Core Stability vs Scapular Stabilization on Hand Grip Strength in Chronic Myofascial Neck Pain

Cairo University60 enrolled

Overview

Chronic myofascial neck pain (CMNP) is a painful non-articular musculoskeletal neck syndrome that is a persistent and prevalent with a high incidence of recurrence rate range 30-93%.Management of myofascial trigger points were directed at its deactivation, and prevention of its recurrence. Based on mechanical kinetic chain, the upper extremity functions as a unique system of connected segments those collaborated in a harmony in order to perform daily life activities. Core stability exercises maximize motor pathways mechanoreceptors' activities, as well scapular stabilization exercises are generally recommended based on reported benefits in terms of chronic neck pain. The relationship between chronic myofascial neck pain, and hand disability is quite strong. From mechanical point of view, core stability exercises improve trunk stability in line to enhance upper extremity efficiency that facilitates hand, and pinch grasping. In addition, scapular stabilization exercises could improve both hand, and pinch grasp strength and dexterity. Therefore, this randomized clinical trial will be conducted in line to clarify the superiority of the therapeutic effects between core stability exercises, scapular stabilization exercises, and conventional physical therapy program on hand grip strength, pinch grip strength, neck pain intensity level, pain pressure threshold, and whole upper extremity functional level in patients with chronic myofascial neck pain.

Chronic myofascial neck pain (CMNP) is a painful non-articular musculoskeletal neck syndrome that is a persistent and prevalent with a frequently reported myofascial trigger points (MTrPs) at upper trapezius with a reported prevalence of up to 93.75%. Individuals with upper trapezius MTrPs would have an overall upper extremity muscular strength reduction that ultimately resulting in decline hand grip strength. positive relation between core endurance and hand grip strength. That finding may be explained by the fact that the core region exhibits an anatomical, and biomechanical interconnection with the extremities, characterized by a prominent muscular linkage. Both core and scapular stabilization exercises has been addressed as one of the most evidence-based modalities. core acts as a the central most part of the kinetic chain, or a double walled cylinder with abdominals in front, multifidis as back, diaphragm as a roof, pelvic floor at the bottom. Where upper extremities connect with core, and attached extremities articulations that transfer energy from torso proximally to extremities' parts distally during functional activities . Scapular stability represents a vital role in terms of whole upper extremity functioning. The research gap to answer the question; Are there any significant differences between core stability exercises, scapular stabilization exercises, and conventional physical therapy program on hand grip strength, pinch grip strength, neck pain intensity level, pain pressure threshold, and whole upper extremity functional level in patients with chronic myofascial neck pain?

Interventions

Core Stability Exercise ProtocolOTHER

The core stability exercise protocol will be conducted to experimental group (A), only. The core stability exercise protocol will be conducted for 40-45 minutes (10 minutes worm-up 'stretch exercises', 25 minutes core stabilization exercises, and 5-10 minutes cool down exercises 'stretch exercises') 3 sections/ week for six weeks 1\. Diaphragm Core '';360 degree expansion breathing, weighted breathing 2. Transverse abdominis 'Abdominal drawing in maneuver, supine vacuum, pelvic tilt'; 3. Multifidus 'quadruped altered leg/arm, bridge with leg extension'; 4. Pelvic Floor muscles/Kegel, bridging, and bridging dog, and squat Core stability exercise.

Scapular stabilization Exercise ProtocolOTHER

The scapular stabilization exercise protocol will be conducted to experimental group (B), only. The core scapular stabilization exercise protocol will be conducted for 40-45 minutes (10 minutes worm-up 'stretch exercises', 25 minutes scapular stabilization exercises, and 5-10 minutes cool down exercises 'stretch exercises') 3 sections/ week for six weeks a. Open chain stabilization exercises 'scapular elevation/depression, upward/downward rotation', b. Static closed chain stabilization exercises 'Protected weight bearing through both hands leaning against wall', c. Dynamic closed chain stabilization exercises 'scapular retraction'

Traditional Physical Therapy ProtocolOTHER

1. Ischemic compression; apply an intermittent ischemic compression on the identified MTrPs within upper trapezius via the researcher thumb for ninety seconds. 2. Strain-counter strain; apply pressure at MTrPs within stretched upper trapezius, with patient will move the affected shoulder passively to 90° of abduction and external rotation for ninety seconds. 3. Muscle Energy Technique; patient will do lateral neck flexion to opposite side, and will maintained for 10 seconds, will apply thirty seconds of stretch for ipsilateral affected upper trapezius

Eligibility

Sex: ALLMin age: 25 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients diagnosed with chronic myofascial neck pain depending on referral, and physical examination. 2. Sixty patients diagnosed with chronic myofascial neck pain for more than six months. 3. Patients age range will 25-45 years 4. Patients body mass index (BMI) will be 18.5-24.9 kg/m2 5. Each patient suffering from all active MTrPs in the upper trapezius muscle with painful/ tender nodule. 6. Patients have a constant neck pain with positive jump sign when palpating the upper trapezius muscle. 7. Patients have referred pain, and symptoms of ipsilateral hand muscle weakness. 8. No history of undergoing physiotherapy modalities or corticosteroid injection therapies in the past six months before the study Exclusion Criteria: 1. Presence of signs of severe pathology such as malignancies, mainly of the cervical region. 2. Fracture of the cervical spine. 3. Cervical radiculopathy or myelopathy. 4. Diabetes mellitus. 5. Trauma, cognitive anomalies, and surgery around neck, shoulders, or hand. 6. Fibromyalgia or vascular syndromes such as vertebral basilar insufficiency. 7. Pregnancy. 8. Having undergone physical therapy within the past three months before the study. 9. Having corticosteroid injection therapies in the past 3 months before the study.

Outcomes

Primary Outcomes

Hand Grip Strength

Hand-held Dynamometer (SAMMONS PRESTON, INC. Bolingbrook, IL604404989) will be used to measure it. The patient will sit on a standard height chair with no armrest with his/ her forearm in a neutral position, and shoulder in adducted and neutral rotation, with elbow flexed 90 degrees (°). The patient will be requested to squeeze the ipsilateral hand on the hand grip dynamometer handle accordingly to the ordered verbs 'i.e., one, two, three, squeeze…harder, harder'. Three measures will be conducted with one minute a break in between, then the average will be recorded in value score.