This trial compared eccentric exercise training and the proprioceptive neuromuscular facilitation (PNF) technique, each added to a common cervical stretching and stabilisation programme, in individuals with non-specific neck pain. Outcomes were neck-related disability, multidimensional pain, cervical range of motion, deep cervical flexor endurance, kinesiophobia and health-related quality of life, assessed at baseline and after 6 weeks.
The study was planned as a quantitative study. Volunteer individuals with nonspecific neck pain between the ages of 18-65 will be included in the study, and the participants will be randomly distributed into 3 groups. Control group (n=15), proprioceptive neuromuscular facilitation technique application group (n=15), eccentric muscle training technique application group (n=15). People included in the study will be explained in detail and will be asked to sign a voluntary consent form approved by the ethics committee. Demographic information of individuals in all three groups will be recorded first. Participants in all three groups will be evaluated at the beginning and end of the applications. In our study, participants were evaluated with the McGill Pain Questionnaire to evaluate the character and character of pain, their physical fitness with the Deep Neck Flexor Endurance Test, their functionality related to daily living activities with the Neck Disability Index (NDI, and their quality of life with the World Health Organization Short Form of Quality of Life (WHOQOL-BREF) Tampa Kinesiophobia Scale and a goniometer for Cervical Region Joint Range of Motion Measurement will be used to evaluate kinesiophobia, which is the fear of pain and re-injury, as well as anxiety towards activity and physical movement. This study will be planned five times a week for six weeks. Stretching and stabilization exercises will be applied to the control group in 3 sets of 10 repetitions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
Proprioceptive Neuromuscular Facilitation Technique group; In addition to the exercises applied to the participants and the control group, combined isotonic contractions and dynamic stabilization will be used as facilitation techniques, and hold-relax technique will be used as an inhibition technique.
Eccentric Muscle Training Technique: Participants will receive eccentric muscle training in addition to the exercises given to the control group. Before the application, 5-minute warm-up exercises will be given to the neck area. Eccentric muscle training will be applied to the muscles of the participants in the cervical region. Eccentric exercise will be strengthened in the cervical region muscles in the direction of movement in each plane, that is, flexion / extension and lateral flexion. The movements will first be explained and demonstrated to the patient.
Uskudar University
Istanbul, Turkey (Türkiye)
Cervical Deep Flexor Muscle Endurance Test
Patients were asked to lie in a supine position with knees flexed at 90° and hands on the abdomen in a hook position. A 0.5 kilogram (kg) weight was placed on the forehead with the help of a band passed over the ears. The patients were asked to first perform cervical retraction and then 10° cervical flexion, and the degree of flexion was determined with the help of a goniometer. The patients were asked to maintain this position and the time was determined with a stopwatch and recorded in seconds. Patients must be able to maintain this position for 60 seconds (sec) in order to have sufficient muscle endurance. Those below this period have insufficient muscle endurance. Cervical flexion for 60 seconds. Patients holding it above were considered to have sufficient endurance and were not included in the study.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period). No further follow-up.
World Health Organization Quality of Life Survey Short Form
The scale measures 28 general health, physical, psychological, social and environmental well-being and consists of 26 questions. Turkey version consists of 27 questions. The 27th question is the national question that determines the Environmental Score. Since each domain expresses the quality of life in its own field independently of each other, domain scores are calculated between 4-20. As the score increases, the quality of life increases.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period). No further follow-up.
Neck Disability Index
Neck Disability Index will be used to evaluate the disability specific to neck pain. The Neck Disability Index has been modified from the Oswestry Disability Index. It consists of 10 sections: pain intensity, personal care, weight bearing, reading, headache, concentration, working, driving, sleep and recreational activities. Each section consists of 6 answers and is scored from 0, no disability, to 5, representing total disability. According to total score; 0-4: no limitation, 5-14: mild limitation, 15-24: moderate limitation, 25-34: severe limitation, 34 and above: completely limited.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period). No further follow-up.
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Cervical stretching and stabilisation exercise programme. Stretching was applied in flexion, extension, rotation and lateral flexion (30-second hold, 10 repetitions). Stabilisation exercises were performed with the participant applying self-resistance from a seated position (10-second contraction, 15-second rest). Both components were performed in 3 sets of 10 repetitions with 1-minute rest between sets, in 45-minute sessions, 5 days per week for 6 weeks. This programme was also delivered as the base programme to both experimental groups.
Tampa Kinesiophobia Scale
Tampa Kinesiophobia Scale was used to evaluate kinesiophobia, which is a state of anxiety that develops against activity and physical movement due to fear of pain and re-injury. It was developed to differentiate between non-excessive fear and phobia in patients with chronic musculoskeletal pain. It is frequently used in the literature to evaluate movement-related fear and anxiety. The scale is a 17-item scale that includes parameters of injury, re-injury and fear-avoidance in work-related activities. As the score increases, it is accepted that the kinesiophobia of the individual with pain increases.Results consist of a total raw score (range between 17 and 68) A low score indicates low kinesiophobia.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period). No further follow-up.
Cervical joint goniometric measurements
Goniometric measurements in the neck are methods used to evaluate and record neck joint range of motion. These measurements are important to evaluate the patient's condition during the treatment process, follow the progress and create the treatment plan.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period). No further follow-up.
McGill Pain Questionnaire (long form)
The long-form McGill Pain Questionnaire was used to characterise the multidimensional quality of pain, including pain localisation, the sensory, affective and evaluative word-descriptor dimensions, the number of words chosen, the pain-time relationship, and present pain intensity. Higher scores indicate greater pain.
Time frame: Baseline (before the first session) and 6 weeks (immediately after the final session of the intervention period).