi.org/10.1016/j.jbmt.2021.03.007
  33. Kim SY, Kwon JH. Lumbar stabilization exercises using the sling system. The Journal of Korean Academy of Orthopedic Manual Physical Therapy. 2001;7(2):23-39.
  34. Kim YM. The effect of the deep neck flexor exercise for the proprioception in the neck. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 2013, 19(2):23-29.
  35. Kim YN, Lee DK. Effects of active vibration exercise on neck pain, disability index, and muscle activity of patients with forward Head posture. J Kor Phys Ther. 2018;30(6):218-223. https://doi.org/10.18857/jkpt.2018.30.6.218
  36. Kim YJ, Lee SB, Jeon BS, et al. 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. The Journal of Korean Academy of Orthopedic Manual Physical Therapy. 2017;23(1):43-51.
  37. Krawczky B, Mainenti MRM, Pacheco AGF. The impact of pilates exercises on the postural alignment of healthy adults. Rev Bras Med Esporte, 2016;22:485-490. https://doi.org/10.1590/1517-869220162206153957
  38. Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after Pilates-based exercise in healthy older adults. Spine, 2009;34:1046-1051. https://doi.org/10.1097/BRS0b013e31819c11f8.
  39. Kucukcakir N, Altan L, Korkmaz N. Effects of Pilates exercises on pain, functional status and quality of life in women with post-menopausal osteoporosis. J Bodyw Mov Ther. 2013;17(2):204-211. https://doi.org/10.1016/j.jbmt.2012.07.003
  40. Lau KT, Cheung KY, Chan KB, et al. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010;15(5):457-462. https://doi.org/10.1016/j.math.2010.03.009
  41. LEE EW, Shin WS, Jung KS, et al. Reliability and validity of the neck disability index in neck pain patients. Physical Therapy Korea. 2007;14(3):97-106.
  42. Lee GC, Bae WS. The effect of shoulder exercise program for improving forward head posture. Journal of The Korean Society of Integrative Medicine. 2015;3(3):1-8. https://doi.org/10.15268/ksim.2015.3.3.001
  43. Lee HJ, Yoon JY, Choi JG. Effects of SNPE program on postural correction and neck pain relief in women with forward head posture. Korea Society for Wellness. 2020;15(2):565-573. https://doi.org/10.21097/ ksw.2020.05.15.2.565
  44. Lee JN, Jung SM, Jeon JH. The effect of rectus abdominis functional massage on forward head posture and pain in patients with chronic neck pain. The Journal of Korean Academy of Orthopedic Manual Physical Therapy. 2018;24(1):15-21.
  45. Lee NY. A comparison of the effects of manual therapy plus stabilization exercise with manual therapy alone in patients with chronic mechanical neck pain. Journal of the Korean Society of Physical Medicine. 2022,;17(1):63-74. https://doi.org/10.13066/ kspm.2022.17.1.63
  46. Lee SM, Lee CH, O'Sullivan D. Clinical effectiveness of a pilates treatment for forward head posture. J Phys Ther Sci. 2016;28(7):2009-2013. https://doi.org/10.1589/jpts.28.2009
  47. Iqbal ZA, Alghadir AH, Anwer S. Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: A clinical trial. Biomed Res Int. 2021. https://doi.org/10.1155/2021/7190808
  48. Iqbal ZA, Rajan R, Khan SA, et al. Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain. J Phys Ther Sci. 2013;25(6):657-661. https://doi.org/10.1589/jpts.25.657
  49. Lukasiewicz AC, Mcclure P, Michener L, et al. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29(10):574-586. https://doi.org/10.2519/jospt.1999.29.10.574
  50. Mclean, Sionnadh Mairi, et al. Risk factors for the onset of non-specific neck pain: A systematic review. J Epidemiol Community Health. 2010;64(7):565-572. http://dx.doi.org/10.1136/jech.2009.090720
  51. 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
  52. Nakamaru K, Aizawa J, Kawarada K, et al. Immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain: a randomized controlled trial. J Bodyw Mov Ther. 2019;23(2):417-424. https://doi.org/10.1016/j.jbmt.2018.05.008
  53. Nezamuddin Md, Anwer S, Khan SA, et al. Efficacy of pressure-biofeedback guided deep cervical flexor training on neck pain and muscle performance in visual display terminal operators. Journal of musculoskeletal research. 2013;16(03):1350011. https://doi.org/10.1142/S0218957713500115
  54. Quek J, Pua YH, Clark RA, et al. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18(1):65-71. https://doi.org/10.1016/j.math.2012.07.005
  55. Paksaichol A, Janwantanakul P, Purepong N, et al. Office workers' risk factors for the development of non-specific neck pain: A systematic review of prospective cohort studies. Occup Environ Med. 2012;69(9):610-618. http://dx.doi.org/10.1136/oemed-2011-100459
  56. Park SE, Lee HR, Park SJ. The effect of corrective exercise and TECAR therapy on neck alignments and pain in forward head posture patients. Journal of Digital Convergence. 2018;16(11):543-551. https://doi.org/10.14400/JDC.2018.16.11.543
  57. Pernold G, Monica M, Christina W, et al. Neck/shoulder disorders in a general population. Natural course and influence of physical exercise: A 5-year follow-up. Spine. 2005;30(13):E363-E368. https://doi.org/10.1097/01.brs.0000167819.82642.f7
  58. Pilates JH, Miller WJ, Robbins J, et al. A Pilates' Primer: The Millenium Edition: Includes the Complete Works of Joseph Pilates. Presentation Dynamics. 1934.
  59. Puentedura EJ, Landers MR, Cleland JA, et al. Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(4):208-220. https://www.jospt.org/doi/10.2519/jospt. 2011.3640
  60. Ruivo RM, Pezarat CP, Carita, AI. Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents. J Manipulative Physiol Ther. 2017;40(1):1-10. https://doi.org/10.1016/j.jmpt.2016.10.005
  61. Ryan C, Lee D, Smith NK. The Thorax: An in Tegrated Approach. Jessica Kingsley Publishers, 2018.
  62. Sarhan N, Youssef EF, Ghuiba K, et al. Effect of body-blade exercises on cranio-vertebral angle and pain in individuals with forward head posture. Turkish Journal of Physiotherapy and Rehabilitation. 2021;32:3.
  63. Sheikhhoseini, Shahrbanian, Sayyadi, et al. Effectiveness of therapeutic exercise on forward head posture: A systematic review and meta-analysis. J Manipulative Physiol Ther. 2018;41(6):530-539. https://doi.org/10.1016/j.jmpt.2018.02.002
  64. Silva AG Punt TD, Sharples P, et al. Head posture and neck pain of chronic nontraumatic origin: A comparison between patients and pain-free persons. Arch Phys Med Rehabil. 2009;90(4):669-674. https://doi.org/10.1016/j.apmr.2008.10.018
  65. Song GB, Kim JJ, Kim KR, et al. The effects of neck stabilization exercise and proprioceptive neuromuscular facilitation on neck alignment, NDI, and static balance in adults with forward-head posture in a sitting position. PNF and Movement. 2020;18(1):11-22. https://doi.org/10.21598/JKPNFA.2020.18.1.11
  66. Song JE, Kim SY, Jang HJ. A comparison of the effects of self-mobilization and strengthening exercise of the thoracic region in young adults with thoracic hyperkyphosis. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 2013;19(2):11-18.
  67. 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.x
  68. Wells C, Kolt GS, Bialocerkowski A. Defining Pilates exercise: A systematic review. Complement Ther Med. 2012;20(4):253-262. https://doi.org/10.1016/j.ctim.2012.02.005
  69. Willford CH, Kisner C, Glenn TM, et al. The interaction of wearing multifocal lenses with head posture and pain. J Orthop Sports Phys Ther. 1996;23(3):194-199. https://www.jospt.org/doi/10.2519/jospt.1996.23.3.194
  70. Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, et al. The ability to change of three questionnaires for neck pain. Joint Bone Spine. 2004;71(4):317-326. https://doi.org/10.1016/j.jbspin.2003.04.004
  71. Weon JH, Oh JS, Cynn HS, et al. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies, 2010;14(4):367-374. https://doi.org/10.1016/j.jbmt.2009.06.006
  72. Yoon SW, Kim SY. Effects of upper trapezius inhibition dynamic taping on pain, function, range of motion, psychosocial status, and posture of the neck in patients with chronic neck pain. Phys Ther Korea. 2022;29(1):1-10. https://doi.org/10.12674/ptk.2022.29.1.1
  73. Young JL, Walker D, Snyder S, et al. Thoracic manipulation versus mobilization in patients with mechanical neck pain: A systematic review. J Man Manip Ther. 2014;22(3):141-153. https://doi.org/10.1179/2042618613Y.0000000043
  74. Vernon H, Mior S. The Neck Disability Index: A study of reliability and validity. J Manipulative Physiol Ther. 1991. https://psycnet.apa.org/record/2018-23295-001