Efficacy of Neck Stabilization and Postural Correction Exercise on Pain, Posture, Disability, Respiratory Dysfuntions and Mental Status in Desk Job Workers – A Randomised Controlled Double Blinded Study

 

Rajalaxmi. V^1*, V. K. Madhu Ranjani², Jibi Paul³, S. S. Subramanian⁴, Bernard Ebenezer Cyrus⁵, V. Pavithralochani⁶

¹Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India.

²Internee, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University,

Velappanchavadi, Chennai - 600 077, Tamil Nadu, India

³Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University,

pallikaranai, Chennai - 600 077, Tamil Nadu, India.

⁴Sri Balaji College of Physiotherapy, Bharath University, Pallikaranai, Chennai.

^5,6Assistant Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India.

 

ABSTRACT:

Objective: The study aims to analyse and compare the efficacy of neck stabilization exercise and postural correction exercise over conventional exercises on pain, disability, posture, Respiratory dysfunction in desk job workers with neck pain. Background of The Study: Neck pain is a common disorder mainly caused by awkward posture, tightness in both the neck and upper back muscles and prolonged sitting while using computers, twisting and bending of the trunk. Rounded shoulder is a condition characterized by protracted shoulder girdle from its normal. Imbalance between agonist and antagonist results in muscle imbalance affecting the cervical curvature resulting in pain. Materials and Methods: Once the study is approved by Institutional Review Board Ref no: IV C – 018 / PHYSIO / IRB /2017-2018 50 samples were selected from 60 volunteers based on the inclusion criteria. The study was conducted is the outpatient department of physiotherapy & took nearly 3months (Jan 2018 – May 2018) to complete the study.. Group A received Neck Stabilization exercise and postural correction exercise with deep breathing exercise. Group B received stretch and strengthening exercise with deep breathing exercise. Pre and post-test measured with NDI-Neck disability index, CSBQ-Cervical Spine Bournemouth Questionnaire, SEBQ-Self-Evaluation Breathing Questionnaire, DST-Double square test. Result: On comparing Pre-test and Post-test within Group A and Group B on Double Square Test(Right and Left), Neck Disability Index, Cervical Spine Bournemouth Questionnaire, Self-Evaluation of Breathing Questionnaire shows significant decrease in the post test Mean values but Group A which has the Lower Mean value is more effective than Group B at P ≤ 0.001.

 

 

 

 

 

INTRODUCTION:

Neck pain is the most common problem with a reported prevalence ranging from 22%to 30% [1]. 43%of population reported neck pain more in women than men [2]. Most of the desk job workers are affected by neck pain; because of prolong sitting and bending the neck, upper back, protracted shoulders. Neck pain may be associated with postural abnormality such as forward head, rounder shoulder, and loss of stabilization. Sometimes pain in the neck worsens with movement of the neck or turning the head, which also cause migraine.

 

The forward protraction of neck and shoulder. This anterior, or forward, position of the neck puts a huge amount of extra stress on the muscles of the shoulders and neck causing them to become overloaded, tight and painful. Some of the nerves and blood vessels that supply the arm exit the neck by passing through the neck muscles, under the clavicle (collar bone), under the Pec (chest) muscles, through the arm pit and into the arm. The muscles that are predominantly affected by poor sitting posture. Research has indicated that 41% of people sleep in the foetal position. This posture, however, isn’t optimal in maintaining correct spinal alignment. Posture has been defined as the alignment of the body segments at a particular time. Neck pain may be spread out over the back, neck, elbow pain. Neck muscle scalene muscles, sub occipital muscle, pectoralis muscle, sub scapulae becomes tight when these muscles are affected it leads to poor posture and resulting in loss of neck stabilization can occur (3).

 

Rounded shoulder posture is when the scapulae are abducted and the acromion process is anterior to the vertical postural line. Exercise programs for managing neck pain differ with regard to duration and mode of exercises [4]. Neck stabilization exercise and postural correction exercise are given to the patients to correct the posture and increases the stabilization and reduce the pain. Neck posture and forward shoulder posture is analysed using double square scale. A review of literature revealed no definitive, evidence-based method of measuring shoulder posture (5) investigated the validity and reliability of 4method of measuring forward shoulder posture. The double square method used in this study had high intrarater reliability, but several variable still exist (6).

 

Measurements were taken at baseline and after the 12 month intervention period. Neck and upper limb pain during the previous week were assessed by VAS and NDI (7). The NDI has a fair to moderate test-retest reliability in patients with mechanical neck pain but also for patients with cervical radiculopathy (8). Although intra class correlations can change between 0.50 and 0.98. These differences may occur because some studies do not separate chronic or acute neck pain or due to the fact that the study only used patients with acute neck pain. The Neck Disability Index (NDI) is a 10-item questionnaire that measures a patient’s self-reported neck pain related disability. It was the first of its kind when it was published in 1991 in JMPT and was based on the Oswestry Low Back Pain Disability Questionnaire. The NDI was reviewed in 2008 by the same author. The NDI is the most widely used, translated and oldest questionnaire for neck pain. It has been shown to have high “test-retest” reliability. (9)

 

The NDI has also been shown to be valid when comparing it to other pain and disability measures. 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 multiplying it by two. A higher NDI score means the greater a patient’s perceived disability due to neck pain. The “minimally clinically important change” by patients has been found to be 5 or 10% (10).

 

Cervical Spine Bournemouth questionnaire is used to analyse the cervical spine. Cervical Spine Bournemouth questionnaire reliability Interrater and intrarater reliability analysis were performed in order to evaluate the reproducibility of the questionnaire. Brazil-NBQ was applied by a researcher and, after 1 hr, it was applied by a second researcher (interrater). In a period of three to seven days, the first researcher applied once again the questionnaire (intrarater). Furthermore, internal consistency was evaluated, which appreciates the interrelation of different topics or domains of a tool, measuring the homogeneity of the related topics. Validation validity analysis was performed through association among Brazil-NBQ and other questionnaires that measure pain, quality of live and function. The Short Form b36 topics divided into eight domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. The correlation among Brazil-NBQ topics and their domains was based on validity process of NBQ original version. (30) Neck disability NDI, Neck Bournemouth questionnaire NBQ in patients with chronic uncomplicated neck pain. Score of NDI was 6.22and the NBQ, 14.00[11.99] (11).

 

Prevalence in the world ranges from 16.7% to 75.1%. Life time prevalence women reported more neck pain than men. For 1year prevalence Scandinavian countries reported more neck pain than the rest of Europe and Asia. Total cost of neck pain. In the Netherland in 1996 was estimated to about 1% of the total health care expenditure or 0.1% of the Dutch gross domestic product. [12].

 

The prevalence of neck pain was 20.3% which is similar to reported in studies from southern brazil 24.01% (20) 2011. spain 19.5% (Fernandez –de- las- panes.c et al)  spine (14) 2011Greece 20.4%. These number are lower than those found in china 48.7%. Srilanka 56.9% (18) and higher than those found in the U.S 44% (Strine T.W, Hootmanj. m 2007).1.7% of subjects reported neck pain with predominance in women (2.1%) than men (0.7%). A Higher prevalence of neck pain (6.8%) was reported by (Joshi et al)2009 among the rural population in India. (13)

 

MATERIALS AND METHODS:

Once the study is approved by Institutional Review Board Ref no: IV C – 018 / PHYSIO / IRB /2017-2018 50 samples were selected from 60 volunteers based on the inclusion criteria. The study was conducted is the outpatient department of physiotherapy & took nearly 3months (Jan 2018 – May 2018) to complete the study. Inclusion criteria rounded shoulders, abnormal posture, neck pain, upper cross syndrome, respiratory dysfunction. Exclusion criteria osteomyelitis, non co - operative samples, High BP, cardiac disorder, recent spinal injury. They were then assigned to two equal groups by lottery method, 50 chits were drawn where odd no: will be categorized as group A and even in group B where each groups has 25 participants.

 

The patients were fully explained about the study and asked to fill the consent form in acceptance to participate in the study which was duly signed by the participant and the researched. They were also given a detailed explanation about the questionnaire and benefits and answering them. Initial screening was done after obtaining basic demographic data’s like age, sex, height and weight assuring confidentiality. The outcome measure used to assess neck disability and forward shoulder. Group A received Neck Stabilization exercise and postural correction exercise with deep breathing exercise (i.e) Chin tuck, chin tuck with towel, Cervical flexion and extension exercise, side bending right and left, cervical brace in quadruped with arm raise, press forehead in palm, shoulder blade squeeze, shoulder shrugs, prone cobra and deep breathing exercise.

 

GROUP B received stretch and strengthening exercise (i.e) chest stretch, lateral stretch, upper trapezius stretch, levator scapular stretch, door way stretch, wall push up, clasp hands behind head press, neck rotation and deep breathing exercise.

 

30 min per session and 1 session/day, for 5 days / week, for 8 weeks. Pre and post-test measured with NDI-Neck disability index, CSBQ-Cervical Spine Bournemouth Questionnaire, SEBQ-Self-Evaluation Breathing Questionnaire, DST-Double square test.

 

OUTCOME MEASURES:

Questionnaire and SCALE: NDI- Neck disability index, Cervical Spine Bourne mouth, Self-Evaluation Breathing.  Double Square test to measure shoulder posture.

 

NDI Neck disability index is a 10 – item questionnaire that measure a patient’s self – reported neck pain related disability. It was the first of its kind when it was published in 1991 in JMPT and was based on the oswestry low back pain disability questionnaire. The NDI was reviewed in 2008 by the same author. 0-4points (0-8%) no disability, 5-14points (10 – 28%) mild disability, 15-24points (30-48%) moderate disability, 25-34points (50- 64%) severe disability,35-50points (70-100%) complete disability

 

Double Square Test: The double square (Model #420EM, Johnson Level and Tool Manufacturing, Inc, Mequon, Wisc) was used to quantify forward shoulder posture. (5)The double square consists of a 40-cm combination square with a second square/level added in an inverted position. (4)

 

Cervical Spine Bournmouth is a short, self –report questionnaire, developed by J. BOLTON. It was developed to assess pain in patients suffering from nonspecific neck pain. Bolton et al 2004 indicates that an improvement of 13 points on the total score or percentage changes score of 36%was associated with clinically significant improvement.

 

Self Evaluation Breathing is use to analyse the respiratory dysfunction. The score is above 11 the patient have respiratory dysfunction.

 

DATA ANALYSIS:

The collected data were tabulated and analyzed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24. Paired t-test was adopted to find the statistical difference within the groups and Independent t-test (Student t-Test) was adopted to find the statistical difference between the groups.

 

 

TABLE-1. Comparison of Double Square Test (Right) between Group – A and Group - B in Pre and Post Test

 

TABLE-2 Comparison of Double Square Test (Left) between Group – A and Group - B in Pre and Post Test

 

TABLE – 3 Comparison of Neck Disability Index(NDI) between group – A and group - B in pre and post test

 

TABLE – 4 Comparison of Cervical Spine - Bournemouth Questionnaire Between Group – A and Group - B in Pre and Post Test

 

TABLE – 5 Comparison of Self Evaluation of Breathing Questionnaire Between Group – A and Group - B in Pre and Post Test

 

TABLE – 6 Comparison of DST, NDI, CSBQ and SEBQ within group – A Between PRE and Post test values

 

TABLE – 7 Comparison Of DST, NDI, CSBQ and SEBQ within Group – B between PRE and POST Test values

 

RESULTS:

On comparing the Mean values of Group A and Group B on Double Square Test (Right) Score, it shows significant decrease in the post test Mean values but Group A shows 11.84 which has the Lower Mean value is more effective than Group B 12.30atP ≤ 0.001. Hence Null Hypothesis is rejected.

 

On comparing the Mean values of Group A and Group B on Double Square Test (Left) Score, it shows significant decrease in the post test Mean values but Group A shows 12.30 which has the Lower Mean value is more effective than Group B 13.66 at P ≤ 0.001. Hence Null Hypothesis is rejected.

 

On comparing the Mean values of Group A and Group B on Neck Disability Index (NDI) Score, it shows significant decrease in the post test Mean values but Group A shows 27.56 which has the Lower Mean value is more effective than Group B 47.40atP ≤ 0.001. Hence Null Hypothesis is rejected.

 

On comparing the Mean values of Group A and Group B on Cervical Spine Bournemouth Questionnaire Score, it shows significant decrease in the post test Mean values but Group A shows 28.80 which has the Lower Mean value is more effective than Group B 47.40atP ≤ 0.001. Hence Null Hypothesis is rejected.

 

On comparing the Mean values of Group A and Group B on Self Evaluation of Breathing Questionnaire Score, it shows significant decrease in the post test Mean values but Group A shows 8.96 which has the Lower Mean value is more effective than Group B 10.40 at P ≤ 0.001. Hence Null Hypothesis is rejected.

 

On comparing Pre-test and Post-test within Group A and Group B on Double Square Test (Right and Left), Neck Disability Index, Cervical Spine Bournemouth Questionnaire, Self Evaluation of Breathing Questionnaire shows highly significant difference in Mean values at P ≤ 0.001

 

DISCUSSION:

From this study we found statistical significant difference in neck stabilization, postural correction and stretch and strengthening exercise to decrease in neck pain and forward shoulder patient (or) upper cross syndrome. The comparison has been done on the neck stabilization, postural correction with deep breathing exercise and stretch and strengthening exercise with deep breathing exercise for the duration of 2 months.

 

The samples are divided into two groups name A and B. Two groups treated with two different exercises. The results of the study statistically indicated that the described data’s such as mean and standard deviation values.

 

Comparison of Double Square Test (DST) in right and left shoulder between group A and B. The table 1 and 2 shows that statistically highly significant difference in post-test values of the DST between group A shows 11.84 and group B12.30 at P ≤ 0.001. Comparison of Neck Disability Index (NDI) between group A and B. The table 3 shows the highly significant difference in post-test value of the NDI between group A shows 27.56 and B 47.40atP ≤ 0.001.

 

Comparison of Cervical Spine-Bournemouth Questionnaire between group A and B. The table-4 shows that statistically highly significant difference in post-test values of the Bournemouth Questionnaire between group A shows 28.80 and B 47.40 at P ≤ 0.001

 

Comparison of Self-Evaluation of Breathing Questionnaire between groups–A and B. The table -5 shows that statistically highly significant difference in post-test values of the Self-Evaluation of Breathing Questionnaire between group A shows 8.96 and B 10.40 at P ≤ 0.001^(GRAPH-V). The table – 6 reveals of the Mean, Standard Deviation (S.D), t-value and p-value of the DST, NDI, CSBQ, and SEBQ between pre and post-test values within group-A. It shows that there is a statistically highly significant difference between the pre-test and post-test values within group A (-P 0.001)

The table – 7 reveals of the Mean, Standard Deviation (S.D), t-value and p-value of the DST, NDI, CSBQ, and SEBQ between pre and post-test values within group-B. It shows the that there is a statistically highly significant difference between the pre-test and post-test values within group B (-P 0.001)

 

 

Jull G [et al] in 2002.Randomized controlled study showing exercise therapy to be effective in case of headache. Yesim Dusunceli [et al] 2009 Efficacy of neck stabilization exercise for neck Pain: A randomized controlled study. He showed the stabilization exercise is more effective than other groups. Barton and Hayes (et al) 50% lower maximal neck flexor muscle strength in patients with unilateral neck pain and headache compared with healthy controls. In conclusion, stabilization and postural correction exercise, when accompanied with deep breathing exercise, were showed to be an effective treatment for neck pain and poor shoulder posture in desk job. The study shows that the positive effect in result of exercise therapy is relieving the pain in neck associated with forward shoulders.⁽¹⁴⁾

 

In this study the result shows that the statistically highly significance in post test Mean but (Group-A) which has the lower mean value is more effective than (Group-B).The study concluded that the Yoga is more effective than the Pilates and Tai chi and Control Group exercise for chronic mechanical neck pain while Pilates, Tai chi and control Group exercise even showed a considerable decrease in symptoms when comparing the post-test mean values¹⁵. The study concluded that the postural alignment achieved from schroth method is better than that achieved by yoga¹⁶. Almost all the studies showed that there was a significant difference between the endurance training group and the other intervention group in improving the neck functional abilities and in reducing the neck pain¹⁷. On comparing the prevalence of musculoskeletal problems among desk job workers, the collected data shows that the prevalence of neck pain with 47 % and shoulder pain with 28% is more than the other sites like lower back, upper back, elbow, knee, leg and ankle¹⁸.

 

CONCLUSION:

The study concluded that samples in groups A neck stabilization and postural correction showed better significance than group B stretch and strengthening exercise in reducing pain and disability and improving posture and breathing patterns.

 

LIMITATIONS OF THE STUDY:

Small sample size, Study was performed only for age group 25-40, Study was performed only for desk job workers those who working for 6 to 8 hour in day, short duration study.

 

RECOMMENDATION:

Large sample size can be analysed, Duration of the intervention can be increased, Can be done on drivers and other textile industries, Can be done on school children’s.

 

 

AUTHORS CONTRIBUTION:

All authors have contributed equally.

 

CONFLICT OF INTEREST:  

Conflicts of interest: none'

 

Ethical Considerations:

The manuscript is approved by the Institutional Review board of faculty of physiotherapy. All the procedures were performed in accordance with the ethical standards of the responsible ethics committee both (Institutional and national) on human experimentation and the Helsinki Declaration of 1964 (as revised in 2008).

 

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

 

FUNDING:

Nil. This is a self-funded study.

 

ACKNOWLEDGEMENT:

I would like to thank the authorities of Dr. MGR Educational and Research Institute, University and the Principal Faculty of Physiotherapy for providing me with facilities required to conduct the study.

 

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Received on 23.12.2018          Modified on 26.02.2019

Accepted on 28.03.2019        © RJPT All right reserved