Effect of Bruegger's Exercise in Chronic Mechanical Neck Pain With Forward Head Posture

Aktiv komparator: Core stability exercises

The participants will receive conventional core stability exercise for 12 sessions (3 sessions per week for four weeks).

Andet: Core stability exercise

The participants will be treated with conventional core stability exercise; Neck Stability Exercises-Free exercise for cervical spine, Neck isometric exercises (flexion, extension, lateral flexion, rotation), Wall angle exercises for lower trapezius, Chin tuck, Chin tuck into the towel

Eksperimentel: Bruegger's training and core stability exercises

will receive a program of Bruegger's training plus conventional core stability exercise for 4 weeks, 3 sessions per week, total 12 sessions, with about 30:45 minutes per session.

Andet: Core stability exercise

The participants will be treated with conventional core stability exercise; Neck Stability Exercises-Free exercise for cervical spine, Neck isometric exercises (flexion, extension, lateral flexion, rotation), Wall angle exercises for lower trapezius, Chin tuck, Chin tuck into the towel

Andet: Bruegger's training

Bruegger's Position of external arm rotation, shoulder abduction and retraction of the scapulae . This position with simultaneous head and neck retraction is a strengthening exercise for deep neck flexors and lower scapular stabilizers. The subjects are instructed to place their feet on the floor completely and keep their knee joints 10 ㎝ below the hip joints in 45° of abduction. The subjects sit hitting their ischial tuberosity on the chair and maintained their physiological curvature for the TL spine. Following external rotation of the glenohumeral joints, tension is relaxed with each inhalation, and depression and retraction of the shoulder girdle are performed with each exhalation.

Assessment of pain intensity

The numerical pain rating scale will be used to assess pain intensity. It is 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable.

Assessment of craniocervical angle (CVA)

The CVA will be evaluated with forward head posture (FHP) application on a Xiaomi® MiA2.

Two markers are placed on the ground separated by 1.5 m, where the camera or smart phone and the subject are located. Reference markers are placed on the spinous process of C7 and in the swallow of the subjects' ears, which were identified through palpation. The subject is placed on the floor mark, barefoot and standing, lateral to the evaluator.

The application provides the complement to the CVA, thus making further calculation necessary. To determine the CVA, it is necessary to subtract the angle provided by the application from 360°.

The presence of FHP will be determined by an angle value lower than 50°, and the absence of FHP if the angle value is greater than or equal to 50°

Assessment of craniocervical flexion endurance

Craniocervical flexion endurance test (CCFE test) will be used. The position of the participant is supine with cervical spine in the neutral position. The PBU is placed between the plinth and the posterior neck just below the occiput. The cuff is then inflated to a baseline of 20 mmHg. The participant was then asked to avoid head lift during CCFE test, thereby reducing the recruitment of superficial flexors.

Each participant will be asked to perform the neck flexion movement at five different pressure levels (22, 24, 26, 28, and 30 mmHg) with 10 s hold at each level and 30 s rest between each level.

The test is terminated if the subject is not able to hold the position of the neck for 10 s at a specific pressure level or if the maximum level of 30 mmHg is achieved.

Assessment of function disability

Arabic version of neck disability index will be used to assess function disability.

Questions include activities of daily living, such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each question is measured on a scale from 0(no disability) to 5, and an overall score out of 100 is calculated by adding each item score together and multiply in it by two. A higher NDI score means the greater a patient's perceived disability due to neck pain.