Core Stability vs Scapular Stabilization on Hand Grip Strength in Chronic Myofascial Neck Pain

Core Stability Exercises Versus Scapular Stabilization Exercises on Hand Grip Strength in Patients With Chronic Myofascial Neck Pain

Chronic myofascial neck pain (CMNP) is a painful non-articular musculoskeletal neck syndrome that is a persistent and prevalent with a high incidence of recurrence rate range 30-93%.Management of myofascial trigger points were directed at its deactivation, and prevention of its recurrence. Based on mechanical kinetic chain, the upper extremity functions as a unique system of connected segments those collaborated in a harmony in order to perform daily life activities. Core stability exercises maximize motor pathways mechanoreceptors' activities, as well scapular stabilization exercises are generally recommended based on reported benefits in terms of chronic neck pain. The relationship between chronic myofascial neck pain, and hand disability is quite strong. From mechanical point of view, core stability exercises improve trunk stability in line to enhance upper extremity efficiency that facilitates hand, and pinch grasping. In addition, scapular stabilization exercises could improve both hand, and pinch grasp strength and dexterity. Therefore, this randomized clinical trial will be conducted in line to clarify the superiority of the therapeutic effects between core stability exercises, scapular stabilization exercises, and conventional physical therapy program on hand grip strength, pinch grip strength, neck pain intensity level, pain pressure threshold, and whole upper extremity functional level in patients with chronic myofascial neck pain.

Study Overview

• Status: Recruiting
• Conditions: Myofascial Neck Pain; Neck Pain Musculoskeletal; Pressure Pain Threshold; Hand Grip Strength; Scapular Muscle Endurance; Core Muscle Weakness; Trigger Point in Trapezius Muscle; Disability of the Arm, Shoulder, and Hand Questionnaire
• Intervention / Treatment: Other: Core Stability Exercise Protocol; Other: Traditional Physical Therapy Protocol; Other: Scapular stabilization Exercise Protocol

Detailed Description

Chronic myofascial neck pain (CMNP) is a painful non-articular musculoskeletal neck syndrome that is a persistent and prevalent with a frequently reported myofascial trigger points (MTrPs) at upper trapezius with a reported prevalence of up to 93.75%. Individuals with upper trapezius MTrPs would have an overall upper extremity muscular strength reduction that ultimately resulting in decline hand grip strength. positive relation between core endurance and hand grip strength. That finding may be explained by the fact that the core region exhibits an anatomical, and biomechanical interconnection with the extremities, characterized by a prominent muscular linkage. Both core and scapular stabilization exercises has been addressed as one of the most evidence-based modalities. core acts as a the central most part of the kinetic chain, or a double walled cylinder with abdominals in front, multifidis as back, diaphragm as a roof, pelvic floor at the bottom. Where upper extremities connect with core, and attached extremities articulations that transfer energy from torso proximally to extremities' parts distally during functional activities . Scapular stability represents a vital role in terms of whole upper extremity functioning. The research gap to answer the question; Are there any significant differences between core stability exercises, scapular stabilization exercises, and conventional physical therapy program on hand grip strength, pinch grip strength, neck pain intensity level, pain pressure threshold, and whole upper extremity functional level in patients with chronic myofascial neck pain?

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

Contacts and Locations

• Study Contact: Name: Adnan AA Gharib, PHD; Phone Number: +201065798861; Email: dradnanpts@gmail.com
• Study Contact Backup: Name: Magda Ramadan Zahran, Assistant Professor; Phone Number: 01065798861; Email: dradnanpts@gmail.com

Study Locations

• Egypt
  • Giza Governorate
    • Giza, Giza Governorate, Egypt, 11432
      • Recruiting
      • Cairo University
      • Contact: Magda Ramadan Zahran, Assistant Professor; Phone Number: 01065798861; Email: dradnanpts@gmail.com
      • Contact: Adnan AA Gharib, PHD; Phone Number: 01065798861; Email: dradnanpts@gmail.com
      • Principal Investigator: Adnan AA Gharib, PHD

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Patients diagnosed with chronic myofascial neck pain depending on referral, and physical examination.
2. Sixty patients diagnosed with chronic myofascial neck pain for more than six months.
3. Patients age range will 25-45 years
4. Patients body mass index (BMI) will be 18.5-24.9 kg/m2
5. Each patient suffering from all active MTrPs in the upper trapezius muscle with painful/ tender nodule.
6. Patients have a constant neck pain with positive jump sign when palpating the upper trapezius muscle.
7. Patients have referred pain, and symptoms of ipsilateral hand muscle weakness.
8. No history of undergoing physiotherapy modalities or corticosteroid injection therapies in the past six months before the study

Exclusion Criteria:

1. Presence of signs of severe pathology such as malignancies, mainly of the cervical region.
2. Fracture of the cervical spine.
3. Cervical radiculopathy or myelopathy.
4. Diabetes mellitus.
5. Trauma, cognitive anomalies, and surgery around neck, shoulders, or hand.
6. Fibromyalgia or vascular syndromes such as vertebral basilar insufficiency.
7. Pregnancy.
8. Having undergone physical therapy within the past three months before the study.
9. Having corticosteroid injection therapies in the past 3 months before the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Group A (Core Stability); consists of 20 participants who receive core stability exercises, plus the traditional physical therapy program in the form of ischemic compression of upper trapezius muscle, strain-counter strain of upper trapezius muscle, and muscle energy technique of upper trapezius muscle, three sessions per week for 6 weeks.	Other: Core Stability Exercise Protocol; The core stability exercise protocol will be conducted to experimental group (A), only. The core stability exercise protocol will be conducted for 40-45 minutes (10 minutes worm-up 'stretch exercises', 25 minutes core stabilization exercises, and 5-10 minutes cool down exercises 'stretch exercises') 3 sections/ week for six weeks 1. Diaphragm Core '';360 degree expansion breathing, weighted breathing 2. Transverse abdominis 'Abdominal drawing in maneuver, supine vacuum, pelvic tilt'; 3. Multifidus 'quadruped altered leg/arm, bridge with leg extension'; 4. Pelvic Floor muscles/Kegel, bridging, and bridging dog, and squat Core stability exercise.; Other: Traditional Physical Therapy Protocol; Ischemic compression; apply an intermittent ischemic compression on the identified MTrPs within upper trapezius via the researcher thumb for ninety seconds.; Strain-counter strain; apply pressure at MTrPs within stretched upper trapezius, with patient will move the affected shoulder passively to 90° of abduction and external rotation for ninety seconds.; Muscle Energy Technique; patient will do lateral neck flexion to opposite side, and will maintained for 10 seconds, will apply thirty seconds of stretch for ipsilateral affected upper trapezius
Experimental: Experimental Group B (Scapular Stabilization); consists of 20 participants who receive scapular stabilization exercise, plus the traditional physical therapy program, three sessions per week for 6 weeks.	Other: Traditional Physical Therapy Protocol; Ischemic compression; apply an intermittent ischemic compression on the identified MTrPs within upper trapezius via the researcher thumb for ninety seconds.; Strain-counter strain; apply pressure at MTrPs within stretched upper trapezius, with patient will move the affected shoulder passively to 90° of abduction and external rotation for ninety seconds.; Muscle Energy Technique; patient will do lateral neck flexion to opposite side, and will maintained for 10 seconds, will apply thirty seconds of stretch for ipsilateral affected upper trapezius; Other: Scapular stabilization Exercise Protocol; The scapular stabilization exercise protocol will be conducted to experimental group (B), only. The core scapular stabilization exercise protocol will be conducted for 40-45 minutes (10 minutes worm-up 'stretch exercises', 25 minutes scapular stabilization exercises, and 5-10 minutes cool down exercises 'stretch exercises') 3 sections/ week for six weeks a. Open chain stabilization exercises 'scapular elevation/depression, upward/downward rotation', b. Static closed chain stabilization exercises 'Protected weight bearing through both hands leaning against wall', c. Dynamic closed chain stabilization exercises 'scapular retraction'
Active Comparator: Control Group C (Traditional Physical Therapy Program); consists of 20 participants who receive the traditional physical therapy program, three sessions per week for 6 weeks, only	Other: Traditional Physical Therapy Protocol; Ischemic compression; apply an intermittent ischemic compression on the identified MTrPs within upper trapezius via the researcher thumb for ninety seconds.; Strain-counter strain; apply pressure at MTrPs within stretched upper trapezius, with patient will move the affected shoulder passively to 90° of abduction and external rotation for ninety seconds.; Muscle Energy Technique; patient will do lateral neck flexion to opposite side, and will maintained for 10 seconds, will apply thirty seconds of stretch for ipsilateral affected upper trapezius

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Grip Strength	Hand-held Dynamometer (SAMMONS PRESTON, INC. Bolingbrook, IL604404989) will be used to measure it. The patient will sit on a standard height chair with no armrest with his/ her forearm in a neutral position, and shoulder in adducted and neutral rotation, with elbow flexed 90 degrees (°). The patient will be requested to squeeze the ipsilateral hand on the hand grip dynamometer handle accordingly to the ordered verbs 'i.e., one, two, three, squeeze…harder, harder'. Three measures will be conducted with one minute a break in between, then the average will be recorded in value score.	1. At Baseline (Pre-procedure), 2. Post-treatment (Post 6 weeks of treatment program).
Pinch Grip Strength	The pinch gauge (FEI, White plains, NY 10602, USA) will be used to measure the pinch grip strength, it is a valid and reliable tool. The patient will sit on a standard height chair with no armrest with his/ her shoulder, elbow, forearm, and wrist in a neutral position. The patient will be requested to squeeze the thumb pad as firm as possible against the lateral aspect of index fingers' middle phalanx, while the examiner will hold the distal end of the pinch gauge. Three measures will be conducted with one minute a break in between, then the average will be recorded in a score value.	1. At Baseline (Pre-procedure), 2. Post-treatment (Post 6 weeks of treatment program).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chronic Myofascial Neck Pain Intensity assessment using Numerical Pain Rating Scale:	Numerical Pain Rating Scale will be used to assess chronic myofascial neck pain intensity, The patient will be in a relaxed position then will be given the appendix which contains numerical pain rating scale. It involves a 0-10 scale, where 0 represents "no pain" and 10 represents "the worst pain imaginable" The patient will be instructed to place a vertical mark on the line to indicate his/her pain.	1. At Baseline (Pre-procedure), 2. Post-treatment (Post 6 weeks of treatment program).
Pressure Pain Threshold using electronic pressure algometer	The electronic pressure algometer 'force one gauge model FDI' (Wagner instruments, Greenwash, CT, USA) will be used to measure it, it is a valid and reliable tool. Over trigger point recognized via jump sign clinically, a dial-style pressure algometry will be installed while a steady vertical pressure will be applied. When the patient reported only mild pain, the patient will be asked to raise hand to indicate it. Three measures will be conducted with one minute a break in between, then average will be recorded in value.	1. At Baseline (Pre-procedure), 2. Post-treatment (Post 6 weeks of treatment program).
Whole Upper Extremity Functional Level using Arabic-Q-DASH scale	The whole upper extremity functional level will be evaluated using Arabic-Q-DASH it is a valid and reliable tool. The Arabic-Q-DASH is like the original questionnaire. Items have a rating scale ranged from 1 to 5. The patient will be instructed to place a score that the examiner will transform it into a value between 0 and 100. The high score indicates better hand function outcomes with exception of pain, where high value indicates more intense pain score.	1. At Baseline (Pre-procedure), 2. Post-treatment (Post 6 weeks of treatment program).

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Sohair Shehata Rezkallah, Professor, Cairo University; Faculty of Physical Therapy

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: June 29, 2026
• First Submitted That Met QC Criteria: July 2, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 10, 2026
• Last Update Submitted That Met QC Criteria: July 8, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Hand Grip Strength; Trigger Points; Pressure Pain Threshold; Upper Trapezius; Pinch Grip Strength; Core Stability Exercise; Hand Held Dynamometer; Scapular Stabilization Exercises; Chronic Myofascial neck syndrome; Pressure Algometer; Diability of the Arm, Shoulder, and Hand Questionnaire (Arabic version), (Arabic-Q-DASH)
• Other Study ID Numbers: P.T.REC/012/006550

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