The Effect of Cervical Stabilization Exercises on the Cervical Proprioception in Patients With Chronic Neck Pain

The Effect of Cervical Stabilization Exercises on the Sense of Cervical Proprioception in Patients With Chronic Neck Pain

Neck pain is one of the most common musculoskeletal complaints and its prevalence is between 10-22%. Approximately half of all individuals will experience a clinically important neck pain episode over the course of their lifetime. Neck pain is categorized by duration as acute, subacute and chronic neck pain (acute, <6 weeks; subacute, ≤3 months; chronic, >3 months). Chronic neck pain is more common in women and its incidence increases with age. Cervical disc herniation, cervical spondylosis, cervical stenosis, myofascial pain syndrome, cervical instability, whiplash injury, Klippel feil syndrome, thoracic outlet syndrome, cervical sprain, cervical strain, tumors, rheumatic diseases, torticollis, inflammatory neck pain are the main causes.

Anterior tilt of the head is a common posture in neck pain. In this posture, the upper cervical vertebrae are extension, the lower cervical vertebrae are flexion and the cervical lordosis is decreased. With neck pain, inhibition occurs in the deep neck flexor (longus coli and capitis) and extensor (multifidus, rotator, semispinalis) muscles, increased fat infiltration, deterioration in type 1 and 2 fiber ratios, and muscle atrophy. The risk of micro and macro trauma increases and muscle support decreases. Thus, there is an increase in the activation response and fatigue of the neck superficial muscle group (trapeze, scalene, sternocleidomastoid muscles), and a decrease in neck joint movement and proprioception sense. As a result, it was determined that there are deficiencies in the sense of proprioception in patients with neck pain.

Studies have shown that many receptors related to the sense of position are on deep cervical flexor muscles such as Musculus Longus Capitis and Musculus Longus Colli. In cases where there are changes such as atrophy and fat infiltration in these muscles, there is a decrease in proprioceptive sensation.Conservative treatment is the first choice in the treatment of neck pain. The important components of this treatment are stretching, strengthening, posture, stabilization, proprioception, relaxation, joint movement exercises and aerobic exercises. The purpose of stabilization exercises, which have been used in the treatment of chronic neck pain recently; to support the vertebral column by activating the stabilizing muscles and to improve posture by increasing kinesthetic awareness.

This study will examine the relationship between the sense of cervical proprioception and cervical stabilization exercises in patients with chronic neck pain.

In this study, between 15 June 2022 and 30 January 2023; 72 volunteers, aged between 18-55 years, with neck pain for more than 3 months, with good cognitive function, who applied to the our Physical Medicine and Rehabilitation Clinic will be included. The patients will be randomized to two groups as cervical stabilization exercise group and conventional cervical exercise treatment group. The patients in group 1 will receive cervical stabilization exercises 1 session a day, 3 days a week for 6 weeks, and the patients in group 2 will perform cervical stabilization exercises for 6 weeks, 3 days a week, 1 session a day. conventional cervical exercises will be given. Patients of both groups will do their exercises in the first 3 weeks accompanied by a physiotherapist, and in the last 3 weeks as a home exercise program.

Before the start of the treatment, at the end of the 3rd week and at the end of the 6th week; pain intensity, level of neck disability, quality of life, cervical range of motion and cervical joint position sense will be evaluated and both groups will be compared in these parameters.

Demographic information (address, telephone, age, occupation, height, weight, marital status, etc.) of the patients to be included in the study will be recorded and general musculoskeletal examinations will be performed. The patients will be compared to evaluate for Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Short Form-36 (SF-36), cervical range of motion and cervical joint position sense after intervention. Cervical range of motion and cervical joint position sense will be evaluated with the Cervical Range of Motion Deluxe Device (CROM).

Study Overview

• Status: Completed
• Conditions: Neck Pain; Chronic Neck Pain
• Intervention / Treatment: Behavioral: Cervical Stabilization Exercise; Behavioral: Cervical Standard Exercise Group

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Zonguldak, Turkey, 67100
    • Zonguldak Bülent Ecevit University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. The patients age is between the ages of 18-55
2. Being literate and with good cognitive function,
3. Having neck pain longer than 3 months
4. Not taking painkillers and nsaid in the last 1 week

Exclusion Criteria:

1. Cervical extruded or sequestered disc herniation, diagnosis of myelopathy
2. Having neck and shoulder surgery
3. Diagnosis of major trauma, infection, malignancy, inflammatory disease or peripheral nerve compression, spinal congenital anatomical deformity
4. Having severe cardiovascular disease, neurological or mental illness and inability to tolerate treatment
5. Kyphoscoliosis
6. Osteoporosis
7. Stage 3-4 osteoarthritis
8. Diagnosis of diabetes mellitus, uncontrolled hypertension
9. Having a diagnosis of fibromyalgia
10. Spinal stenosis
11. Pregnancy
12. Receiving physical therapy in less than 3 months
13. Obesity (BMI>30)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Cervical Stabilization Exercise Group; The patients age is between the ages of 18-55; Being literate and with good cognitive function,; Having neck pain longer than 3 months; Not taking painkillers and nsaid in the last 1 week	Behavioral: Cervical Stabilization Exercise; The cervical stabilization exercise group will receive cervical stabilization exercises 1 session a day, 3 days a week for 6 weeks. Patients will do their exercises in the first 3 weeks accompanied by a physiotherapist, and in the last 3 weeks as a home exercise program.Before the start of the treatment, at the end of the 3rd week and at the end of the 6th week; pain intensity, level of neck disability, quality of life, cervical range of motion and cervical joint position sense will be evaluated and both groups will be compared in these parameters.Demographic information of the patients to be included in the study will be recorded . The patients will be compared to evaluate for Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Short Form (SF-36), cervical range of motion and cervical joint position sense after intervention. Cervical range of motion and cervical joint position sense will be evaluated with the Cervical Range of Motion Deluxe Device (CROM).
Active Comparator: Cervical Standard Exercise Group; The patients age is between the ages of 18-55; Being literate and with good cognitive function,; Having neck pain longer than 3 months; Not taking painkillers and nsaid in the last 1 week	Behavioral: Cervical Standard Exercise Group; The patients in cervical standard exercise group will receive conventional cervical exercise for 6 weeks, 3 days a week, 1 session a day. Patients will do their exercises in the first 3 weeks accompanied by a physiotherapist, and in the last 3 weeks as a home exercise program.Before the start of the treatment, at the end of the 3rd week and at the end of the 6th week; pain intensity, level of neck disability, quality of life, cervical range of motion and cervical joint position sense will be evaluated and both groups will be compared in these parameters.Demographic information of the patients to be included in the study will be recorded . The patients will be compared to evaluate for Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Short Form (SF-36), cervical range of motion and cervical joint position sense after intervention. Cervical range of motion and cervical joint position sense will be evaluated with the Cervical Range of Motion Deluxe Device (CROM).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of cervical joint position sense	Cervical joint position sense will be evaluated with the CROM (Cervical Range of Motion) Deluxe Device.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assessment of cervical range of motion	Cervical range of motion will be evaluated with the CROM (Cervical Range of Motion) Deluxe Device.	6 weeks
assessment of neck disability	The patients will be evaluate with the Neck Disability Index (NDI) for assessment of neck disability. The score ranges from 0 to 50. As the score increases, disability increases.	6 weeks
assessment of pain	The patients will be evaluate with the Visual Analogue Scale (VAS) for assessment of pain. They are numbered from 1 to 10. As the score increases, pain intensity increases.	6 weeks
assessment of life quality	The patients will be evaluate with the Short Form (SF-36) for life quality. The SF-36 consists of 36 items - that are grouped in 8 subscales or domains: Physical functioning (10 items); Role limitations due to physical health (4 items); Role limitations due to emotional problems (4 items); Energy/fatigue (4 items); Emotional well-being (5 items); Social functioning (2 items); Pain (2 items); General health (5 items). Scoring is between 0-100, higher scores indicate good health status.	6 weeks

Collaborators and Investigators

• Sponsor: Şenay Özdolap
• Collaborators: Zonguldak Bulent Ecevit University

Study record dates

Study Major Dates

• Study Start (Actual): October 7, 2022
• Primary Completion (Actual): November 25, 2022
• Study Completion (Actual): January 30, 2023

Study Registration Dates

• First Submitted: November 7, 2022
• First Submitted That Met QC Criteria: March 23, 2024
• First Posted (Actual): March 29, 2024

Study Record Updates

• Last Update Posted (Actual): April 2, 2024
• Last Update Submitted That Met QC Criteria: March 30, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Chronic Neck Pain; Cervical Proprioception; Cervical Stabilization Exercises
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: 2021/16-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No