Efficacy of Deep Cervical Flexor Muscle Training on Neck Pain, Functional Disability, and Muscle Endurance in School Teachers: A Clinical Trial

Zaheen A Iqbal, Ahmad H Alghadir, Shahnawaz Anwer, Zaheen A Iqbal, Ahmad H Alghadir, Shahnawaz Anwer

Abstract

Background: Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP.

Methods: Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines.

Results: On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback.

Conclusions: Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).

Conflict of interest statement

The authors declare that they have no conflict of interest.

Copyright © 2021 Zaheen A. Iqbal et al.

References

    1. Cote P., Cassidy J. D., Carroll L. The Saskatchewan health and back pain survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998;23(15):1689–1698. doi: 10.1097/00007632-199808010-00015.
    1. Iqbal Z., Alghadir A. Prevalence of work-related musculoskeletal disorders among physical therapists. Medycyna Pracy. 2015;66(4):459–469. doi: 10.13075/mp.5893.00142.
    1. Keyserling W. M., Brouwer M., Silverstein B. A. A checklist for evaluating ergonomic risk factors resulting from awkward postures of the legs, trunk and neck. International Journal of Industrial Ergonomics. 1992;9(4):283–301. doi: 10.1016/0169-8141(92)90062-5.
    1. Eltayeb S., Staal J. B., Hassan A., De Bie R. A. Work related risk factors for neck, shoulder and arms complaints: a cohort study among Dutch computer office workers. Journal of Occupational Rehabilitation. 2009;19(4):315–322. doi: 10.1007/s10926-009-9196-x.
    1. van den Heuvel S. G., van der Beek A. J., Blatter B. M., Hoogendoorn W. E., Bongers P. M. Psychosocial work characteristics in relation to neck and upper limb symptoms. Pain. 2005;114(1):47–53. doi: 10.1016/j.pain.2004.12.008.
    1. Dellve L., Lagerström M., Hagberg M. Work-system risk factors for permanent work disability among home-care workers: a case-control study. International Archives of Occupational and Environmental Health. 2003;76(3):216–224. doi: 10.1007/s00420-002-0414-5.
    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. Chiu T., Ku W., Lee M., et al. A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong. Journal of Occupational Rehabilitation. 2002;12(2):77–91. doi: 10.1023/A:1015008513575.
    1. Korkmaz N. C., Cavlak U., Telci E. A. Musculoskeletal pain, associated risk factors and coping strategies in school teachers. Scientific Research and Essays. 2011;6(3):649–657. doi: 10.5897/SRE10.1064.
    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. Darwish M. A., Al-Zuhair S. Z. Musculoskeletal pain disorders among secondary school Saudi female teachers. Pain Research and Treatment. 2013;2013:7. doi: 10.1155/2013/878570.878570
    1. Durmus D., Ilhanli I. Are there work-related musculoskeletal problems among teachers in Samsun, Turkey? Journal of Back and Musculoskeletal Rehabilitation. 2012;25(1):5–12. doi: 10.3233/BMR-2012-0304.
    1. IJmker S., Blatter B. M., van der Beek A. J., van Mechelen W., Bongers P. M. Prospective research on musculoskeletal disorders in office workers (PROMO): study protocol. BMC Musculoskeletal Disorders. 2006;7(1) doi: 10.1186/1471-2474-7-55.
    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. Mayoux-Benhamou M. A., Revel M., Vallee C., Roudier R., Barbet J. P., 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. Cagnie B., Dickx N., Peeters I., et al. The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. Journal of Applied Physiology. 2008;104(1):230–235. doi: 10.1152/japplphysiol.00918.2007.
    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. Silverman J. L., Rodriquez A. A., Agre J. C. Quantitative cervical flexor strength in healthy subjects and in subjects with mechanical neck pain. Archives of Physical Medicine and Rehabilitation. 1991;72(9):679–681.
    1. Fernández-De-Las-Peñas C., Pérez-de-Heredia M., Molero-Sánchez A., Miangolarra-Page J. C. Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study. Journal of Orthopaedic & Sports Physical Therapy. 2007;37(2):33–39. doi: 10.2519/jospt.2007.2401.
    1. Subbarayalu A. V. Measurement of craniovertebral angle by the Modified Head Posture Spinal Curvature Instrument: a reliability and validity study. Physiotherapy Theory and Practice. 2016;32(2):144–152. doi: 10.3109/09593985.2015.1099172.
    1. Subbarayalu A. V., Ameer M. A. Relationships among head posture, pain intensity, disability and deep cervical flexor muscle performance in subjects with postural neck pain. Journal of Taibah University Medical Sciences. 2017;12(6):541–547. doi: 10.1016/j.jtumed.2017.07.001.
    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. 2013;7(4):p. 141. doi: 10.5958/j.0973-5674.7.4.138.
    1. Hünting W., Grandjean T. L. E. Postural and visual loads at VDT workplaces. I. Constrained postures. Ergonomics. 2007;24(12):917–931. doi: 10.1080/00140138108924914.
    1. Conley M. S., Meyer R. A., Bloomberg J. J., Feeback D. L., Dudley G. A. Noninvasive analysis of human neck muscle function. Spine. 1995;20(23):2505–2512. doi: 10.1097/00007632-199512000-00009.
    1. Jull G., Trott P., Potter H., et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835–1843. doi: 10.1097/00007632-200209010-00004. discussion 1843.
    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. 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. Wing Chiu T. T., Hung Law E. Y., Fai Chiu T. H. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. Journal of Orthopaedic & Sports Physical Therapy. 2005;35(9):567–571. doi: 10.2519/jospt.2005.35.9.567.
    1. Grant R., Jull G., Spencer T. Active stabilisation training for screen based keyboard operators - a single case study. The Australian Journal of Physiotherapy. 1997;43(4):235–242. doi: 10.1016/S0004-9514(14)60412-8.
    1. Sikka I., Chawla C., Seth S., Alghadir A. H., Khan M. Effects of deep cervical flexor training on forward head posture, neck pain, and functional status in adolescents using computer regularly. BioMed Research International. 2020;2020:7. doi: 10.1155/2020/8327565.
    1. Vernon H., Mior S. The neck disability index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 1991;14(7):409–415.
    1. Taylor D., Fryer G., McLaughlin P. The effect of cervical spine isometric contract-relax technique on hamstring extensibility. Australas Chiropr Osteopathy. 2003;11(1):21–26.
    1. O’Leary S., Falla D., Jull G., Vicenzino B. Muscle specificity in tests of cervical flexor muscle performance. Journal of Electromyography and Kinesiology. 2007;17(1):35–40. doi: 10.1016/j.jelekin.2005.10.006.
    1. Duchateau J., Semmler J. G., Enoka R. M. Training adaptations in the behavior of human motor units. Journal of Applied Physiology. 2006;101(6):1766–1775. doi: 10.1152/japplphysiol.00543.2006.
    1. Spence S. H., Sharpe L., Newton-John T., Champion D. Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders. Pain. 1995;63(2):199–206. doi: 10.1016/0304-3959(95)00047-V.
    1. Jull G., Kristjansson E., Dall’Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Manual Therapy. 2004;9(2):89–94. doi: 10.1016/S1356-689X(03)00086-9.
    1. Hakala P. T., Rimpela A. H., Saarni L. A., Salminen J. J. Frequent computer-related activities increase the risk of neck-shoulder and low back pain in adolescents. European Journal of Public Health. 2006;16(5):536–541. doi: 10.1093/eurpub/ckl025.
    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.

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