Do Oculomotor Exercises Added to Classical Physiotherapy Contribute to Pain Intensity, Range of Motion, Activation of Deep Flexor Muscle and Function in Participants with Chronic Neck Pain?

Abstract

Purpose: This study was carried out to compare the effects of oculomotor exercises (OE) combined with a classical physiotherapy (CF) program on pain intensity, range of motion (ROM), activation of deep cervical flexor (DCF) muscles and function in patients with chronic neck pain. Methods: A total of 48 patients were equally randomized into two groups to receive CF+OE or CF. The protocol was applied for three days in a week for a total of 8 weeks with complete 24 sessions. Numeric Pain Scale used for neck pain intensity, an inclinometer for cervical ROM, biofeedback pressure unit for activation of DCF and Neck Disability Index for evaluating function. Results: Both groups experienced a significant decrease in neck pain intensity (p<0.001) with similarity (p>0.05). A significant increase was observed in ROM values in all directions in both groups (p<0.05), difference between the groups was found in favor of CF+OE group (p<0.05). A significant increase was observed in the activation of DCF muscles and function (p<0.001) in both groups. The activation of the DCF (p<0.001) and function (p=0.020) in CF+OE group was identified to be higher than the CF. OE and CF were found to be effective in the improvement of clinical symptoms in patients with chronic neck pain. Conclusion: OE added to CF can be chosen for patients with limitation in rotational direction hence it increases activation of DCF due to its proprioceptive training content, and produces more effective results on function.

Keywords

• Neck pain
• Exercise
• Range of motion

Kronik boyun ağrılı bireylerde klasik fizyoterapiye eklenen okulomotor egzersizler ağrı şiddeti, eklem hareketi, derin fleksör kas aktivasyonu ve fonksiyonellik üzerine ilave katkı sağlar mı?

Abstract

Amaç: Bu çalışma, kronik boyun ağrısı (KBA) olan bireylerde klasik fizyoterapi (KF) programı ile okülomotor egzersizlerin (OE) ağrı şiddeti, eklem hareket açıklığı (EHA), derin servikal fleksör (DSF) kaslarının aktivasyonu ve fonksiyon üzerine etkilerini karşılaştırmak amacıyla gerçekleştirildi. Yöntem: 48 KBA’lı birey KF ve KF+OE olmak üzere iki gruba randomize edildi. Bireylere, 8 hafta boyunca haftada üç gün, 24 seans uygulandı. Numerik Ağrı Skalası ile boyun ağrısı şiddeti, inklinometre ile servikal EHA, biyofeedback basınç ünitesi ile DSF kasların aktivasyonu ve Boyun Özürlülük İndeksi ile fonksiyon değerlendirildi. Bulgular: Her iki grupta da boyun ağrısı şiddetinde anlamlı azalma elde edildi (p<0,05). Bu azalma gruplar arasında benzerdi (p>0,05). Her iki grupta tüm EHA yönlerinde anlamlı artış görüldü (p<0,05). Gruplar arası fark KF+OE grubu lehine bulundu (p<0,05). Her iki grupta da DSF kasların aktivasyonunda ve fonksiyonellikte anlamlı artış gözlendi (p<0,001). KF+OE grubunda DSF aktivasyonu (p<0,001) ve fonksiyonellik (p<0,020) KF'ye göre daha yüksek olduğu görüldü. KBA’lı bireylerde klinik semptomların iyileşmesinde OE ve KF'nin etkili olduğu bulundu. Sonuç: Klasik fizyoterapiye eklenen OE’nin rotasyonel yöndeki hareket kısıtlılıkları belirgin olan hastalarda tercih edilebileceği, proprioseptif eğitim içerikli olması nedeniyle derindeki kasların aktivasyonunu arttırabileceği kronik boyun ağrılı hastalarda fonksiyonellik üzerinde daha etkin sonuçlar oluşturduğu sonucuna varıldı.

Keywords

• Boyun ağrısı
• Egzersiz
• Eklem hareket açıklığı

References

1. Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:39-51.
2. Childs JD, Cleland JA, Elliott JM, et.al. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38: A1-34.
3. Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991;72:288-291.
4. McPartland JM, Brodeur RR, Hallgren RC. Chronic neck pain, standing balance, and suboccipital muscle atrophy–a pilot study. J Manipulative Physiol Ther. 1997;20:24-29.
5. McPartland, JM, Brodeur RR. Rectus capitis posterior minor: a small but important suboccipital muscle. J Bodyw Mov Ther. 1999;3:30-35.
6. Southerst D, Nordin MC, Cote P, et. al. Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. 2016;16:1503-1523.
7. Revel M, Minguet M, Gergoy P, et. al Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil. 1994;75:895-899.
8. Humphreys BK, Irgens PM. The effect of a rehabilitation exercise program on head repositioning accuracy and reported levels of pain in chronic neck pain subjects. Journal of Whiplash & Related Disorders. 2002;1:99-112.

9. Tariq M, Sarfraz N, Gilani H. Comparative efficacy of isometric exercises and active range of motion exercises in mechanical neck pain of female sewing machine operators. Isra Medical Journal. 2018;10:301-305.
10. Kanık, EA, Taşdelen B, Erdoğan S. Randomization in clinical trials. Marmara Medical Journal. 2011;24:149-155.
11. Sayin YY, Akyolcu N. Comparison of pain scale preferences and pain intensity according to pain scales among Turkish Patients: a descriptive study. Pain Manag Nurs. 2014;15:156-164.
12. Williams MA, McCarthy CJ, Chorti A, et. al. A systematic review of reliability and validity studies of methods for measuring active and passive cervical range of motion. J Manipulative Physiol Ther. 2010;33:138-155.
13. Fabrication Enterprises [Internet]. [a.yer 08 September 2022]. Baseline Bubble Inclinometer. Retrieved from: https://www.fab-ent.com/evaluation/range-of-motion- evaluation-7495/baseline-bubble-inclinometer/
14. Bergmann TF, Peterson DH. Chiropractic Technique – E-Book. Elsevier Health Sciences, 2010.
15. Bush KW, Collins N, Portman L, et al. Validity and intertester reliability of cervical range of motion using inclinometer measurements. J Man Manip Ther. 2000;8:52-61.
16. Jull GA, O’Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008;31:525-533.
17. ManualsLib [Internet]. [a.yer 08 September 2022]. Chattanooga Group Stabilizer Operating Instructions Manual Pdf Download. Available from:https://www.manualslib.com/manual/1215120/Chattanooga-Group-Stabilizer.html
18. Hudswell S, Von Mengersen M, Lucas N. The cranio-cervical flexion test using pressure biofeedback: A useful measure of cervical dysfunction in the clinical setting? Int J Osteopath Med. 2005;8:98-105.
19. Aslan E, Karaduman A, Yakut Y, et. al. The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study. Spine. 2008;33:362-365.
20. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14:409-415.
21. Dusunceli Y, Ozturk C, Atamaz F, et. al. Efficacy of neck randomized on exercises for neck pain: a randomized controlled study. J Rehabil Med. 2009;41:626-631.
22. Benjaboonyanupap D, Paungmali A, Pirunsan U. Effect of therapeutic sequence of hot pack and ultrasound on physiological response over trigger point of upper trapezius. Asian J Sports Med. 2015;6:e23806.
23. Bakar Y, Sertel M, Oztürk A, et. al. Short term effects of classic massage compared to connective tissue massage on pressure pain threshold and muscle relaxation response in women with chronic neck pain: a preliminary study. J Manipulative Physiol Ther. 2014;37:415-421.
24. Morimoto H, Asai Y, Johnson EG, et al. Effect of oculo-motor and gaze stability exercises on postural stability and dynamic visual acuity in healthy young adults. Gait Posture. 2011;33:600-603.
25. Louw S, Makwela S, Manas L, et. al. Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis. South Afr J Physiother. 2017;73:392.
26. De Campos TF, Maher CG, Steffens D, et. al. Exercise programmes may be effective in preventing a new episode of neck pain: a systematic review and meta- analysis. J Physiother. 2018;64:159-165.
27. Lee H, Nicholson LL, Adams RD. Cervical range of motion associations with subclinical neck pain. Spine. 2004;29:33-40.
28. Pérez-Cabezas, V, Ruiz-Molinero C, Jimenez-Rejano, et al Effectiveness of an eye-cervical Re-education program in chronic neck pain: a randomized clinical trial. Evid Based Complement Alternat Med. 2020:2760413.
29. Javanshir K, Mohseni-Bandpei MA, Rezasoltani A, et al. Ultrasonography of longus colli muscle: A reliability study on healthy subjects and patients with chronic neck pain. J Bodyw Mov Ther. 2011;15:50-56.
30. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29:2108-2114.
31. Falla D, Farina D, Kanstrup Dahl M. Pain-induced changes in cervical muscle activation do not affect muscle fatigability during sustained isometric contraction. J Electromyogr Kinesiol Off J Int Soc Electrophysiol Kinesiol. 2008;18:938-946.
32. Gallego Izquierdo T, Pecos-Martin D, Lluch Girbés E, et al. Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial. J Rehabil Med. 2016;48:48-55.
33. Sayilir, S. The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain. Complement Ther Clin Prac. 2018;31:278-281.