Muscular Endurance And Its Association With Neck Pain, Disability, Neck Awareness, And Kinesiophobia
Condition: Cervical Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Neck Pain; Hernia; Kinesiophobia
Study type: Observational

Summary: 
      The aim of this study was to investigate the relationship of muscular endurance of the trunk,
      upper extremities, and scapular region as well as cervical region, with pain, neck awareness,
      and kinesiophobia in patients with cervical disc herniation. Thirty-six patients between
      18-65 years with a diagnosis of cervical disc herniation and having neck pain of 2 and above
      at rest according to the Visual Analogue Scale (VAS) were included in the study. After the
      evaluation of musculoskeletal system, endurance tests were performed for 9 muscles/muscle
      groups in the cervical and scapular regions, upper limb, and trunk. Pain severity was
      measured by VAS and Neck Disability Index (NDI), neck awareness with Fremantle Neck Awareness
      Questionnaire (FreNAQ), and fear of movement with Tampa Kinesiophobia Scale (TKS).
    

Detailed description: 
      Cervical disc herniation occurs as a result of a sudden trauma or chemical/mechanical
      degenerative changes in the cervical spine, and is more common in women. The most common age
      range for disc herniation is 51-60 years with the increase in prevalence with age in both
      genders, and the most affected disc level is C6-C7. The clinical presentation such as
      weakness in cervical musculature, decreased endurance, loss of motor control and postural
      stabilization, changes in reflexes, loss of sensation, and movement limitations varies based
      on the location of the disc. The pain caused by any damage or compression in the cervical
      spinal nerve root is seen along the affected nerve dermatome as well as the head, neck,
      scapula, shoulder, and upper extremity, and accompanied by spasm in the cervical muscles.

      Cervical muscles have a large number of sensory receptors responsible for vestibular, visual,
      and postural control by the deep suboccipital muscles with dense muscle spindles. They are
      responsible for the stabilization of the head, neck, and the thoracic region against
      involuntary perturbation by maintaining the continuity of the posture; they ensure the
      mobility of neck and upper limbs, and contribute neck awareness and postural reflexes.
      Intense proprioceptive receptors of deep cervical muscles support the motor control of the
      trunk muscles, mutually trunk muscles contribute to stabilization of the head and neck; and
      through the thoracolumbar fascia they work in coordination with scapular muscles. It has been
      known that any involvement of cervical, trunk, and scapular region muscles, as a whole,
      contribute to the etiology of the neck pain in patients due to their strong anatomical
      relations. In addition, the contribution of the upper extremity muscles in the stabilization
      of the cervical spine and the triggering of neck pain during upper extremity movements also
      reveal the importance of the motor control of upper extremity muscles in these patients.

      Endurance of the cervical muscles has been known to have more responsibility on the spinal
      stabilization than strength in patients with chronic neck pain, causing an increase in pain
      with the decrease in endurance. In cervical disc herniation, the pathology in the cervical
      region causing the malalignment of the spine not only deteriorate the strength and endurance
      of the neck muscles, but it also affects other muscles around the spine. Further,
      proprioceptive receptors in the cervical muscles lose the ability to detect changes in muscle
      tension due to the reduced endurance, which in turn affect neck awareness. On the other hand,
      since chronic pain is closely related to cognitive and behavioral factors, pain worsens as a
      result of activity avoidance according to the fear-avoidance model, hence the kinesiophobia
      also increases by the decrease in cervical muscle endurance in chronic neck pain.

      Recent studies revealed the connection between the endurance of neck muscles and pain, neck
      awareness, and fear of movement in patients with cervical disc herniation in literature.
      However, the evidence related to the relation between scapular, upper extremities, and trunk
      muscles' endurance and neck pain, neck awareness, and fear of movement has still been
      lacking. Therefore, the aim of the present study was to investigate the association between
      the endurance of these muscles and neck pain, neck awareness, and kinesiophobia in patients
      with cervical disc herniation.
    

Intervention name(s): Pain Assessment; Assessment of Muscular Endurance; Assessment of Neck Awareness; Assessment of Fear of Movement
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Visual Analogue Scale (VAS) were included in the study; The endurance of the 9 muscles/muscle groups including cervical flexor, extensor, deep flexor muscles, trunk flexor, extensor, lateral flexor, and stabilizer muscles, upper extremity, and scapular muscles (mm. serratus anterior and trapezius) were evaluated based on the assessment instructions given in the studies of Edmonston et al., Grimmer et al., Evans et al., Reece et al., ACSM guideline; The Turkish version of the Fremantle Neck Awareness Questionnaire (FreNAQ) which was developed by Wand et al. to assess neck awareness in patients with chronic neck pain was used in this study; The fear of movement was assessed by the Turkish version of the Tampa Scale of Kinesiophobia which originally developed by Kori et al.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        This study was carried out by patients who were diagnosed with cervical disc herniation and
        directed to Hacettepe University, Faculty of Physical Medicine and Rehabilitation for
        physical therapy consultation. The patients who met the inclusion criteria were given
        detailed information about the study, and signed a consent form.
      
Keywords: Degenerative Disc Disease; Cervical Spine; Neck Pain; Muscles