Electromyographic activity, pain, disability, and improvement perception in chronic neck pain after multimodal physiotherapy
DOI:
https://doi.org/10.47197/retos.v65.107458Keywords:
Cervical muscle activity, chronic neck pain, clinical course, disability, physiotherapyAbstract
Introduction: Few studies have explored the clinical course in patients with chronic neck pain. Understanding the clinical course can help clinicians evaluate individual patient outcomes, define goals, and establish prognosis.
Objective: To describe the clinical course of patients with non-specific chronic neck pain (NCNP) in response to a multimodal physiotherapy program.
Methodology: A total of 15 patients with NCNP participated in a six-week physiotherapy multimodal program. Baseline assessments included sociodemographic characteristics and clinical history of neck pain. The main outcome measures were cervical muscle activity, pain, disability, and global perception of improvement. The Friedman and post-hoc tests with Bonferroni correction were used for statistical analysis.
Results: All variables under study varied significantly (p<0.001) over the six-week physiotherapy multimodal program. In the first 3 weeks, sternocleidomastoid and anterior scalene muscles showed a significant decrease in muscle activity of 64% and 24%, respectively. All self-reported variables were also observed early significant clinical improvements, with pain and disability decreasing by 50% and 24% at the end of the 3-week intervention. Discussion: Patients with NCNP who are treated with a physiotherapy multimodal program that includes specific motor control exercises can expect a short-term influence on the muscular activity of superficial neck muscles and a reduction of symptoms. Physiotherapists may use this information to make more informed decisions when treating patients with NCNP.
Conclusions: The results of the present study may be useful in designing clinical trials to establish whether the improvements were due to the treatment provided or natural condition recovery.
References
Abuin, V., Pedersini, P., Morales, C., Paret-Fernández, A., Bermejo, P., Rodríguez-Costa, I., & Villafañe, J. (2024). Exploring the Impact of Cervical Multifidus Muscle Morphology on Postural Balance in Post-Stroke Patients: A pilot study. Retos, 54, 216-223. https://doi.org/https://doi.org/10.47197/retos.v54.102135
Akodu, A. K., Nwanne, C. A., & Fapojuwo, O. A. (2021). Efficacy of neck stabilization and Pilates exercises on pain, sleep disturbance and kinesiophobia in patients with non-specific chronic neck pain: A randomized controlled trial. J Bodyw Mov Ther, 26, 411-419. https://doi.org/10.1016/j.jbmt.2020.09.008
Bernal-Utrera, C., Gonzalez-Gerez, J. J., Anarte-Lazo, E., & Rodriguez-Blanco, C. (2020). Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial. Trials, 21(1), 682-682. https://doi.org/10.1186/s13063-020-04610-w
Bertozzi, L., Gardenghi, I., Turoni, F., Villafane, J. H., Capra, F., Guccione, A. A., & Pillastrini, P. (2013). Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther, 93(8), 1026-1036. https://doi.org/10.2522/ptj.20120412
Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther, 47(7), A1-A83. https://doi.org/10.2519/jospt.2017.0302
Bobos, P., Billis, E., Papanikolaou, D.-T., Koutsojannis, C., & MacDermid, J. C. (2016). Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial. Rehabilitation Research and Practice, 2016, 6480826. https://doi.org/10.1155/2016/6480826
Borghouts, J. A. J., Koes, B. W., & Bouter, L. M. (1998). The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain, 77(1), 1-13. https://doi.org/10.1016/S0304-3959(98)00058-X
Carroll, L. J., Holm, L. W., Hogg-Johnson, S., Cote, P., Cassidy, J. D., Haldeman, S., Nordin, M., Hurwitz, E. L., Carragee, E. J., van der Velde, G., Peloso, P. M., Guzman, J., Bone, Joint Decade - Task Force on Neck, P., & Its Associated, D. (2008). Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976), 33(4 Suppl), S83-92. https://doi.org/10.1097/BRS.0b013e3181643eb8
Cecchi, F., Molino-Lova, R., Paperini, A., Boni, R., Castagnoli, C., Gentile, J., Pasquini, G., & Macchi, C. (2011). Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up. Intern Emerg Med, 6(5), 413-421. https://doi.org/10.1007/s11739-010-0499-x
Cleland, J. A., Childs, J. D., & Whitman, J. M. (2008). Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil, 89(1), 69-74. https://doi.org/10.1016/j.apmr.2007.08.126
Cruz, E. B., Fernandes, R., Carnide, F., Domingues, L., Pereira, M., & Duarte, S. (2015). Cross-Cultural Adaptation and Validation of the Neck Disability Index to European Portuguese Language. Spine, 40(2), E77-E82. https://doi.org/10.1097/brs.0000000000000692
Domingues, L., & Cruz, E. B. (2011). Adaptação cultural e contributo para a validação da escala Patient Global Impression of Change. Ifisionline.
Domingues, L., Pimentel-Santos, F. M., Cruz, E. B., Sousa, A. C., Santos, A., Cordovil, A., Correia, A., Torres, L. S., Silva, A., Branco, P. S., & Branco, J. C. (2019). Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clinical Rehabilitation, 33(12), 1908-1918. https://doi.org/10.1177/0269215519876675
Enthoven, P., Skargren, E., & Oberg, B. (2004). Clinical course in patients seeking primary care for back or neck pain: a prospective 5-year follow-up of outcome and health care consumption with subgroup analysis. Spine (Phila Pa 1976), 29(21), 2458-2465. https://doi.org/10.1097/01.brs.0000143025.84471.79
Falla, D., Dall'Alba, P., Rainoldi, A., Merletti, R., & Jull, G. (2002a). Location of innervation zones of sternocleidomastoid and scalene muscles--a basis for clinical and research electromyography applications. Clin Neurophysiol, 113(1), 57-63. https://doi.org/10.1016/s1388-2457(01)00708-8
Falla, D., Dall'Alba, P., Rainoldi, A., Merletti, R., & Jull, G. (2002b). Repeatability of surface EMG variables in the sternocleidomastoid and anterior scalene muscles. Eur J Appl Physiol, 87(6), 542-549. https://doi.org/10.1007/s00421-002-0661-x
Falla, D., & Farina, D. (2007). Neural and muscular factors associated with motor impairment in neck pain. Current Rheumatology Reports, 9(6), 497-502. https://doi.org/10.1007/s11926-007-0080-4
Falla, D., Jull, G., Dall'Alba, P., Rainoldi, A., & Merletti, R. (2003). An Electromyographic Analysis of the Deep Cervical Flexor Muscles in Performance of Craniocervical Flexion. Physical Therapy, 83(10), 899-906. https://doi.org/10.1093/ptj/83.10.899
Falla, D., Lindstrøm, R., Rechter, L., Boudreau, S., & Petzke, F. (2013). Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: a randomized controlled study. Eur J Pain, 17(10), 1517-1528. https://doi.org/10.1002/j.1532-2149.2013.00321.x
Falla, D., O'Leary, S., Farina, D., & Jull, G. (2012). The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. Clin J Pain, 28(7), 628-634. https://doi.org/10.1097/AJP.0b013e31823e9378
Falla, D. L., Jull, G. A., & Hodges, P. W. (2004). Patients With Neck Pain Demonstrate Reduced Electromyographic Activity of the Deep Cervical Flexor Muscles During Performance of the Craniocervical Flexion Test. Spine, 29(19), 2108-2114. https://doi.org/10.1097/01.brs.0000141170.89317.0e
Hermens, H. J., Freriks, B., Disselhorst-Klug, C., & Rau, G. (2000). Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. https://doi.org/10.1016/S1050-6411(00)00027-4
Hermens, H. J., Freriks, B., Merletti, R., Stegeman, D., Blok, J., Rau, G., Disselhorst-Klug, C., & Hägg, G. (1999). European Recommendations for Surface ElectroMyoGraphy. Roessingh Research and Development, 8-11. https://doi.org/10.1016/S1050-6411(00)00027-4
Hoy, D., March, L., Woolf, A., Blyth, F., Brooks, P., Smith, E., Vos, T., Barendregt, J., Blore, J., Murray, C., Burstein, R., & Buchbinder, R. (2014). The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(7), 1309-1315. https://doi.org/10.1136/annrheumdis-2013-204431
Javdaneh, N., Saeterbakken, A. H., Shams, A., & Barati, A. H. (2021). Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain. Int J Environ Res Public Health, 18(16). https://doi.org/10.3390/ijerph18168848
Jones, L. B., Jadhakhan, F., & Falla, D. (2024). The influence of exercise on pain, disability and quality of life in office workers with chronic neck pain: A systematic review and meta-analysis. Appl Ergon, 117, 104216. https://doi.org/10.1016/j.apergo.2023.104216
Jull, G., & Falla, D. (2016). Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain? Man Ther, 25, 43-47. https://doi.org/10.1016/j.math.2016.05.336
Jull, G., O'Leary, S., & Falla, D. (2008). Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther, 31(7), 525-533. https://doi.org/10.1016/j.jmpt.2008.08.003
Jull, G., Sterling, M., Falla, D., Treleaven, J., & O'Leary, S. (2008). Whiplash, headache, and neck pain: research-based directions for physical therapies. Elsevier Health Sciences. https://doi.org/10.1016/B978-0-443-10047-5.X5001-2
Jull, G. A., Falla, D., Vicenzino, B., & Hodges, P. W. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther, 14(6), 696-701. https://doi.org/10.1016/j.math.2009.05.004
Juul-Kristensen, B., Clausen, B., Ris, I., Jensen, R. V., Steffensen, R. F., Chreiteh, S. S., Jørgensen, M. B., & Søgaard, K. (2013). Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study. J Rehabil Med, 45(4), 376-384. https://doi.org/10.2340/16501977-1120
Kaka, B., Ogwumike, O. O., Adeniyi, A. F., Maharaj, S. S., Ogunlade, S. O., & Bello, B. (2018). Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial. Scandinavian Journal of Pain, 18(2), 321-331. https://doi.org/doi:10.1515/sjpain-2017-0146
Kashfi, P., Karimi, N., Peolsson, A., & Rahnama, L. (2019). The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: protocol for a randomized clinical trial (RCT). BMC Musculoskeletal Disorders, 20(1), 540-540. https://doi.org/10.1186/s12891-019-2880-x
Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A.-A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskeletal Disorders, 23(1), 26-26. https://doi.org/10.1186/s12891-021-04957-4
Kislaya, I., & Neto, M. (2015). Caracterização sociodemográfica da prevalência da dor lombar crónica autorreportada na população residente em Portugal através do Inquérito Nacional de Saúde 2014. Instituto Nacional de Saúde - Doutor Ricardo Jorge, 8, 39-42.
Kosek, D. J., Kim, J. S., Petrella, J. K., Cross, J. M., & Bamman, M. M. (2006). Efficacy of 3 days/wk resistance training on myofiber hypertrophy and myogenic mechanisms in young vs. older adults. J Appl Physiol (1985), 101(2), 531-544. https://doi.org/10.1152/japplphysiol.01474.2005
Lauche, R., Cramer, H., Hohmann, C., Choi, K.-E., Rampp, T., Saha, F. J., Musial, F., Langhorst, J., & Dobos, G. (2012). The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study. Evidence-Based Complementary and Alternative Medicine, 2012, 429718. https://doi.org/10.1155/2012/429718
Leaver, A. M., Maher, C. G., McAuley, J. H., Jull, G., Latimer, J., & Refshauge, K. M. (2013). People seeking treatment for a new episode of neck pain typically have rapid improvement in symptoms: an observational study. J Physiother, 59(1), 31-37. https://doi.org/10.1016/S1836-9553(13)70144-9
Maitland, G., Hengeveld, E., Banks, K., & English, K. (2005). Maitland’s Vertebral Manipulation (7th ed.). Butterworth-Heinemann.
Martin-Gomez, C., Sestelo-Diaz, R., Carrillo-Sanjuan, V., Navarro-Santana, M. J., Bardon-Romero, J., & Plaza-Manzano, G. (2019). Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis. Musculoskelet Sci Pract, 42, 52-59. https://doi.org/10.1016/j.msksp.2019.04.010
Miyamoto, G. C., Lin, C.-W. C., Cabral, C. M. N., van Dongen, J. M., & van Tulder, M. W. (2019). Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis. British Journal of Sports Medicine, 53(3), 172-181. https://doi.org/10.1136/bjsports-2017-098765
Noori, S. A., Rasheed, A., Aiyer, R., Jung, B., Bansal, N., Chang, K.-V., Ottestad, E., & Gulati, A. (2019). Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review. Pain Medicine, 21(7), 1482-1493. https://doi.org/10.1093/pm/pny287
O'Sullivan, K., Smith, S. M., & Sainsbury, D. (2010). Electromyographic analysis of the three subdivisions of gluteus medius during weight-bearing exercises. BMC Sports Science, Medicine and Rehabilitation, 2(1), 17-17. https://doi.org/10.1186/1758-2555-2-17
Okilanda, A., Suganda, M., Chaeroni, A., Rozi, M., Saputra, M., Nugroho, S., Bhosle, J., Mishra, R., Singh, J., Rajpoot, Y., Govindasamy, K., Elayaraja, M., & Gogoi, H. (2024). Comparative Analysis of Ground-Based and Elevated Pushup Exercises for Pectoralis Major Muscle Activation. Retos, 57, 747-752. https://doi.org/https://doi.org/10.47197/retos.v57.107264
Pereira, M. (2012). Contribuição para a adaptação cultural do Neck Disability Index e caraterização da prática de fisioterapia em pacientes com Dor Crónica Cervical Faculdade de Ciências Médicas. UNL].
Price, J., Rushton, A., Tyros, I., Tyros, V., & Heneghan, N. R. (2020). Effectiveness and optimal dosage of exercise training for chronic non-specific neck pain: A systematic review with a narrative synthesis. PLoS One, 15(6), e0234511. https://doi.org/10.1371/journal.pone.0234511
Rasmussen-Barr, E., Halvorsen, M., Bohman, T., Bostrom, C., Dedering, A., Kuster, R. P., Olsson, C. B., Rovner, G., Tseli, E., Nilsson-Wikmar, L., & Grooten, W. J. A. (2023). Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord, 24(1), 806. https://doi.org/10.1186/s12891-023-06930-9
Safiri, S., Kolahi, A.-A., Hoy, D., Buchbinder, R., Mansournia, M. A., Bettampadi, D., Ashrafi-Asgarabad, A., Almasi-Hashiani, A., Smith, E., Sepidarkish, M., Cross, M., Qorbani, M., Moradi-Lakeh, M., Woolf, A. D., March, L., Collins, G., & Ferreira, M. L. (2020). Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ, 368, m791. https://doi.org/10.1136/bmj.m791
Seynnes, O. R., de Boer, M., & Narici, M. V. (2007). Early skeletal muscle hypertrophy and architectural changes in response to high-intensity resistance training. J Appl Physiol (1985), 102(1), 368-373. https://doi.org/10.1152/japplphysiol.00789.2006
Shabbir, M., Arshad, N., Naz, A., & Saleem, N. (2021). Clinical outcomes of maitland mobilization in patients with Myofascial Chronic Neck Pain: A randomized controlled trial. Pak J Med Sci, 37(4), 1172-1178. https://doi.org/10.12669/pjms.37.4.4220
Skargren, E. I., Carlsson, P. G., & Oberg, B. E. (1998). One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine (Phila Pa 1976), 23(17), 1875-1883; discussion 1884. https://doi.org/10.1097/00007632-199809010-00016
Sterling, M., Hendrikz, J., & Kenardy, J. (2010). Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study. Pain, 150(1), 22-28. https://doi.org/10.1016/j.pain.2010.02.013
Sterling, M., Jull, G., Vicenzino, B., Kenardy, J., & Darnell, R. (2003). Development of motor system dysfunction following whiplash injury. Pain, 103(1-2), 65-73. https://doi.org/10.1016/s0304-3959(02)00420-7
Tsakitzidis, G., Remmen, R., Dankaerts, W., & Royen, P. v. (2013). Non-Specific Neck Pain and Evidence-Based Practice. European Scientific Journal, 9(3), 1-19.
Walton, D. M., Eilon-Avigdor, Y., Wonderham, M., & Wilk, P. (2014). Exploring the clinical course of neck pain in physical therapy: a longitudinal study. Arch Phys Med Rehabil, 95(2), 303-308. https://doi.org/10.1016/j.apmr.2013.09.004
Weigl, M., Letzel, J., & Angst, F. (2021). Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain. BMC Musculoskelet Disord, 22(1), 330. https://doi.org/10.1186/s12891-021-04194-9
Ylinen, J., Takala, E. P., Nykanen, M., Hakkinen, A., Malkia, E., Pohjolainen, T., Karppi, S. L., Kautiainen, H., & Airaksinen, O. (2003). Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA, 289(19), 2509-2516. https://doi.org/10.1001/jama.289.19.2509
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