The comparison between the effects of pain education interventions with online and face-to-face exercise and the control group received biomedical education + standardized physical therapy in patients with chronic nonspecific neck pain during COVID-19: protocol for a parallel-group randomized controlled trial.

BACKGROUND: Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions. OBJECTIVE: This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. METHODS/DESIGN: Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis. DISCUSSION: It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021.

Comparison the Effect of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic.

INTRODUCTION: Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. METHODS: In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. RESULTS: No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] - 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen's d = 0.34, 95% CI 0.11-0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%↓). CONCLUSION: In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.

Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial.

OBJECTIVE: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. DESIGN: Randomized controlled trial. SETTING: Outpatient setting. SUBJECTS AND INTERVENTIONS: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. MAIN OUTCOME MEASURES: Pain, neck disability, deep cervical flexor muscular endurance, and health status. RESULTS: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): -2.8 to -1.27, P = 0.021) for pain (d = -0.99, 95% CI = -1.75 to -0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = -2.75, 95% CI = -8.81 to -1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. CONCLUSION: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

Hip and Core Muscle Activation During High-Load Core Stabilization Exercises.

BACKGROUND: There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles. HYPOTHESIS: Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals. DESIGN: Cross-sectional study. SETTING: Research laboratory. LEVEL OF EVIDENCE: Level 4. METHODS: In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years). RESULTS: The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise (P < 0.001), back bridge with left leg lift (P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg (P = 0.002), and elbow-toe exercise with right leg horizontally lifted (P < 0.001). CONCLUSION: The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation. CLINICAL RELEVANCE: The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial.

BACKGROUND: In this study, the effect of adding a smartphone app to an 8-week global postural reeducation (GPR) on neck pain, endurance, quality of life, and forward head posture (FHP) in patients with chronic neck pain and FHP was evaluated. METHODS: Sixty male and female office workers (38.5 ± 9.1 years) with chronic neck pain were randomly assigned into three groups: group 1 (GPR+ a smartphone app, n = 20), group 2 (GPR alone, n = 20), and group 3 (the control group, n = 20). The primary outcome was pain and the secondary outcomes were disability, quality of life, endurance, and posture. Pain, disability, endurance, quality of life, and posture were evaluated using the visual analog scale (VAS), neck disability index (NDI), progressive iso-inertial lifting evaluation (PILE) test, quality of life questionnaire (SF-36), and photogrammetry, respectively, at pre-and post-8-week interventions. A one-way analysis of covariance (ANCOVA) has been conducted to statistically analyze the data. RESULTS: The GPR+ a smartphone app had statistically significant improvements versus GPR alone in pain (mean difference, - 2.05 ± 0.65, ES (95% CI) - 0.50 (- 1.04 to - 0.01), P = 0.04), disability (difference = 11.5 ± 1.2, ES (95% CI) = 0.31 (0.22 to 0.97), p = 0.033), FHP (difference = 1.6 ± 0.2, ES (95% CI) = 0.31 (0.09 to 0.92), p = 0.047), and endurance (difference = 2 ± 3.3, ES (95% CI) = 0.51 (0.02 to 1.03), p = 0.039). Both of the GPR+ a smartphone app and GPR alone groups had statistically significant differences versus the control group in all outcomes. CONCLUSION: When a workplace assessment and management could not be as part of any intervention, adding a smartphone app to GPR for NP may be an appropriate tool to administer a home and work exercise program resulting in elevating pain and disability, as well as improving FHP and endurance. TRIAL REGISTRATION: Current Controlled Trials using the UMIN-RCT website UMIN000039720 . Retrospectively registered on January 9, 2020.

Effects of Corrective Exercises on Posture, Pain, and Muscle Activation of Patients With Chronic Neck Pain Exposed to Anterior-Posterior Perturbation.

OBJECTIVES: This study aimed to evaluate the effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation. METHODS: A total of 32 women (37.76 ± 3.83 years) with chronic, nonspecific neck pain were randomized into corrective exercise and control groups. The experimental group underwent a corrective exercise program for 8 weeks, 30 min/d, 3 days per week. The control group received active self-exercise instructions. Neck pain, forward head and protracted shoulder posture, and timing of superficial neck muscle activation were evaluated using the visual analog scale, photogrammetry, and electromyogram, respectively, before and then 48 hours after the 8-week program for both the experimental and control groups. All measurements at pretest and posttest were taken by a blinded assessor. RESULTS: Significant alterations were observed in cervical angle (P = .003, effect size = 0.329), shoulder angle (P = .008, effect size = 0.457), neck pain and disability (P = .009, effect size = 0.645), movement control (P = .038, effect size = 0.353), activation onset of the upper trapezius (P = .015, effect size = 0.746), the sternocleidomastoid (P = .018, effect size = 0.879) and cervical erector spinae (P = .031, effect size = 0.765), and the root mean square of the upper trapezius (P = .033, effect size = 0.742), the sternocleidomastoid (P = .041, effect size = 0.587), and the cervical erector spinae (P = .024, effect size = 0.832) in the intervention group from pre- to posttest (P < .05). CONCLUSION: Positive and significant alterations have been observed in the forward head and protracted shoulder posture, the timing of superficial neck muscle activation, neck pain, and disability in female patients with chronic neck pain exposed to anterior-posterior perturbation after performing an 8-week corrective exercise program.

Efficacy of throwing exercise with TheraBand in male volleyball players with shoulder internal rotation deficit: a randomized controlled trial.

BACKGROUND: The Glenohumeral internal-rotation deficit (GIRD) is related to the altered eccentric external-rotator (ER), the concentric internal-rotator (IR), muscle strength, and the ER: IR ratio. GIRD has been documented as a risk factor for shoulder injuries. However, few studies have investigated the effect of an exercise training on these parameters in athletes with GIRD. Therefore, the purpose of this study was to evaluate the effects of an 8-week throwing exercise with a TheraBand for retraining the rotator cuff on Electromyography (EMG) activity of selected muscles, rotator cuff muscle strength, the glenohumeral (GH) joint IR range of motion (ROM) and GH joint position sense in asymptomatic male volleyball players with GIRD. METHODS: Sixty male volleyball players with GIRD were randomized into either a training group or a control group. The experimental group underwent an 8-week throwing exercise with a TheraBand including 5 sessions of stretching and 3 sessions of strengthening exercises per week. The control group received an active self-exercise program. EMG (onset time and muscle activation), shoulder range of motion (ROMs), strength and GH joint position sense were all assessed pre and post trainings. RESULTS: There were statistically significant within-group differences in the EMG activity of the anterior deltoid (p = 0.005), middle deltoid (p = 0.007), posterior deltoid (p = 0.004), infraspinatus (p = 0.001) and supraspinatus (p = 0.001) muscles, IR ROM (p = 0.001), rotator cuff muscle strength ratio (p = 0.001), and GH joint position sense (p = 0.033) in the experimental group. A 2 × 2 analysis of variance with a mixed model design and independent and paired t-tests were used for statistical analysis. CONCLUSIONS: Throwing exercise with a TheraBand improved shoulder muscle activation, IR ROM, rotator cuff muscle strength ratio and GH joint position sense in participants with GIRD. These findings may improve the treatment of GIRD in a clinical setting. Although the results are significant, further studies should follow up the long-term effects of the Throwing exercise with a TheraBand on GIRD. TRIAL REGISTRATION: Current Controlled Trials using the UMIN-RCT website with ID number of, UMIN000038416 "Retrospectively registered" at 2019/10/29.

Trunk and hip control neuromuscular training to target inter limb asymmetry deficits associated with anterior cruciate ligament injury.

OBJECTIVE: The primary aim of this study was to determine the effect of NMT on female basketball players (performing at least 3 exercise sessions per week for at least 90 min) with inter limb asymmetry. DESIGN: Controlled laboratory study. SETTING: University research laboratory. PARTICIPANTS: 40 female basketball players (age 22.4 ±â€¯1.7 years, height 168.4 ±â€¯5.31 cm, weight 66.6 ±â€¯6.6 kg) who demonstrated neuromuscular deficits on the tuck jump test were allocated to a control group (n = 20), and the NMT group (n = 20). INTERVENTION: Experimental group participate in an 8-week NMT program including 6 weeks (18 sessions), each session almost lasted for 30 min. MAIN OUTCOME MEASURES: The peak torque as well as time to peak torques of hip abductors and external rotators as well as knee flexors and extensors muscles, and the performance were measured before and at the end of a 6-week NMT using the isokinetic dynamometer and the hop test battery respectively. RESULTS: A significant improvement was observed in the NMT group for the peak torque and time to peak torque in hip and knee muscles both concentric and eccentric states at 60 and 180ºsec. Also, they showed a significant improvement in the distance of single leg hop and single leg triple crossover hop tests. However, no significant 20 and 21. change was seen in the control group. CONCLUSIONS: An NMT program can significantly improve muscle strength, hop tests scores, and the inter limb asymmetry in female basketball players. The NMT may be used in ACL prevention in female basketball players with lower limb asymmetry.

Comparing the Effects of SUREE Programs on People With Scapular Downward Rotation Syndrome: A Randomized Clinical Trial.

CONTEXT: Scapular downward rotation syndrome (SDRS) is an impaired alignment that causes shoulder and neck pain. Interventions may lead to the reduction of pain intensity and joint position error (JPE) and improved range of motion (ROM). OBJECTIVE: To evaluate the effects of 6-week Scapular Upward Rotation and Elevation Exercises (SUREE) with and without visual feedback on pain, ROM, and JPE in people with SDRS. STUDY DESIGN: Randomized control trial. SETTING: Institutional practice. PARTICIPANTS: Forty-two young and active subjects (22.61 [1.80] y; 27 males and 15 females) with unilateral SDRS randomly assigned into 3 groups (2 intervention groups and 1 control group). INTERVENTIONS: SUREE without and with visual feedback programs. MAIN OUTCOME MEASURES: Pain, neck-flexion and rotation ROMs, and JPE were measured using visual analog scale (score), double inclinometer method, universal goniometer method (degrees), and a dual digital inclinometer (degrees), respectively, before and after interventions. RESULTS: The results showed statistically significant changes within the experimental groups in all variables except for the neck rotation ROM in the SUREE intervention without visual feedback (P < .05). However, there were no changes in the control group before and after the interventions in all dependent variables (P < .05). Also, there were no significant differences between both experimental groups concerning all dependent variables except for the rotation ROM (P < .05). CONCLUSION: The results suggest that the 6-week SUREE with and without visual feedback programs result in decreased neck pain and improved flexion ROM and JPE during active neck motions in subjects with unilateral SDRS. However, the 6-week SUREE with visual feedback may improve the neck rotation ROM in subjects with unilateral SDRS. However, further studies are needed to confirm the results of this study.

Effects of eight-week "gyroscopic device" mediated resistance training exercise on participants with impingement syndrome or tennis elbow.

BACKGROUND: Rehabilitation of injuries in the upper extremity and reestablishment of muscle strength throughout the range of motion in overhead movements, are the major concerns of athletes and coaches in the sports field. PURPOSE: To determine the effect of eight-week "gyroscopic device" mediated resistance training exercise on grip strength, wrist and shoulder strength and proprioception, and upper extremity performance, in participants with impingement syndrome or tennis elbow. DESIGN AND METHODS: For this study, in a university rehabilitation clinic 45 volleyball players (aged 22-28) purposefully were selected and divided into 3 groups: shoulder impingement (group I), tennis elbow (group II), and control (group III). The experimental groups performed the "gyroscopic device" mediated resistance training, three sessions a week over 8 wks. Grip strength, wrist and shoulder strength and proprioception, and upper extremity performance were measured before and after implementation of the intervention (eight-week resistance training using a "gyroscopic device") using a hand hold dynamometer, isokinetic dynamometer, and Y balance test respectively. RESULTS: After 8 weeks of "gyroscopic device" exercise, improvement in the shoulder, wrist and grip strength, shoulder and wrist proprioception and performance scores of both experimental groups was significant. There were no significant differences between study groups I and II, both groups, however, demonstrated significant differences when compared to the control group, but between group I and the control group, and between group II and the control group, the difference was significant. However, no significant change was seen in the control group. CONCLUSIONS: Due to the significant effects of the "gyroscopic device" mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables. More research is needed to confirm the result of this study.