Combination of Upper Extremity Proprioceptive Neuromuscular Facilitation and Scapular Stabilization in Nonspecific Chronic Neck Pain with Scapular Dyskinesia
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In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: PNF, Traditional neck pain treatment, Traditional neck pain treatment + Blackburn scapular stabilization exercises.
- Who it may be relevant to
- Registry conditions: Scapular Dyskinesis. Basic parameters: 18 years — 40 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Egypt
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
To study the combination of upper extremity PNF patterns and SS exercises on improving neck pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
Detailed description
Nonspecific chronic neck pain (NSCNP) affects between 10.4% and 21.3% of office and computer workers, making it one of the most prevalent disorders that physical therapists treat. It frequently has a significant impact on daily living and necessitates the utilization of several healthcare resources.
NSCNP caused by Various factors-such as female sex, older age, high job demands, low social/work support, ex-smoker status, and a history of lower back disorders. Among them, the working conditions of office workers cause postural misalignment in the neck and shoulder regions. Patients with nonspecific chronic neck pain display altered dynamic scapular stability during scapular orientation.
The scapular bone connects the neck and shoulder and plays a very important role in stabilizing the neck and shoulder complex. Helgadottir et al., 2011 reported that patients who suffer from neck pain have malfunctions, such as decreased clavicular retraction and upward rotation. The axioscapular muscles, including the trapezius, serratus anterior, rhomboid major and minor, and levator scapulae, are attached to the scapular bone and can attribute to movement of the neck and shoulder complex. Several studies demonstrated that tightness and weakness of the axioscapular muscles could induce scapular dyskinesia (SD), which refers to abnormal scapular position or movement. Rehabilitation of NSCNP is highly supported by physical therapy with evidence-based interventions. Massage and ischemic compression target the surrounding muscles. These techniques decrease tension build-up, which directly improves spasticity and hyper-tonicity. Scapular stabilization exercises proved to be very advantageous in rectification of mal alignment of the neck. The scapular stabilization (SS) helps to correct muscular imbalances and gives early insight for activating superficial cervical muscles to perform a normal range of motion (ROM) and restores clavicular retraction and normal symmetry of the cervical-scapular region.
However, (Sciascia \& Kibler, 2022) reported that the identified maneuvers were often performed in an isolated manner with the body in horizontal (prone or supine) stationary positions could lead to a less than optimal rehabilitation outcome likely due to these exercises focusing on strength and encouragement of inefficient or improper motor patterns. Finally, if strength shouldn't be the focus, then it is possible scapular dysfunction is more likely rooted in issues related to motor control.
Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation concept which is widely used by physiotherapists and described as a comprehensive rehabilitation concept, promoting motor learning, motor control, strength, and mobility. Upper extremity PNF patterns are often included in exercises thought to affect recruitment of the scapular muscles. These patterns improve both muscular strength and flexibility as well as utilize sensory cues such as cutaneous, visual, and auditory stimuli to improve neuromuscular control and function. Incorporation of Upper extremity PNF patterns into shoulder rehabilitation programs may also be effective in treatment of SD.
Up to the authors' knowledge, there are no empirical reports or randomized control trials that have compared a motor control focused program against a program that focuses on strength of scapular muscles. Therefore, the purpose of this study was to study the combined effect of upper extremity PNF patterns and SS exercises on pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
Interventions
- Other PNF
Upper extremity PNF exercise is an exercise method that dynamically stabilizes the scapula and affect scapular muscles activity (Witt et al., 2011). Upper extremity PNF patterns consisted of four diagonal patterns (D1 flexion, D2 flexion, D1 extension, and D2 extension) and six key components manual contact, body position, verbal cues pattern of movement, timing of movement and resistance. Patient will be at sitting position with involved side up, head, spine, and scapula in neutral - Other Traditional neck pain treatment
Cervical muscles stretch + Craniocervical retraction ex + Manual therapy - Other Traditional neck pain treatment + Blackburn scapular stabilization exercises
The patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). Blackburn exercises are one of the ways to treat scapular dyskinesia. Perform 2 sets of 20 repetitions of each exercise each session (3 sessions per week) for four weeks (panse et al .,2018). The exercise load will be 60% of the one-repetition maximum (1-RM) during the first week due to their first exposure to the exercises. The evaluation of one-repetition maximum (1-RM) will
Primary outcome measures
- scapular muscle strength [Time frame: up to 4 weeks]
- Assessment of scapular posture [Time frame: up to 4 weeks]
Eligibility criteria
Inclusion criteria
- 1- Have referred from orthopedic surgeon diagnosed with non specific chronic neck pain (NSCNP) that has been localized to the cervical and periscapular areas for at least three months.
2- Aged from 18-40 years. 3- Having a score more than 10 on the Neck disability index (NDI). 4- Having SD according to Kibler's description. 5- BMI from 18.5 to 29.9 kg/m2.
Exclusion criteria
- History of previous neck surgery.
- Recent or old fractures.
- Cognitive impairment and inability to understand the scale.
- Systematic inflammatory disease e.g., rheumatoid arthritis and ankylosing spondylitis, neck pain with radiculopathy or neuropathy.
- Scapular dyskinesia due to other pathology such as shoulder impingement.
- A score of below 10 or above 40 points out of 50 on the NDI.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Double blind
- Primary purpose
- Treatment
Study locations
Egypt · 1 center
- Faculty of physical therapy Cairo university — Giza
Identifiers
NCT: NCT06594809 · Upper extremity PNF and SD