Effect of Sensory Motor Training for Neck Muscles on Hand Grip Strength in Post-menopausal Fibromyalgia Neck Pain.

Aktivní komparátor: Neuro dynamic nerve gliding exercises

The participants will receive neuro dynamic nerve gliding exercises in the form of median, radial and ulnar nerve gliding exercises for 50 minutes/session.

Jiný: Neuro dynamic nerve gliding exercises

The participants will receive neuro dynamic nerve gliding exercises in the form of median, radial and ulnar nerve gliding exercises for 50 minutes/session (for 15 repetitions, each repetition held for 1-2 minutes with 30 seconds rest intervals between each repetition)

Experimentální: Sensory motor neck training and neuro dynamic nerve gliding exercises

The participants will receive sensory motor neck training using laser pointer technique for 15 minutes/session, 3 times/week for four weeks in addition to neuro dynamic nerve gliding exercises in the form of median, radial and ulnar nerve gliding exercises for 50 minutes/session.

Jiný: Neuro dynamic nerve gliding exercises

The participants will receive neuro dynamic nerve gliding exercises in the form of median, radial and ulnar nerve gliding exercises for 50 minutes/session (for 15 repetitions, each repetition held for 1-2 minutes with 30 seconds rest intervals between each repetition)

Jiný: Sensory motor neck training

The participants will perform sensory motor neck training by using laser pointer exercise for 15 minutes/session, 3times/ week for four weeks.

• The laser pointer exercise will be positioned exactly in the center of the participants' forehead and parallel to the ground.
• Each participant will assume sitting position on comfortable chair at 90cm (about 3 feet) away from the target board (circles shapes), their knees and hips at 90°, their pelvis and low back resting firmly against the back of a chair and their hands resting on their knees.
• Therapist will be behind the patient and will give her instructions.
• Align the laser so that it will point straight at the center of the target when the head is in a neutral position
• at 90 cm away from the target board.
• The patient will move the head (flexion/extension/rotation), then attempts to return to the starting position
• Five repetitions will be performed for each movement direction

Assessment of hand grip strength

The hand-held dynamometer (Hoggan Health Industries, Salt Lake City, USA) is an enclosed hydraulic system recording the applied strength in kilograms.

Hand grip strength will be measured for all participants in both groups before and after the end of the study.

Each participant in both groups will be asked to place hand-held dynamometer in her hand, with her arm beside the trunk, the shoulder in a neutral position, the elbow flexed at 90° and to pull the metal bar with her fingers. This procedure will be conducted bilaterally. The mean of three trials for each side (with 3 min resting periods between repetitions to avoid fatigue) will be calculated

Assessment of Disability of the Arm, Shoulder and Hand (DASH)

This 30-item tool evaluates symptoms along with physical function, specifically focusing on the level of disability, and offers five response options for each item. Each item offers five response options, spanning from 1, indicating "no difficulty or symptoms present," to 5, indicating "incapable of participating in an activity or experiencing very severe symptoms." Greater score on the DASH indicates increased levels of disability.

The DASH score is used to assess upper limb disability, with higher scores indicating greater impairment. A score of 0 reflects no disability, 1-20 indicates mild disability, 21-40 is moderate, 41-60 is severe, and 61-100 represents very severe disability.

Assessment of neck pressure pain threshold

The force dial FDK 20 algometer is a handheld device used to assess the pressure pain threshold (PPT), which is the minimum amount of pressure that induces a sensation of pain. It provides an objective measure of mechanical pain sensitivity in neck.

Each participant will be asked to assume upright position with feet flat, arms relaxed, and neck in a neutral position.

Pressure will be applied perpendicularly to the site of pain at a constant rate of 1 kg/cm² per second.

Each participant will be instructed to indicate when the sensation changed from pressure to the first feeling of pain.

Three readings will be taken at each site with 30-60 seconds rest between trials, and the average will be recorded as the final PPT value

Assessment of pain intensity

The visual analogue scale will be used to assess pain intensity. It is a subjective method to determine pain intensity. The scale consists of a 10-centimeter horizontal line, with the left end marked as "no pain" (0) and the right end marked as "worst possible pain" (10).