Investigation of the Effectiveness of Proprioceptive Neuromuscular Facilitation Techniques in Text Neck Syndrome

March 14, 2024 updated by: Meltem Kaya, Atlas University
Smartphones and tablets are increasingly widespread mobile technological devices used for many purposes such as communication, transportation, entertainment, education and security. Increasing use of mobile technology leads to various symptoms such as insomnia, difficulty concentrating and anxiety, especially musculoskeletal problems. "Text neck" is a musculoskeletal problem seen in individuals who use smartphones and tablets for a long time due to increased head and neck flexion posture. It causes neck, back, shoulder, and head pain, insomnia, tingling and numbness in the hands. Implementation of exercise programs for both preventive and therapeutic purposes is one of the main goals in this picture dominated by posture and pain problems. Proprioceptive neuromuscular facilitation (PNF) treatment technique; In the 1940s by H. Kabat and M. Knott, PNF was expressed as a means of facilitating neuromuscular responses by stimulation of proprioceptors. It is stated that it increases joint stabilization, strength, normal range of motion, endurance and circulation and is effective in improving coordination. Although PNF techniques have been used for different spinal problems, there is no study investigating PNF techniques in text neck syndrome. The study was aimed to compare the effect of a method including muscle relaxation in the anterior elevation direction and repetition techniques in the posterior depression direction from PNF neck patterns on pain intensity, neck normal range of motion, neck muscle endurance, posture and functionality in individuals with text neck syndrome with another method including ergonomic adjustments and simple cervical exercises recommended in the literature to be included in standard treatment.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Smartphones and tablets are increasingly widespread mobile technological devices used for many purposes such as communication, transportation, entertainment, education and security. Increasing use of mobile technology leads to various symptoms such as insomnia, difficulty concentrating and anxiety, especially musculoskeletal problems. "Text neck" is a musculoskeletal problem seen in individuals who use smartphones and tablets for a long time due to increased head and neck flexion posture. It causes neck, back, shoulder, and head pain, insomnia, tingling and numbness in the hands. Implementation of exercise programs for both preventive and therapeutic purposes is one of the main goals in this picture dominated by posture and pain problems. Proprioceptive neuromuscular facilitation (PNF) treatment technique; In the 1940s by H. Kabat and M. Knott, PNF was expressed as a means of facilitating neuromuscular responses by stimulation of proprioceptors. It is stated that it increases joint stabilization, strength, normal range of motion, endurance and circulation and is effective in improving coordination. Although PNF techniques have been used for different spinal problems, there is no study investigating PNF techniques in text neck syndrome. The study was aimed to compare the effect of a method including muscle relaxation in the anterior elevation direction and repetition techniques in the posterior depression direction from PNF neck patterns on pain intensity, neck normal range of motion, neck muscle endurance, posture and functionality in individuals with text neck syndrome with another method including ergonomic adjustments and simple cervical exercises recommended in the literature to be included in standard treatment. Our study is planned as a randomized controlled, prospective, single-blind case-control study. Demographic and clinical information of all participants to be included in the study will be recorded with the "Demographic and Clinical Information Form". Neck pain will be assessed by visual analog scale (VAS), cervical joint normal range of motion will be assessed by cervical flexion, cervical extension, cervical lateral flexion and cervical rotation normal range of motion measurements, neck muscle endurance will be assessed by neck flexor and extensor muscle endurance tests, posture will be assessed by New York Posture Evaluation Scale and functionality will be assessed by Neck Disability Index.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
38

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Istanbul, Turkey
        • Istanbul Atlas University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • at least 1 year of using a smartphone
  • using smartphones>4 hours per day, having recurrent neck pain which is increased by sustained posture and feeling of stiffness on turning the head and neck after long usages
  • be able to read written and understand spoken language and willing to participate were included.

Exclusion Criteria:

  • Subjects with spinal infections or inflammatory disorders
  • a history of neck surgery, trauma, torticollis, scoliosis, malignancies, pregnancy, diagnosed disc prolapse, stenosis, herniation, spondylolisthesis, osteoporosis
  • currently continuing or participating in a regular exercise program
  • unable to perform tests or exercises because of diagnosed comorbidities or presently undergoing medication or physical therapy treatments

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Experimental Group
Participants in the experimental group underwent the exercise program including active cervical range of motion, strengthening, and posture correction exercises for 6 weeks, 3 days a week, once a day for 10 repetitions. Active cervical range of motion exercise program consists of the general range of movement for flexors, extensors, both sides flexors, and rotator neck muscles. Strengthening exercises were planned for weak, lengthened, inhibited muscles. Ergonomic modifications while using a smartphone were taught. Additionally, participants in the experimental group were included in a PNF exercise program to be applied by a physiotherapist 3 days a week for 6 weeks. The contract-relax technique for the neck extension pattern and the replication technique for the scapular posterior elevation pattern were used.
Other: Exercise program including active cervical range of motion, strengthening, and posture correction exercises and ergonomic modifications
Active cervical range of motion exercise program consists of the general range of movement for flexors, extensors, both sides flexors, and rotator neck muscles. Participants were instructed to perform exercises in a sitting position, but they were allowed to perform exercises in supine and prone lying if they had problems with sitting position. Strengthening exercises were planned for weak, lengthened, inhibited muscles e.g. Longus colli, and longus capitis. Chin tucks, chin tucks against gravity, and chin nod exercises were selected. Ergonomic modifications while using a smartphone were taught such as taking breaks and changing positions frequently while using a smartphone, avoiding cradling the phone between your ear and shoulder, choosing a smartphone that fits your hands properly, holding the smartphone near chest level rather than waist level, and using features including predictive text or auto-complete tools
Other: PNF exercise program
The contract-relax technique for the neck extension pattern and the replication technique for the scapular posterior elevation pattern were used.
Active Comparator: Control Group
Participants in the experimental group underwent the exercise program including active cervical range of motion, strengthening, and posture correction exercises for 6 weeks, 3 days a week, once a day for 10 repetitions. Active cervical range of motion exercise program consists of the general range of movement for flexors, extensors, both sides flexors, and rotator neck muscles. Strengthening exercises were planned for weak, lengthened, inhibited muscles. Ergonomic modifications while using a smartphone were taught.
Other: Exercise program including active cervical range of motion, strengthening, and posture correction exercises and ergonomic modifications
Active cervical range of motion exercise program consists of the general range of movement for flexors, extensors, both sides flexors, and rotator neck muscles. Participants were instructed to perform exercises in a sitting position, but they were allowed to perform exercises in supine and prone lying if they had problems with sitting position. Strengthening exercises were planned for weak, lengthened, inhibited muscles e.g. Longus colli, and longus capitis. Chin tucks, chin tucks against gravity, and chin nod exercises were selected. Ergonomic modifications while using a smartphone were taught such as taking breaks and changing positions frequently while using a smartphone, avoiding cradling the phone between your ear and shoulder, choosing a smartphone that fits your hands properly, holding the smartphone near chest level rather than waist level, and using features including predictive text or auto-complete tools

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Pain intensity
Time Frame: 6 weeks
The neck pain score was measured using the visual analog scale. The VAS is a subjective scoring method for recording the degree of present pain from 0 (no pain) to 10 (the most severe pain ever experienced) on a 10-cm scale. The minimum clinical important difference (MCID) for VAS is 1.4 cm (on a 10 cm scale)
6 weeks
Cervical range of motion
Time Frame: 6 weeks
Active cervical range of motion was measured in all directions with a plastic universal goniometer. Participants were instructed to sit upright while securing their thoracic area to a chair to assess their cervical range of motion. They were then directed to perform a series of standard movements: flexion, extension, left-right lateral flexion, and left-right rotation. Three consecutive measurements were obtained and the average value was recorded as degree. Before measurements, all participants were encouraged to perform each neck movement to the end range to familiarize themselves with the testing method and to reduce the creep.
6 weeks
Neck flexor-extensor muscle endurance test
Time Frame: 6 weeks
The neck flexor muscle endurance test was performed in the supine and crook lying position. The participant lifted the head and neck until the head was approximately 2.5 cm off the plinth. The "hold your head up" command was given. The test was stopped if the participant's head touched the investigator's hand for over one second. Holding time was recorded in seconds with a stopwatch. The neck extensor muscle endurance test was performed in the prone position. The participant was asked to retract the chin and hold the head steady horizontally. The test was stopped if the subject could not maintain the head in a horizontal position. The endurance time was measured in seconds by stopwatch
6 weeks
Posture
Time Frame: 6 weeks
The evaluation of posture involved using the New York Posture Rating Chart (NYPR), a cost-effective, easily applicable method commonly employed for subjective postural assessment in clinical settings. This chart allows for the assessment of 13 body areas, based on the idea that posture reflects the body's alignment and its various segments.
6 weeks
Disability
Time Frame: 6 weeks
The assessment of disability relied on the Neck Disability Index (NDI), comprising a self-reported scale of 10 items. Each item addresses various complaints related to neck pain, primarily focusing on limitations in activities of daily living. Each item is represented by six different statements, graded on a scale from 0 to 5, where 0 denotes no disability and 5 signifies the most severe disability.
6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Atlas University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 31, 2023

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
March 14, 2024

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
March 15, 2024

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
March 4, 2024

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 11, 2024

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
March 12, 2024

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 15, 2024

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 14, 2024

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
March 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AtlasUmkaya02

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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