Comparison of Pilates and Conventional Treatment in Addition to Pilates in Patients With Chronic Neck Pain
Condition: Chronic Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effects of clinical pilates exercises and
      electrotherapy on pain level, physical condition, functional status and psychosocial status
      in patients with chronic neck pain.In the study, individuals will be divided into two groups.
      Pilates will be applied to one group for 6 weeks, pilates and conventional therapy will be
      applied to one group. Individuals will be evaluated before and after treatment. In the
      evaluation, pain, disability, anxiety and depression status, quality of life of individuals
      will be questioned. In addition, cervical joint range of motion and endurance will be
      evaluated.
    

Detailed description: 
      Neck pain is often described by pain and/or stiffness dorsal to the region between the
      occipital condyles and the C7 vertebra. Pain and/or disability for more than 12 weeks is
      defined as chronic neck pain. Neck pain is one of the major musculoskeletal disorders in the
      adult population. Neck pain, which is increasingly prevalent all over the world,
      significantly affects individuals, families, society, health care systems and businesses.
      This situation causes serious disability and economic costs. Two-thirds of the entire
      population faces neck pain at some point in their lives. Its lifetime prevalence ranges from
      40% to 70%. The prevalence of neck pain increases with age. It is more common in women
      approximately in the 5th decade of their life.

      In various studies, various changes have been observed in the activation of the superficial
      and deep neck flexor (DBF) muscles of individuals experiencing neck pain. In studies
      conducted with electroneuromyography, it was determined that neuromuscular muscle activation
      increased more in superficial muscles, and decreased undesirably in DBF muscles. DBF muscles
      provide a fundamental contribution to the preservation of physiological cervical lordosis and
      the maintenance of spine stability in cranio-vertebral junction movements. For this reason,
      exercise methods for gaining strength and endurance of these muscles have become very
      important recently.

      The neck region contains deep suboccipital muscles with dense muscle spindles, nerve
      connections to the vestibular and visual systems. Especially the high muscle spindle density
      in the superior and inferior oblique muscles and the rectus capitis posterior major and minor
      muscles is important in terms of proprioceptive input in coordinated head-eye movements. In a
      disorder in the neck region, muscle dysfunction occurs as a result of pain, disruption of
      sensory-motor input, and the transfer of deep muscles to superficial muscles. All these
      problems can cause asymmetrical, tight, position and movement of the neck to be perceived
      abnormally.

      Fear avoidance beliefs are significantly associated with the experience of pain, especially
      when the pain becomes chronic. The anticipated threat of intense pain often causes constant
      alertness of pain dermatomes. This can cause even low-intensity pain sensations to be
      unbearable for the person. Only the increased expectation of pain or re-injury can further
      encourage avoidance behaviors. Increased pain or fear of re-injury interferes with many
      activities. Studies have shown that fear of movement in chronic neck pain increases pain and
      disability, worsens functional status, and negatively affects physical performance.

      Studies associate individuals who experience persistent neck pain with psychological factors,
      including cognitive stress, anxiety, and depressed mood. In addition, it has been reported
      that sleep disorders are seen in parallel with the severity of pain in patients with chronic
      neck pain. These psychological factors may play a role in the chronicity of symptoms and
      cause increased pain, disability or fear-avoidance.

      Studies have shown that chronic neck pain is associated with low quality of life. It has been
      stated that the quality of life of patients with chronic neck pain is worse than normal
      individuals, and that many of these individuals face mental problems and may also experience
      psychosocial disorders such as anxiety and depression.

      Clinical Pilates exercises are a set of exercises that emphasize mind-body unity. Pilates
      strengthens the deep stabilizing muscles of the spine, gives flexibility to the spine,
      develops mind-body awareness and improves posture. Pilates also promotes the activation of
      the deep neck flexor muscles by promoting a neutral position of the cervical spine with mild
      upper cervical flexion at the cranio-cervical junction. Studies investigating the effect of
      clinical pilates on pain and disability in patients with chronic neck pain have shown that
      clinical pilates is effective in these parameters. Although it has been shown that neck
      perception is associated with factors such as pain, disability, anxiety and quality of life,
      no study has been found in the literature examining the effects of exercise and
      electrotherapy methods on neck awareness. In addition, there was no study examining the
      effect of electrotherapy on fear of movement and fear avoidance beliefs in individuals with
      chronic neck pain, and the effects of clinical pilates exercises on body awareness, fear of
      movement, and biopsychosocial factors.
    

Intervention name(s): Clinical Pilates Exercises; Clinical Pilates Exercises and Conventional Treatment
Intervention type(s): Other; Other
Intervention description(s): Pilates exercises; warm-up and cool-down exercises will be performed for 5 repetitions, while other exercises will be performed by the same physiotherapist as 10 repetitions depending on the patient's pain and fatigue. The exercises will be advanced at the end of the 3rd week.; In addition to pilates exercises, a conventional treatment program will be applied. As part of the conventional treatment program, 20 minutes of Hotpack to the cervical area, 20 minutes of conventional Transcutaneous Electrical Nerve Stimulation (TENS) to the painful area (80 Hertz (Hz), 100 microseconds (μs), until tingling is felt, asymmetrical biphasic rectangular waveform), 8 minutes to the cervical area Ultrasound (US) (4 minutes + 4 minutes, 1.5 watts/cm2, 1 MHz, continuous) will be applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pilates; convantional therapy; chronic neck pain