A Study to find the effectiveness of Scapular Strengthening Exercise in patients with Cervical Dysfunction
Kotteeswaran. K1*, Chiranjibi Kumar Nayak2
1Professor, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences,
Chennai-602 105 Tamilnadu, India.
2MPT Second Year, Saveetha College of Physiotherapy, SIMATS, Chennai, India.
*Corresponding Author E-mail: k.kotteeswaran@gmail.com
ABSTRACT:
Background: Cervical spine dysfunction is a cause of neck pain. The cause for it is believed to be a disorder (most likely malalignment) of the pain-sensitive facet joints (which may also be due to disc disruption). Dysfunction can also cause secondary muscle spasm, which can may lead to more pain and stiffness. Objective: To find the effectiveness of SNAGs and scapular strengthening exercises in the patients with chronic cervical dysfunction. To find the Neck disability index (NDI) score difference between the functional activities of experimental group and conventional treatment group. Methodology: According to inclusion and exclusion criteria a prior to the study, the principal researcher explained the procedures to all the subjects and inform consent obtained, 30 subjects taken through Random block design and numbering was done for all the subjects. All the odd numbers in one group and all the even numbers in another group are allocated by random table where each group had 15 subjects. The collected data was tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) were used. Paired t-test was used to analyze significant changes between pre-test and post-test measurements. Unpaired t-test was used to analyze significant changes between two groups. Result: rom statistical analysis made with the quantitative data revealed statistically significant difference between the Group A and Group B, and also within the group. The Posttest mean value of Neck Disability Index (NDI) in group A is 12.00 and in group B is 13.80. This shows that Neck Disability Index (NDI) in Group B disability value were comparatively more than Group A disability value, P<0.0001. Conclusion: This study shows better improvement in reducing cervical spine dysfunction (neck pain) by scapular strengthening exercise than resisted neck isometrics. Both the techniques can be used in clinical practice.
KEYWORDS: Cervical Spine Dysfunction, Scapular strengthening exercises, Neck Disability Index (NDI).
INTRODUCTION:
The prevalence of Neck pain affects about 330 million people globally as of 2012 (5.9% of the population). This is more common in women (6.7%) than men (4.9%). It is less common than low back pain. The Neck pain will aggravate due to any change in the posture, tightness in the muscle, and any injury to the nerve. Joints or muscles problems in the neck cause neck pain, upper back or upper extremity.2
Neck pain or cervicalgia is a common neuromuscular-skeletal problem, according to the available statistics with two-thirds of the population having neck pain at some point in their lives. Neck pain is defined as the sensation of discomfort in the neck area, it is generalized neck or shoulder pain provoked by sustained neck postures, neck movement, or palpation of the cervical musculature and it also arises from numerous different conditions and is sometimes referred to as cervical pain3. The common symptoms of localized or radicular pain are tenderness, spasm, associated with functional disability.
Physical therapy is an important component of conservative management of neck pain and postsurgical rehabilitation after neck surgeries. The conservative physical therapy management includes; muscle strengthening, flexibility, and stabilization exercises, mobilization, manipulation, and mechanical traction procedures.4 Scapulothoracic (ST) muscle impairment has been associated with neck pain. There is evidence of weakness or altered activity in the middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) muscles in patients with neck pain5. Specifically, the guidelines state that weakness in the MT, LT and SA may be present in patients with certain types of neck pain. Upper extremity strengthening has been shown to help alleviate neck pain symptoms, with the potential for long term benefits. It is imperative that the proximal stabilizing muscles of the thorax, neck, and scapula function properly before initiating dynamic strengthening of the muscles that move the cervical spine and GH joint through the ROM to avoid faulty mechanics. Strengthening exercises can be done in both open- and closed chain positions. Progress exercises with repetitions and resistance within the mechanical limits of the involved tissues. Initially apply light resistance with multiple repetitions to develop dynamic control and muscular endurance. As control develops, progress to combined patterns of motion and training for muscle groups to function in a coordinated sequence. Begin with simple functional activities and progress to more complex and challenging activities. Both muscular endurance and strength are necessary for postural and dynamic control of activities.
MATERIALS AND METHOD:
The study was done at Physiotherapy outpatient department, Saveetha College of Physiotherapy. The study design is Quasi Experimental study and the Sampling Method is Random block design. The Sample Size was 30 (15 in each group). Assuming the proportion of subject with moderate disability is 90%. The sample size is estimated as 15 in each group to get significant difference of at least 30% for 80% power at 5% significant level. The samples were selected on the basis of inclusion and exclusion criteria. Inclusion criteria was Both male and female subjects diagnosed with neck pain with the age group of 20 to 60yrs and the Exclusion criteria was Any contraindication like inflammation, infection, advanced degeneration, congenital mal formation, trauma, cerebrovascular abnormalities and any history of cervical spine surgery or stenosis, metabolic or systemic disorders or cancer. The materials used are Interferential unit (Calibrated), Weights (For Resistance), Treatment couch. According to inclusion and exclusion criteria prior to the study, the principal researchers explained the procedures to all of the subjects and inform consent obtained, Using random block method, 30 patients will be selected from Physiotherapy –out patient department and will be allocated to two groups namely control group and experimental group, 15 patients in each group. After recruitment on eligibility, informed consent will be obtained on explaining the treatment to be given. The Experimental group will receive scapular strengthening exercises with interferential therapy. Scapular strengthening exercises will be individualized focusing on Serratus anterior, trapezius, Levator scapulae, Rhomboids. Based on assessment of power, resistance added accordingly for strengthening protocol. The Parameters for IFT are Intensity: maximum sensory, mild motor sensation; Frequency of machine: 1-100 Hz; Duration: 15 minutes per session. The Control group will be given the conventional physiotherapy i.e. Resisted neck isometric exercises with interferential therapy. Subject is instructed to sit in a chair with his back straight. Patient is asked to hold the resistance for 10 seconds and relaxed. The neck pain disability index scale will be used to measure disability and consists of 10 questions. Each question is scored from 0 to 5; with high scores indicate more patient rated disability. The scores are then converted to a percentage out of 100.6 The data will be statistically analyzed using “t” test. Paired t test will be used to analyze the pretest and posttest values within the group. Student t test will be used to analyze the pre and posttest values between the groups.
RESULT:
The data from table 1 shows the pre-test and post-test values of Neck Disability Index in Group-A Subjects. The pre-test mean value of NDI is 17.00% with Standard deviation 4.74 and post-test mean value is 14.77 with SD 9.02, this shows that NDI score are gradually increasing with the P value (0.0001) statistically significant. The data from table 2 shows the pre-test and post-test values of NDI in Group-B Subjects. The pre-test mean value of NDI is 20.27 with SD 1.91 and post-test mean value is 13.80 with SD 2.57 this shows that NDI score are gradually increasing with the P value (0.0001) statistically significant. The data from table 3 shows the post-test values of NDI in group A and group B. The posttest mean value of NDI in group- A is 12.00% with SD 3.36 and posttest mean value of NDI IN Group-B is 13.80% with SD 2.57.
From statistical analysis made with the quantitative data revealed significant difference (p<0.0001) between the pretest and posttest values of Neck Disability Index (NDI) with scapular strengthening exercises, IFT and resisted neck isometrics with IFT. The pretest value of NDI with scapular strengthening exercises, IFT (Group-A) was Mean value 17.00 (SD=4.74). The posttest value of NDI with scapular strengthening exercises, IFT (Group-A) was Mean value 14.77(SD=9.02). This shows that Neck Disability Index (NDI) in posttest values are comparatively less than pretest value-p<0.0001 and t-value was 24.55.
The pre test value of NDI with Resisted neck isometrics and IFT (Group-B) was Mean value 20.27 (SD=1.91). The post test value of NDI with Resisted neck isometrics and IFT (Group-B), was Mean value 13.80(SD=1.91). This shows that Neck Disability Index (NDI) in post test values are comparatively less than pre test value-p -0.0001 and t-value was 14.56. The Post test mean value of Neck Disability Index (NDI) in group A is 12.00 (SD=3.36) and in group B is 13.80.(SD=2.57) This shows that Neck Disability Index (NDI) in Group B disability value were comparatively more than Group A disability value, P<0.0001and t-value 1.64. Statistical Analysis of posttest Neck Disability Index (NDI) revealed that there is high statistically significant difference of p<0.0001 seen between group A and group B.
Table 1: Pretest –Posttest values of group A-Experimental group
|
Group A |
|
Mean in% |
Standard deviation in% |
t value |
p value |
|
Neck Disability Index (NDI) in % |
Pre test |
17.00 |
4.74 |
24.55 |
<0.0001 |
|
Post test |
14.77 |
9.02 |
Table 2: Pretest –Posttest values of group B- Control group
|
Group A |
|
Mean in% |
Standard deviation in % |
t value |
p value |
|
Neck Disability Index (NDI) in % |
Pre test |
20.27 |
1.91 |
14.560 |
<0.0001 |
|
Post test |
13.80 |
2.57 |
Table 3: Comparison between group A-Experimental group and group B- Control group
|
Parameter |
Post Test Values |
‘t’ test |
P value |
|||
|
Group A |
Group B |
|||||
|
Mean |
Standard deviation |
Mean |
Standard deviation |
|||
|
Neck Disability Index (NDI) in % |
12.00 |
3.36 |
13.80 |
2.57 |
1.6484 |
<0.0001 |
DISCUSSION:
The present study was conducted to study the effectiveness of scapular strengthening exercises and interferential therapy in treatment of chronic cervical spine dysfunction by comparing with resisted neck isometrics with interferential therapy. Both treatments were done for 3days per week for 4 weeks. Neck Disability Index (NDI) was used to measure outcome. The results of this study demonstrated that scapular strengthening exercises with interferential therapy can better manage pain and disability as compared with resisted neck isometric exercises with interferential therapy alone in the management of chronic cervical spine dysfunction. The current study rigorously tested strengthening technique to determine whether this technique is effective in cervical spine dysfunction (Neck pain). The study results showed statistically and clinically significantly reducing neck pain.
The traditional physiotherapy modalities used for the management of neck pain includes and the traditional exercise program selected results for scapular muscles focusing on Serratus anterior, Trapezius, Levator Scapulae, Rhomboids based on assessment of power, resistance added accordingly for strengthening protocol. Scapulothoracic (ST) muscle impairment has been associated with neck pain. There is evidence of weakness or altered activity in the middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) muscles in patients with neck pain7,8. Specifically, the guidelines state that weakness in the MT, LT and SA may be present in patients with certain types of neck pain. Upper extremity strengthening has been shown to help alleviate neck pain symptoms, with the potential for long term benefits. Neck pain generates psychological problems by decreasing work efficiency, causing troubles in business because of discomfort in the neck, patients with neck pain cannot exercise properly. therapeutic interventions for neck pain make use of positional exercise9,10, strengthening exercise to muscles, education, rest and intensified training of proprioceptive sensibility under the management and instructions of therapists. Patients who came with neck pain, cervical movement restriction and other activities which were limiting their functional movements had an immediate relief from pain and restricted range of motion who underwent strengthening sessions, although few patients had reported mild pain at end range of movements. Patient had difficulty in holding weights during exercise sessions due to pain in the neck11,12. Jorge. P. Fuents, susan Armijo et.al conducted a systematic review and meta-analysis, they concluded that interferential current therapy is having beneficial effect in the management of musculoskeletal pain. Bronfort and team conducted a randomized control trial to determine the relative efficacy of spinal manipulation therapy (SMT), medication and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. However few instructional sessions of HEA resulted in similar outcomes at most time points. Gross and colleagues et.al (2007) conducted a systematic review on manipulation or mobilization for neck pain to determine and concluded that both the techniques had the same effects in neck pain. Miller and colleagues carried out a systematic review on manual therapy and exercise for neck pain and concluded that moderate quality evidence supports this treatment combination for pain reduction improved quality of life over manual therapy alone for chronic neck pain13.
CONCLUSION:
This study shows better improvement in reducing cervical spine dysfunction (neck pain) in scapular strengthening exercise than resisted neck isometrics. Both the techniques can be used in clinical practice.
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Received on 08.04.2019 Modified on 16.11.2019
Accepted on 22.03.2020 © RJPT All right reserved
Research J. Pharm. and Tech. 2021; 14(7):3591-3594.
DOI: 10.52711/0974-360X.2021.00621