To Compare the Effectivness of Balance and Proprioception with Conventional Exercise in Non Specific Neck Pain

 

Rajalaxmi.V¹, Sushmitha Anandhan², K.Kirupa³, K. Kamatchi⁴,

Radhakrishnan Unnikrishnan⁵, Shady Abdullah Alshewaier⁶

¹Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India.

^3,4Assistant Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India.

²Physiotherapist, Aayushman Physiotherapy clinic, Vashi Navi, Mumbai, Maharastra, India.

⁵Lecturer, Department of Physical therapy and Health Rehabilitation, College of Applied medical Sciences, Majmaah university, Kingdom of Saudi Arabia.

⁶Dean of Library affairs, Assistant Professor, Department of Physical Therapy,

Majmaah university, Kingdom of Saudi Arabia.

 

ABSTRACT:

Objective: The objective of the study was to determine the efficacy of proprioception and balance exercise along with conventional exercise in patients with neck pain. Methodology: This was an experimental study design 60 samples were selected based on the inclusion criteria, Group A received balance and Proprioception exercise and Group B conventional exercise. Pre and posttest measurement were taken and compared by using outcome measures of VAS, Four-Square Step Test and Modified Clinical Tests of Sensory Interaction in Balance. Results: On comparing the mean value of Group A and Group B, shows significant difference between group A and group B. Group A Balance and proprioception exercise seems to be more effective than Group B conventional exercises.

 

 

INTRODUCTION:

Neck pain occurs in the world and resulting in substantial disability, economic cost and has large impact on lives. Pain in neck sometimes radiates in the nerve course of arm due to entrapments, varying intensity and may feel achy electric shock from neck to arm¹. With the lack of trauma in neck, there arises the possibility of the proprioceptive dysfunction in neck pain stems from spinal or supra spinal causes^2. Therefore, mechanical neck pain refers to neck pain caused by placing abnormal stress and strain on muscles and mostly results from poor posture^3.

 

In India, since 1990 neck pain has increased by 19.1% by an average of 0.8% a year. Neck pain prevalence is higher in females than in males (41.7 vs 34.4%)^5.  For one year prevalence, Scandinavian countries reported more neck pain than rest of Europe and Asia^6.  Prevalence of neck pain was 20.3% amongst women who were widowers or separated⁷.

 

Balance is considered as an essential component of almost every motor performance task. Its function is regulated by central nervous system based on information from vestibular system⁸. Although Proprioception is generally considered to be a result of peripheral signals, the last decade of research has elucidated the critical role of central factors, such as integrity of proprioceptive maps and the important role of vestibular and visual inputs in body-related perception. Balance and Proprioception has found to be decreased in the patients with chronic mechanical neck pain⁹.  Many mechanisms have been suggested to balance disturbances, but none has emerged as most prominent. The theories involve local factors, sensory and motor, and global factors, for example, central modulation¹⁰.

 

Modified Sensory Interaction test measured on force platform has good to excellent test-retest reliability and validity in a group of young and elderly women and is a means to quantify postural control under various sensory conditions Vestibular Disorders, Brain injury, Cerebral Palsy, Cerebrovascular accidents¹¹.

 

materials and methods:

This experimental study design was conducted in the Physiotherapy department of ACS Medical College and hospital. 60 samples were selected from 90 volunteers based on the inclusion criteria. 90 Samples were divided into two groups Group A and Group B. GROUP A received Exercise for Balance and Proprioception: GROUP B received isometric neck exercises with hot pack Isometric exercises also called neck strengthening exercise. It includes forward, backward, sideward isometric strengthening.

 

DATA ANALYSIS:

The collected data were tabulated and analysed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24. Paired t-test was adopted to find the statistical difference within the groups independent t-test (Student t-Test) was adopted to find the statistical difference between the groups.

 

Table – 1 Comparison of Vas, Ctsib-M And Fst Within Group- A Between Pre and Post Test Values

#GROUP - A	Pre-Test		Post Test		t - TEST	Significance
	Mean	S. D	Mean	S. D
VAS	6.18	1.12	2.60	.733	22.12	.000*
Modified Clinical Test Of Sensory Interaction In Balance	104.00	4.25	116.46	2.19	-18.86	.000***
Four Square Test	16.80	1.61	10.53	1.59	27.46	.000***

 

Table-2 Comparison Of Ctsib-M And Fst Within Group- A Between Pre and Post Test Values

#GROUP - B	Pre-Test		Post Test		t - Test	Significance
	Mean	S. D	Mean	S. D
VAS	6.15	.189	3.26	.453	19.00	.000***
Modified Clinical Test of Sensory Interaction In Balance	104.86	5.04	109.46	4.51	12.68	.000***
Four Square Test	16.60	2.50	13.80	2.17	7.35	.000***

 

RESULTS:

On comparing the Mean values of Group A and Group B on Visual Analogue Scale Score, it shows significant decreasein the post test Mean values but (Group A -Balance and Proprioception Exercise) shows (1.60) which has the Lower Mean value is more effective than (Group B - Isometric Exercise With Hot Packs) (3.06) atP ≤ 0.001.

 

On comparing the Mean values of Group A and Group B on Modified Clinical Test of Sensory Interaction in Balance, it shows significant Increase in the post test Mean values but (Group A -Balance and Proprioception Exercise) shows (116.46) which has the higher Mean value is more effective than (Group B - Isometric Exercise With Hot Packs) (109.46) at P ≤ 0.001.

 

On comparing the Mean values of Group A and Group B on Four Square Test, it shows significant decrease in the post test Mean values but (Group A -Balance and Proprioception Exercise) shows (10.53) which has the Lower Mean value is more effective than (Group B - Isometric Exercise With Hot Packs) (13.80) at P ≤ 0.001.

 

On comparing Pre-test and Post-test within Group A and Group B on VAS, Modified Clinical Test of Sensory Interaction in Balance and Four Square Test shows highly significant difference in Mean values at P ≤ 0.001.

 

DISCUSSION:

The primary aim of the experimental study was to explore a clinical assessment of balance and proprioception in chronic neck pain patients. In combination with lack of trauma in neck pain, raise the possibility that the proprioceptive dysfunction in neck pain stems from spinal or supraspinal causes¹². It was even found that cervical muscle fatigue produced significant disturbances on balance¹³. For instance, impaired balance during quiet standing has been reported in patients with chronic neck pain of different aetiologies¹⁴.

 

The other study concluded that Yoga is compared to Pilates and Tai chi and Control Group exercise for chronic mechanical neck pain. Yoga is effective in reducing pain, disability, quality of life and fear of movements in subjects with mechanical neck pain¹⁵. Both the groups (schroth method and yoga) shows improvement in the postural alignment (forward head shift, shoulder protraction) and pulmonary function¹⁶. Motor control exercises produced statistically significant changes in all the variables of the neck region in the post-intervention measurement than the endurance and conventional training group¹⁷. The study concluded that there is a positive correlation between the neck column length (anterior and posterior) and the head circumference with the neck pain¹⁸. Groups A neck stabilization and postural correction showed better significance than group B stretch and strengthening exercise in reducing pain and disability and improving posture and breathing patterns¹⁹. The study concluded that Modified Trunk Dissociation Retrainer (MTDR) is effective in improving balance and gait velocity in children with developmental delay²⁰. Traditional Push Up and Wall Push Up were compared TPU was a significant when upper quarter Y-balance exercise showed significant difference²¹. Core stabilized and combined exercise on stable and unstable surfaces could improve dynamic mediolateral balance control²². The core stabilization and combined exercise performed on top the stable surface and unstable surface could improve the dynamic balance of the mediolateral direction²³. Study concluded that the Balance exercise circuit (BEC) exercises in older adults improved gait parameters and functional performance²⁴. Functional balance Traning Program is more beneficial in improving postural control and thereby could have the potential to reduce risk of injury when compared to Isolated Ankle Strengthening Exercise among the novice runners²⁵.  The study concluded that Proprioception training with interferential therapy (Group-A) is more effective than (Group-B) in decreasing pain and improving activity of daily living²⁶. However, the balance training Group was considered to be more effective than the conventional exercises program.²⁷

 

CONCLUSION:

The present study demonstrates that there is positive significant improvements in balance and proprioception group among neck pain of old age group. Hence, balance and proprioception is an important determinant factor in neck pain in old age group. This study is to create awareness among neck pain population that Balance and Proprioception is reduced due to neck pain in old age and hence Balance and Proprioceptive exercises should be added in regular routine exercise schedule. Through this study, we conclude that there seems to be evidence that balance and proprioception exercise are more beneficial in general exercise program in reducing neck pain and seems to be advantageous.

 

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Accepted on 23.02.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(11):5192-5195.