Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study

Ahmad H Alghadir, Zaheen A Iqbal, Ahmad H Alghadir, Zaheen A Iqbal

Abstract

Background: Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain.

Methods: This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment.

Results: Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback.

Conclusions: This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Copyright © 2021 Ahmad H. Alghadir and Zaheen A. Iqbal.

References

    1. Iqbal Z. A., Rajan R., Khan S. A., Alghadir A. H. Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain. Journal of Physical Therapy Science. 2013;25(6):657–661. doi: 10.1589/jpts.25.657.
    1. Ariens G. A., Bongers P. M., Douwes M., et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occupational and Environmental Medicine. 2001;58(3):200–207. doi: 10.1136/oem.58.3.200.
    1. Nikolovski D., Saric-Tanaskovic M. Risk factors and health condition of workers in school environment. Srpski arhiv za Celokupno Lekarstvo. 2006;134(Supplement 2):113–118. doi: 10.2298/SARH06S2113N.
    1. Fjellman-Wiklund A., Brulin C., Sundelin G. Physical and psychosocial work-related risk factors associated with neck-shoulder discomfort in male and female music teachers. Medical Problems of Performing Artists. 2003;18(1):33–41. doi: 10.21091/mppa.2003.1007.
    1. Cardoso J. P., Ribeiro I. D., Araújo T. M., Carvalho F. M., Reis E. J. Prevalence of musculoskeletal pain among teachers. Revista Brasileira de Epidemiologia. 2009;12:604–614.
    1. Bergqvist U., Wolgast E., Nilsson B., Voss M. Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors. Ergonomics. 1995;38(4):763–776. doi: 10.1080/00140139508925148.
    1. Hunting W., Laubli T., Grandjean E. Postural and visual loads at VDT workplaces. I. Constrained postures. Ergonomics. 1981;24(12):917–931. doi: 10.1080/00140138108924914.
    1. Sterling M., Jull G., Vicenzino B., Kenardy J., Darnell R. Development of motor system dysfunction following whiplash injury. Pain. 2003;103(1):65–73. doi: 10.1016/S0304-3959(02)00420-7.
    1. Harreby M., Neergaard K., Hesselsoe G., Kjer J. Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children. Spine (Phila Pa 1976) 1995;20(21):2298–2302. doi: 10.1097/00007632-199511000-00007.
    1. Kurumatani N., Iki M., Katagi K. A study on occupational cervicobrachial disorder (OCD) of nursery school teachers based on subjective symptoms related to OCD. Sangyo Igaku. 1984;26:389–396. doi: 10.1539/joh1959.26.389.
    1. Chiu T. T., Lam P. K. The prevalence of and risk factors for neck pain and upper limb pain among secondary school teachers in Hong Kong. Journal of Occupational Rehabilitation. 2007;17(1):19–32. doi: 10.1007/s10926-006-9046-z.
    1. Erick P. N., Smith D. R. The prevalence and risk factors for musculoskeletal disorders among school teachers in Botswana. Occupational Medicine & Health Affairs. 2014;2:1–13.
    1. Rizo A. M. H., Pascual-Vaca Á. O., Cabello M. A., Blanco C. R., Pozo F. P., Carrasco A. L. Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial. Journal of Manipulative and Physiological Therapeutics. 2012;35:446–453. doi: 10.1016/j.jmpt.2012.06.006.
    1. Griegel-Morris P., Larson K., Mueller-Klaus K., Oatis C. A. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical Therapy. 1992;72(6):425–431. doi: 10.1093/ptj/72.6.425.
    1. Nezamuddin M., Anwer S., Khan S. A., Equebal A. Efficacy of pressure-biofeedback guided deep cervical flexor training on neck pain and muscle performance in visual display terminal operators. Journal of Musculoskeletal Research. 2013;16(3, article 1350011) doi: 10.1142/S0218957713500115.
    1. Watson D. H., Trott P. H. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia. 1993;13(4):272–284. doi: 10.1046/j.1468-2982.1993.1304272.x.
    1. Yip C. H. T., Chiu T. T. W., Poon A. T. K. The relationship between head posture and severity and disability of patients with neck pain. Manual Therapy. 2008;13(2):148–154. doi: 10.1016/j.math.2006.11.002.
    1. Padrós E. Cómo cuantificar las funciones y la postura en la consulta de ortodoncia. Ortodoncia Clínica. 2004;7:174–204.
    1. De-La-Llave-Rincón A. I., Fernández-De-Las-PeÑas C., Palacios-CeÑa D., Cleland J. A. Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(9):658–664. doi: 10.2519/jospt.2009.3058.
    1. Silva A. G., Punt T. D., Sharples P., Vilas-Boas J. P., Johnson M. I. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons. Archives of Physical Medicine and Rehabilitation. 2009;90(4):669–674. doi: 10.1016/j.apmr.2008.10.018.
    1. Grimmer-Somers K., Milanese S., Louw Q. Measurement of cervical posture in the sagittal plane. Journal of Manipulative and Physiological Therapeutics. 2008;31(7):509–517. doi: 10.1016/j.jmpt.2008.08.005.
    1. Pilat A. Terapias Miofasciales: Inducción Miofascial. McGraw-Hill Interamericana de España; 2003.
    1. Sonnesen L., Bakke M., Solow B. Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment. The European Journal of Orthodontics. 2001;23(2):179–192. doi: 10.1093/ejo/23.2.179.
    1. Gandevia S. C., Phegan C. M. Perceptual distortions of the human body image produced by local anaesthesia, pain and cutaneous stimulation. The Journal of Physiology. 1999;514(2) Part 2:609–616. doi: 10.1111/j.1469-7793.1999.609ae.x.
    1. Grimmer K. A., Williams M. T., Gill T. K. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine (Phila Pa 1976) 1999;24(21):2262–2267. doi: 10.1097/00007632-199911010-00015.
    1. Painkra J. P., Kumar S., Anwer S., Kumar R., Nezamuddin M., Equebal A. Reliability of an assessment of deep neck flexor muscle endurance test: a cross-sectional study. International Journal of Therapy and Rehabilitation. 2014;21(5):227–231. doi: 10.12968/ijtr.2014.21.5.227.
    1. Mayoux-Benhamou M., Revel M., Vallee C., Roudier R., Barbet J., Bargy F. Longus colli has a postural function on cervical curvature. Surgical and Radiologic Anatomy. 1994;16(4):367–371. doi: 10.1007/BF01627655.
    1. Falla D., Jull G., Hodges P. W. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental Brain Research. 2004;157(1):43–48. doi: 10.1007/s00221-003-1814-9.
    1. Falla D. L., Jull G. A., Hodges P. W. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976) 2004;29(19):2108–2114. doi: 10.1097/01.brs.0000141170.89317.0e.
    1. Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy. 2004;9(3):125–133. doi: 10.1016/j.math.2004.05.003.
    1. Falla D., Jull G., Russell T., Vicenzino B., Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Physical Therapy. 2007;87(4):408–417. doi: 10.2522/ptj.20060009.
    1. Nezamuddin M., Khan S. A., Hameed U. A., Anwer S., Equebal A. Efficacy of pressure biofeedback guided deep cervical flexor training on forward head posture in visual display terminal operators. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal. 2013;7(4):p. 141. doi: 10.5958/j.0973-5674.7.4.138.
    1. Iqbal Z. A., Alghadir A. H., Anwer S. Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: a clinical trial. BioMed Research International. 2021;2021:6. doi: 10.1155/2021/7190808.7190808
    1. Jull G. A., O'Leary S. P., Falla D. L. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. Journal of Manipulative and Physiological Therapeutics. 2008;31(7):525–533. doi: 10.1016/j.jmpt.2008.08.003.
    1. Cleland J. A., Childs J. D., Whitman J. M. Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Archives of Physical Medicine and Rehabilitation. 2008;89(1):69–74. doi: 10.1016/j.apmr.2007.08.126.
    1. Braun B. L., Amundson L. R. Quantitative assessment of head and shoulder posture. Archives of Physical Medicine and Rehabilitation. 1989;70(4):322–329.
    1. Fernandez-de-Las-Penas C., Alonso-Blanco C., Cuadrado M., Pareja J. Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia. 2006;26(3):314–319. doi: 10.1111/j.1468-2982.2005.01042.x.
    1. Raine S., Twomey L. T. Head and shoulder posture variations in 160 asymptomatic women and men. Archives of Physical Medicine and Rehabilitation. 1997;78(11):1215–1223. doi: 10.1016/S0003-9993(97)90335-X.
    1. Kerry C. Reliability of measuring natural head posture using the craniovertebral angle. Irish Ergonomics Review. 2003;37
    1. Kendall F. P., EK M. C., Kendall H. O. Muscles, Testing and Function: Testing and Function. Lippincott Williams and Wilkins; 1983.
    1. Jull G., Barrett C., Magee R., Ho P. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia. 1999;19(3):179–185. doi: 10.1046/j.1468-2982.1999.1903179.x.
    1. Falla D., Jull G., Hodges P., Vicenzino B. An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain. Clinical Neurophysiology. 2006;117(4):828–837. doi: 10.1016/j.clinph.2005.12.025.
    1. Thorén P., Floras J. S., Hoffmann P., Seals D. R. Endorphins and exercise. Medicine & Science in Sports & Exercise. 1990;22(4):417–428. doi: 10.1249/00005768-199008000-00001.
    1. Hutton R. S., Atwater S. W. Acute and chronic adaptations of muscle proprioceptors in response to increased use. Sports Medicine. 1992;14(6):406–421. doi: 10.2165/00007256-199214060-00007.
    1. Osmotherly P., Attia J. The interplay of static and dynamic postural factors in neck pain. Hong Kong Physiotherapy Journal. 2008;26(1):9–17. doi: 10.1016/S1013-7025(09)70003-X.
    1. Lau M., Chiu T. T. W., Lam T.-H. Measurement of craniovertebral angle with electronic head posture instrument: criterion validity. Journal of Rehabilitation Research and Development. 2010;47(9):911–918. doi: 10.1682/JRRD.2010.01.0001.
    1. Strini P. J. S. A., de Godoi Machado N. A., Gorreri M. C., de Freitas Ferreira A., da Cunha Sousa G., Neto A. J. F. Postural evaluation of patients with temporomandibular disorders under use of occlusal splints. Journal of Applied Oral Science. 2009;17(5):539–543. doi: 10.1590/S1678-77572009000500033.
    1. Matheus R. A., de Moraes Ramos-Perez F. M., Menezes A. V., et al. The relationship between temporomandibular dysfunction and head and cervical posture. Journal of Applied Oral Science. 2009;17(3):204–208. doi: 10.1590/S1678-77572009000300014.
    1. Winstein C. J. Knowledge of results and motor learning—implications for physical therapy. Physical Therapy. 1991;71(2):140–149. doi: 10.1093/ptj/71.2.140.
    1. O'Sullivan S. B., Schmitz T. J., Fulk G. Physical Rehabilitation. FA Davis; 2013.
    1. Huang H., Wolf S. L., He J. Recent developments in biofeedback for neuromotor rehabilitation. Journal of Neuroengineering and Rehabilitation. 2006;3(1):p. 11. doi: 10.1186/1743-0003-3-11.
    1. Kluger A. N., DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. American Psychological Association; 1996.
    1. Ballantyne F., Fryer G., McLaughlin P. The effect of muscle energy technique on hamstring extensibility: the mechanism of altered flexibility. Journal of Osteopathic Medicine. 2003;6(2):59–63. doi: 10.1016/S1443-8461(03)80015-1.
    1. Boyd-Clark L., Briggs C., Galea M. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine (Phila Pa 1976) 2002;27(7):694–701. doi: 10.1097/00007632-200204010-00005.
    1. Jull G., Falla D., Treleaven J., Hodges P., Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. Journal of Orthopaedic Research. 2007;25(3):404–412. doi: 10.1002/jor.20220.
    1. Grant R., Jull G., Spencer T. Active stabilisation training for screen based keyboard operators - a single case study. Australian Journal of Physiotherapy. 1997;43(4):235–242. doi: 10.1016/S0004-9514(14)60412-8.
    1. Ylinen J., Ruuska J. Clinical use of neck isometric strength measurement in rehabilitation. Archives of Physical Medicine and Rehabilitation. 1994;75(4):465–469. doi: 10.1016/0003-9993(94)90173-2.
    1. Ono Y., Imaeda T., Shimaoka M., et al. Associations of length of employment and working conditions with neck, shoulder and arm pain among nursery school teachers. Industrial Health. 2002;40(2):149–158. doi: 10.2486/indhealth.40.149.
    1. Grimes P., Legg S. Musculoskeletal disorders (MSD) in school students as a risk factor for adult MSD: a review of the multiple factors affecting posture, comfort and health in classroom environments. Journal of the Human-Environment System. 2004;7(1):1–9. doi: 10.1618/jhes.7.1.
    1. Erick P. N., Smith D. R. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskeletal Disorders. 2011;12(1) doi: 10.1186/1471-2474-12-260.
    1. Chong E. Y., Chan A. H. Subjective health complaints of teachers from primary and secondary schools in Hong Kong. International Journal of Occupational Safety and Ergonomics. 2010;16(1):23–39. doi: 10.1080/10803548.2010.11076825.

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