Construction and verification of rehabilitation nursing program for shoulder and neck discomfort after thyroid cancer surgery: A pilot randomized controlled trial.

BACKGROUND: To develop a nursing program for the prevention and rehabilitation of shoulder and neck discomfort after thyroid cancer surgery based on the empowerment theory, and to evaluate the application effect of the program. METHODS: The prevention and rehabilitation nursing program for shoulder and neck discomfort after thyroid cancer surgery was established by literature review and the Delphi method. Between July 2022 and January 2023, a total of 62 postoperative thyroid cancer patients were recruited and randomly allocated to either the intervention group (n = 31) or the control group (n = 31) in this randomized controlled trial. Comparisons of shoulder and neck function, self-efficacy, and quality of life between the 2 groups were performed using a 2-sample independent t test, Wilcoxon rank-sum test, and repeated-measures analysis of variance. RESULTS: At the end of the study, the control group and intervention group were 30 cases each completed the study. After the intervention, the self-efficacy score of the intervention group was higher than the control group (P < .05), and the score of emotional function, cognitive function, and overall health dimension of the intervention group was higher than the control group (P < .05). The pain dimension score of the intervention group was lower than the control group (P < .05). There were significant differences in the group and time effects of the total shoulder joint scores between the 2 groups (P < .05). CONCLUSION: This study demonstrated that the shoulder and neck rehabilitation nursing program can alleviate the symptoms of shoulder and neck discomfort and improve patients' self-efficacy and quality of life.

Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial.

OBJECTIVE: To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion. DESIGN: Randomized controlled trial. PATIENTS: A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups. METHODS: Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups. RESULTS: There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance. CONCLUSION: Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.

Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial.

BACKGROUND: Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control. AIM: The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia. DESIGN: Monocentric, single-blind, randomized controlled trial. SETTING: We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy. POPULATION: Forty NP participants were enrolled in the study and randomly allocated into two groups. METHODS: The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia). RESULTS: Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031). CONCLUSIONS: Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation. CLINICAL REHABILITATION IMPACT: This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.

Effects of a novel osteopathic visceral technique for the pancreas on pain and range of motion in a patient with neck pain: Case report.

INTRODUCTION: Neck pain is a leading cause of disability worldwide. Visceral referred pain is a common form of disease-induced pain, with visceral nociception being referred to somatic tissues. OBJECTIVE: The aim of this case report was to evaluate the immediate and long term effects of a novel osteopathic visceral technique (OVT) on pain and cervical range of motion (CROM) in a patient with nonspecific neck pain (NS-NP). METHOD: A case of a 47-year-old female suffering with NS-NP for four months. The patient had sought physiotherapy treatment several times, and occasionally used anti-inflammatory medication to relieve symptoms. The patient presented muscle cervical tenderness and hyperalgesia over the spinous processes of C3-C4 spinal segments with limited CROM. A novel osteopathic visceral manipulation (OVM) technique was applied in the epigastric region targeting the pancreas. Immediately after the treatment, the patient reported reduction in pain evaluated with the numerical evaluation scale (NRS), and a clinically significant increase in pressure pain threshold (PPT) in C3 spinous process. Improvement in CROM was also observed. The post-treatment improvements have been maintained at 1-month of follow-up assessment. CONCLUSION: A single OVT was effective in reducing cervical pain and increasing CROM in a patient with NS-NP caused by a viscerosomatic reflex. The results of this case study provides preliminary evidence that OVM can produce hypoalgesia in somatic tissues with segmentally related innervation. This finding encourages future research to gain a better understanding of the mechanisms of regional inhibitory interdependence involving the viscerosomatic reflexes of OVM.

The effect of mulligan mobilization technique application in addition to conventional physiotherapy on pain and joint range of motion in people with neck pain.

BACKGROUND: To evaluate the effect of the Mulligan mobilization technique on pain intensity and range of motion in individuals with neck pain. METHODS: Forty individuals with mechanical neck pain were enrolled in the study. The patients were randomly divided into 2 groups and a total of 10 sessions of treatment were administered to all 2 groups for 2 weeks, 5 days a week. Mulligan mobilization technique, electrophysical agents, active range of motion, and stretching exercises were carried out in the Mulligan group. In contrast, only electrophysical agents and exercises were applied to the conventional physiotherapy group. Range of motion (ROM) of the neck, Visual Analog Scale (VAS), Neck Pain and Disability Scale (NPDS), and Short-Form 36 Health Survey (SF-36) were used for evaluation. RESULTS: Statistical analyses were done to compare the amounts at the baseline and immediately after treatment. Statistically significant improvements were found in the post-treatment ROM, VAS, NPDS values in both groups (p < 0.05). When the differences were compared, the results of the Mulligan group were significantly better than the conventional physiotherapy group (p < 0.05). There was no significant difference between the groups in terms of SF-36 parameters (p > 0.05). CONCLUSIONS: This study showed that the Mulligan mobilization technique plus conventional physiotherapy is more effective than conventional physiotherapy in increasing joint range of motion, reducing pain, and reducing neck disability. TRIAL REGISTRATON: ClinicalTrials.gov (NCT05074576).

Unknotting tech neck by breaking the cycle of pain and disability: Comparing the impact of instrument assisted soft tissue mobilization on specific muscles and superficial back arm line.

BACKGROUND: Computer professionals often develop a forward head posture due to prolonged hours of computer use, leading to neck pain. Instrument-assisted soft tissue mobilization (IASTM), an advanced technique for treating myofascial trigger points, has become increasingly popular for addressing these musculoskeletal issues. OBJECTIVES: The study aimed to compare the effectiveness of IASTM mobilization on SBAL (superficial back arm line) and SM(specific muscles-upper trapezius, levator scapulae, and sternocleidomastoid) in managing chronic neck pain among computer professionals. PARTICIPANTS & METHODS: The study involved 62 computer professionals, randomly divided into two groups. Group A received IASTM on SBAL and group B received IASTM on SM for neck pain each receiving three sessions weekly for four weeks. Outcome variables like Neck Disability Index (NDI), NPRS(Neck Pain Rating Scale), Craniovertebral angle (CVA), and range of motion (ROM) for flexion, and side flexion (right & left side) were evaluated at baseline, 2 weeks and 4 weeks. RESULTS: Significant improvement in NPRS were observed in both the SBAL and SM groups after 2 weeks of IASTM, wth the SBAL group demonstrating greater improvement. At 4 weeks, IASTM on SBAL showed significantly higher improvements in NPRS, CVA, NDI, and flexion compared to the SM group. The repeated measures ANOVA indicated a significant main effect of both time and group, along with a significant interaction between time and group for all outcome variables, except for CVA. CONCLUSION: The study indicates that IASTM on SBAL may offer a more effective treatment for chronic neck pain in computer professionals compared to targeting specific muscles.

Online Exercise Programs for Chronic Nonspecific Neck Pain: A Randomized Controlled Trial Reveals Comparable Effects of Global, Local, and Combined Approaches.

OBJECTIVE: Specific neck exercises are recommended in the rehabilitation of chronic nonspecific neck pain (CNNP). They are unfortunately often accompanied by acute pain flare-ups. Global exercises might be a beneficial addition, as they activate endogenous analgesia without overloading painful structures. However, it is still unclear which type of exercise is most effective. This randomized controlled trial was done to evaluate the effect of an online blended program of global and specific neck exercises, compared to programs including only 1 of both types of exercise. METHODS: Forty-eight patients with CNNP were randomized into 3 groups. Online questionnaires were collected at baseline, at midtreatment, immediately after treatment, and at the 3-month follow-up. Quantitative sensory testing and actigraphy were assessed at baseline and after treatment. Linear mixed-model analyses were performed to evaluate treatment effects within and between groups. Neck pain-related disability after treatment was considered the primary outcome. RESULTS: No time × treatment interaction effects were found. All groups improved in neck pain-related disability, pain intensity, self-reported symptoms of central sensitization, local pain sensitivity, physical activity, and pain medication use. No effects were found on quality of life, sleep quality, depression, anxiety, stress, widespread pain sensitivity, health economics, or actigraphy measurements. A higher global perceived effect was reported after performing the blended program, compared to the other groups. CONCLUSION: A blended exercise program was not superior to the stand-alone programs in reducing disability. Nevertheless, the global perceived effect of this type of exercise was higher. Future research necessitates larger sample sizes to adequately explore the optimal type of exercise for patients with CNNP. IMPACT: Exercise therapy should be an important part of the rehabilitation of patients with CNNP, regardless of the type of exercise.

Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis.

BACKGROUND: Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE: To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD: Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT: Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION: Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER: What does the meta-analysis add to the current literature.

The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome.

PURPOSE: This study aims to examine the effect of deep tissue massage (DTM) on the myofascial trigger point (MTrP) number, neck range of motion (ROM), pain, disability and quality of life in patients with Myofacial pain syndrome (MPS). METHODS: The study involved patients with MPS between the ages of 20-57. The patients were randomly divided into two groups: the control group (n = 40) and the study group (n = 40). Transcutaneous Electrical Neuromuscular Stimulation (TENS), hotpack and ultrasound were applied to 40 patients in the control group. The study group was also administered DTM for 12 sessions in addition to TENS, hotpack and ultrasound applications. Neck pain and disability scale (NPDS) for a neck disability, universal goniometer for neck ROM, MTrP count using manual palpation, Short Form 36 (SF-36) for quality of life and severity of neck pain were evaluated using a visual analog scale (VAS). All patients were evaluated before and after treatment. RESULTS: It was found that the DTM group has statistically more improvement than the control group for VAS, NPDS and SF-36. Moreover, although there was a significant improvement in favour of the study group for extension, lateral flexion, right rotation and left rotation in the neck ROM, there was no significant difference in flexion measurements between the study and control group. CONCLUSION: In addition to the traditional rehabilitation program, DTM is effective on neck ROM, pain, disability and quality of life. Therefore, DTM treatment is a safe and inexpensive treatment method that can be applied in patients with MPS.

Effect of proprioceptive neuromuscular facilitation and cranio-cervical flexor training on pain and function in chronic mechanical neck pain: A randomized clinical trial.

BACKGROUND: Chronic neck pain is known to be caused by the weakness of the deep neck flexors and disturbances in the mechanoreceptors and the proprioceptors of the cervical spine. Proprioceptive neuromuscular facilitation (PNF) is hypothesized to balance the relative stiffness and weakness of the muscles and activate the mechanoreceptors and proprioceptors. OBJECTIVE: To investigate PNF techniques and the craniocervical flexor training (CCFT) techniques for pain and function in chronic neck pain. METHODS: A randomized clinical trial was conducted on 66 chronic mechanical neck pain patients randomly assigned to either the PNF or CCFT groups using block randomization for a duration of 4 weeks. Numerical Pain Rating Scale (NPRS), Neck disability Index (NDI) and Active cervical range of motion (ACROM) were measured at baseline and after 4 weeks of intervention. Data were analysed using independent t test and MANOVA. RESULTS: The mean difference scores for NPRS and NDI were 2.18 and 15.72 in PNF group and 2.26 and 15.76 in the CCFT groups, respectively. Both the groups showed a change that was statistically significant. Also, the mean differences for the ACROM in all the planes in both the groups were statistically significant. However, the between group changes did not reveal any statistical significance in this study except for the right rotation in the CCFT group (p = 0.01). CONCLUSIONS: This study concluded that the PNF treatment is also beneficial to pain and function in treating chronic mechanical neck pain patients as its results stand similar to the CCFT treatment, which is already established to be a reliable tool to treat this condition.

Effects of Interactive Telerehabilitation Practices in Office Workers with Chronic Nonspecific Neck Pain: Randomized Controlled Study.

Aim: Aim of this study is to investigate the effects of interactive telerehabilitation exercises in office workers with chronic nonspecific neck pain. Methods: Office workers (n = 120) were randomly divided into three groups between February and July 2022, taking into account the inclusion and exclusion criteria, and office ergonomics training was given to all of the participants. Group 1 participants were given an interactive telerehabilitation program (strengthening, motor control, and posture correction exercises) for 45 min per day, 3 days a week, for a total of 6 weeks. Group 2 participants were trained to do the home exercise program on their own for 45 min per day, 3 days a week, for a total of 6 weeks. Only office ergonomics training was given to Group 3 patients. Results: Statistically significant improvement in pain (p < 0.001), range of motion (ROM) (p < 0.001), neck disability status (p < 0.001), functional status (p < 0.001), and quality of life (p < 0.001) of 6-week interactive telerehabilitation application in office workers was found. Discussion: In addition to office ergonomics training, interactive telerehabilitation program is the most effective method on pain, ROM, and neck disability compared with home exercise program and office ergonomics training alone, and studies are needed on the long-term effectiveness of telerehabilitation applications and telerehabilitation treatment diversity.

A single session of action observation therapy versus observing a natural landscape in adults with chronic neck pain - a randomized controlled trial.

BACKGROUND: Action observation (AO) has emerged as a potential neurorehabilitation therapy for patients with neck pain (NP), but evidence of its effectiveness is scarce. This study aims to assess the effect of a single session of AO when compared to observing a natural landscape on NP intensity, fear of movement, fear-avoidance beliefs, neck muscles' strength, pressure pain threshold, and tactile acuity. METHODS: Sixty participants with NP were randomly allocated to the AO group (n = 30) or control group (n = 30). Both groups watched an 11-minute video: the AO group watched a video of a person matched for age and sex performing neck exercises, while the control group watched a video of natural landscapes. Neck pain intensity, fear of movement, fear-avoidance beliefs, tactile acuity, pressure pain thresholds, and neck muscle strength were assessed both at baseline and post-intervention. General linear models of repeated measures (ANCOVA of two factors) were used to explore between-group differences at post-intervention. RESULTS: There was a significant main effect of time for pain intensity (p = 0.02; η2p = 0.09; within-group mean change and 95% CI: AO=-1.44 (-2.28, -0.59); control=-1.90 (-2.74, -1.06), but no time versus group interaction (p = 0.46). A time versus group significant interaction was found for one out of the six measurement sites of two-point discrimination and the neck flexors strength (p < 0.05) favoring the control group. No other statistically significant differences were found for the remaining variables). CONCLUSIONS: Results suggest a similar acute benefit for both a single session of AO and observing natural landscapes for promoting hypoalgesia, but no impact on kinesiophobia, fear-avoidance beliefs, or pressure pain thresholds. Also, AO had no positive effect on two-point discrimination and muscle strength. Further research is needed, with longer interventions. TRIAL REGISTRATION: Clinialtrials.gov (NCT05078489).

Effects of a Novel Web-Based Sensorimotor Exercise Program for Patients With Subacute Whiplash-Associated Disorders: Protocol for a Randomized Clinical Trial.

INTRODUCTION: Whiplash-associated disorder (WAD) often becomes a persistent problem and is one of the leading causes of disability in the world. It is a costly condition for individuals, for insurance companies, and for society. Guidelines for the management of WAD have not been updated since 2014, and the use of computer-based sensorimotor exercise programs in treatment for this patient group has not been well documented. The purpose of this randomized clinical trial is to explore the degree of association between self-reported and clinical outcome measures in WAD. METHODS: Individuals (n = 180) with subacute WAD grades I and II will be randomized into 3 groups using block randomization. The 2 primary intervention groups (A and B) will receive physical therapy involving manual therapy and either a remote, novel, computer-based cervical kinesthetic exercise (CKE) program starting at visit 2 (Group A) or neck exercises provided by the corresponding physical therapist (Group B). These groups will be compared to a "treatment as usual" Group C. Movement control, proprioception, and cervical range of motion will be measured. Neck disability and pain intensity, general health, self-perceived handicap, and physical, emotional, and functional difficulties due to dizziness will be measured using questionnaires. The short-term effects will be measured 10 to 12 weeks after the baseline measurements, and the long-term effects will be measured 6 to 12 months after the baseline measurements. IMPACT: The successful completion of this trial will help guide clinicians in the selection of outcome measures for patients with subacute WAD in the assessment of the short- and long-term effectiveness of treatment combining manual therapy with computer-based CKE compared with manual therapy and non-computer-based exercises. This trial will also demonstrate the potential of using a computer-based intervention to increase the exercise dose for this patient group and how this influences outcomes such as levels of pain and disability in the short and long term.

Clinically Relevant Decreases in Neck/Shoulder Pain Among Office Workers Are Associated With Strength Training Adherence and Exercise Compliance: Explorative Analyses From a Randomized Controlled Trial.

OBJECTIVE: The objectives of this study were to quantify training adherence and exercise compliance during a workplace-based strength training intervention delivered to office workers over a 12-week period and to analyze the association with clinically relevant pain reductions. METHODS: A subsample of 269 participants completed a training diary from which measures of training adherence and exercise compliance (training volume, load, and progression) were calculated. The intervention consisted of 5 specific exercises targeting the neck/shoulder area (neck, shoulders, and upper back). The associations of training adherence, quitting time, and measures of exercise compliance with 3-month pain intensity (on a scale from 0 to 9) were analyzed for the whole sample, pain cases (reporting pain of ≥3 at baseline), participants attaining/not attaining clinically relevant pain reductions (≥30%), and participants meeting/not meeting per-protocol training adherence of ≥70%. RESULTS: Participants reported reduced pain in the neck/shoulder area after 12 weeks of specific strength training, especially women and pain cases, with the caveat that attaining clinically relevant pain reductions depended on the levels of training adherence and exercise compliance attained. Over the 12-week intervention, 30% of the participants were absent for a minimum of 2 consecutive weeks (quitting time), with the median quitting time at approximately weeks 6 to 8. With a threshold of 70% training adherence, a total training volume of approximately 11,000 kg (only in women) and progressions of 1 to 2 times baseline values were shown to be significant for clinically relevant pain reductions. CONCLUSION: Strength training produced clinically relevant reductions in neck/shoulder pain when appropriate levels of training adherence and exercise compliance were attained. This finding was particularly evident for women and pain cases. We advocate for the inclusion of both training adherence and exercise compliance measures in future studies. To optimize intervention benefits, motivational activities after 6 weeks are needed to avoid participants quitting. IMPACT: These data can be used to design and prescribe clinically relevant rehabilitation pain programs and interventions.

Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND: When spinal stabilization exercises (SSE) are performed regularly, may provide benefits on outcome measures in chronic nonspecific neck pain (CNNP) patients. The pandemic has made it difficult for CNNP patients to access regular physiotherapy-exercise services. This study aims to compare telerehabilitation (TR) with face-to-face rehabilitation in CNNP. METHODS: Neck Functional Capacity Evaluation Test (NFCET) results were the primary outcomes. Pain intensity (PI), disability, awareness, neck muscles architecture, andexercise satisfaction were the secondary outcomes. Patients were randomized into the TR group (TRG) (n = 15) and the control group (CG) (n = 16). Patients performed SSE 3 days a week, for 8 weeks. The TRG was instructed remotely while the CG was instructed in the clinic. RESULTS: After 8 weeks in both groups, NFCET values and neck awareness increased (p < 0.05), PI and disability decreased (p < 0.05).      Muscle architecture improved in both groups (p < 0.05), except for the Right Sternocleidomastoideus in both groups and the Right Upper-Trapezius in TRG (p > 0.05). There was no difference between the groups for all variables and exercise satisfaction(p > 0.05). CONCLUSION: SSE for CNNP, whether supervised by therapists in the clinic or by telerehabilitation, was equally effective. THE CLINICAL TRIAL NUMBER: NCT04691024.

A randomized controlled trial on the effects of "Global Postural Re-education" versus neck specific exercise on pain, disability, postural control, and neuromuscular features in women with chronic non-specific neck pain.

BACKGROUND: Neck pain is associated with decreased health-related quality of life, decreased work productivity, and increased visits to health care providers. AIM: The aim of this study was to assess the effectiveness of "Global Postural Re-education" (GPR) versus a neck specific exercise (SE) program on neck pain, disability, cervical range of movement, postural stability, and activity of the superficial cervical flexor muscles. DESIGN: A parallel-group and single-blinded clinical trial. SETTING: Community interventions. POPULATION: Fifty women with non-specific chronic neck pain (NSCNP). METHODS: Participants were randomly assigned to one of the two intervention groups (GPR [N.=25] or SE [N.=25]). Both interventions consisted of eight sessions of ~40 minutes duration, performed twice a week, for four weeks. Outcomes included neck pain intensity and disability, cervical range of motion (CROM), postural sway, and activity of the superficial neck flexor muscles during a cranio-cervical flexion test (CCFT). All outcomes were assessed twice before the intervention and immediately following eight treatment sessions over four weeks. RESULTS: Both interventions were equally effective in reducing neck pain (P<0.001, ŋp2=0.770) and disability (P<0.001, ŋp2=0.306), improving neck mobility (P<0.001, 0.385≤ŋp2≤0.623, for all measurements) and decreasing the activity of the superficial cervical flexor muscles (P>0.001). Neither intervention altered postural sway. CONCLUSIONS: Our results revealed that GPR and SE induced significant positive results in all measures apart from postural stability but with no difference between the interventions. CLINICAL REHABILITATION IMPACT: "Global Postural Re-education" (GPR) and neck SE interventions are equally effective in reducing neck pain and disability, and improving neck mobility in women with NSCNP. Overall, this study indicates that GPR and SE interventions can be used to effectively manage patients with NSCNP.

Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery: analyses of a multicenter randomized controlled trial.

BACKGROUND: Dizziness and balance problems are common symptoms in patients with cervical radiculopathy. OBJECTIVE: To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up. METHODS: Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance. RESULTS: Self-reported measures improved at three months (p ˂ 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876). CONCLUSION: Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.

Home exercises for neck pain: A Delphi survey.

PURPOSE: The current context of the COVID-19 pandemic has demonstrated the need for home exercise strategies for the relief of neck pain, which, in recent times, has increased. However, there is a gap regarding home exercises that are aimed at reducing neck pain. Therefore, the aim of this study was to develop, validate and culturally adapt a home exercise protocol for neck pain. METHODS: This was an observational study conducted in three stages: (1) Developing an online search of databases for articles on neck pain exercises. (2) Validating a panel of 12 physical therapists, using the Delphi technique, and (3) Cultural adaptation, through face-to-face assessment with individuals aged 18-30 years with neck pain (n = 15). This resulted in the production of a final version of the protocol. Consensus on the protocol items (using the five-point Likert scale) was considered when the percent agreement was equal to or greater than 75%. Individuals were also asked about pain intensity during the last week before and after performing the protocol. RESULTS: A protocol was developed with the principles of neck and scapular stabilization and upper limb movements, for a period of 4 weeks. Nine physical therapists completed two rounds online, and all items in the second version of the protocol presented an agreement of over 75%. The protocol was culturally adapted by the target population, in which 73% of individuals presented pain reduction with a minimally clinically important difference. CONCLUSION: A 4-week home exercise protocol was created based on the best evidence in the literature, was validated by physical therapists and adapted for the population with neck pain. It proved to be an understandable, useful, practical and convenient tool in the treatment of this disorder and demonstrated an improvement in neck pain. CLINICALTRIALS: GOV: (NCT04187001).

Effect of blood flow restriction training on pressure pain threshold and hand function among adults with persistent neck pain: A study protocol for a randomized controlled trial.

Background: Persistent neck pain is a prevalent musculoskeletal condition that affects the quality of life and functional abilities of individuals. Blood Flow Restriction Training (BFRT) is a novel therapeutic approach that involves restricting blood flow to exercising muscles to enhance strength and function. However, limited research has been conducted on the effects of BFRT on pressure pain threshold and hand function in adults with persistent neck pain. This randomized controlled trial aims to investigate the potential benefits of BFRT as a treatment intervention for this population. Methods: This study will be a prospective 1:1 allocation, parallel group active controlled trail conducted at Physiotherapy Department, Galgotias University. The trial was prospectively registered with the Clinical Trial Registry India CTRI/2023/06/053439. Informed consent will be obtained from all the participants who are eligible to be included in the study. A total of 110 patients with persistent neck pain will be randomly allocated into two groups. The BFRT group will receive supervised training sessions three times a week for eight weeks, performing low-load resistance exercises with blood flow restriction applied using personalized cuff pressure. The control group will receive standard care for neck pain, which may include general advice, manual therapy, and/or home exercises without BFRT. The primary outcome measures will be the pressure pain threshold, assessed using a pressure Algometer, and hand function, evaluated using standardized tests such as Hand Grip Strength and Purdue Peg board Test. Results: The data obtained will be analyzed using appropriate statistical methods, and the significance level will be set at p<0.05. Conclusion: This trial will contribute valuable contribution highlighting the potential benefits of BFR training in improving pressure pain threshold and hand function in adults with persistent neck pain.

Functional exercise evaluation on athletes' cervicalgia management / Avaliação do exercício funcional no tratamento de cervicalgia em esportistas / Evaluación del ejercicio funcional en el tratamiento de la cervicalgia en deportistas

ABSTRACT Introduction Cervicalgia generally refers to the pain syndrome caused by the cervical spine, joints, muscles, ligaments, fascia, soft tissues around the shoulder joint, and visceral diseases. Evidence suggests that resistance exercises are beneficial in solving this dysfunction in various groups, but there is no consensus in athletes. Objective This paper examines functional exercises' effect on athletes' cervicalgia. Methods Using mathematical statistics, the article randomizes equally the intensity of cervicalgia in the control and experimental groups, involving 60 individuals aged 18 to 20 years (31 males). While the control group received conventional rehabilitation treatment, the experimental group had a functional exercise training protocol three times a week, of 10 weeks. The pain was assessed by visual analog scale and self-assessment of functional limitation. Results Differences in shoulder and neck pain were found between the two groups of volunteers before and after the training rehabilitation. A complete improvement was seen in 15 subjects in the experimental group versus 8 in the control group (P<0.05). Conclusion Functional exercise effectively treats cervicalgia in athletes. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução A cervicalgia geralmente refere-se à síndrome de dor causada pela coluna cervical, articulações, músculos, ligamentos, fáscia, tecidos moles ao redor da articulação do ombro e doenças viscerais. Há evidências de que exercícios de resistência são benéficos para a resolução dessa disfunção em vários grupos, mas não há consenso da eficácia dos exercícios de resistência no combate à cervicalgia em esportistas. Objetivo Este artigo analisa o efeito dos exercícios funcionais na cervicalgia em esportistas. Métodos O artigo usa estatísticas matemáticas para controle randomizado equalitário na intensidade da cervicalgia nos grupos controle e experimental, envolvendo 60 indivíduos com idade entre 18 a 20 anos (31 homens). Enquanto o grupo controle passa por um tratamento de reabilitação convencional, o grupo experimental passa por um protocolo de treinamento em exercícios funcionais, na frequência de 3 vezes semanais por 2 meses e meio. A dor foi avaliada pela escala visual analógica e auto-avaliação de limitação funcional. Resultados Houve diferenças nas dores no ombro e pescoço entre os dois grupos de voluntários, antes e depois do treinamento de reabilitação. Houve melhora completa do quadro em 15 indivíduos no grupo experimental contra 8 no grupo controle (P<0,05). Conclusão O exercício funcional trata efetivamente cervicalgia nos esportistas. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción La cervicalgia se refiere generalmente al síndrome de dolor causado por la columna cervical, las articulaciones, los músculos, los ligamentos, la fascia, los tejidos blandos alrededor de la articulación del hombro y los trastornos viscerales. Existen pruebas de que los ejercicios de resistencia son beneficiosos para la resolución de esta disfunción en varios grupos, pero no hay consenso sobre la eficacia de los ejercicios de resistencia para combatir la cervicalgia en los deportistas. Objetivo Este artículo analiza el efecto de los ejercicios funcionales sobre la cervicalgia en los deportistas. Métodos El artículo utiliza estadísticas matemáticas para el control aleatorio de la intensidad del dolor de cuello en los grupos de control y experimental, en el que participaron 60 individuos de entre 18 y 20 años (31 hombres). Mientras que el grupo de control se somete a un tratamiento de rehabilitación convencional, el grupo experimental se somete a un protocolo de entrenamiento de ejercicios funcionales, con una frecuencia de 3 veces por semana durante 2 meses y medio. El dolor se evaluó mediante una escala analógica visual y la autoevaluación de la limitación funcional. Resultados Hubo diferencias en el dolor de hombro y cuello entre los dos grupos de voluntarios antes y después del entrenamiento de rehabilitación. Hubo una mejora completa en 15 individuos del grupo experimental frente a 8 del grupo de control (P<0,05). Conclusión El ejercicio funcional trata eficazmente la cervicalgia en los deportistas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.