The Inhibition of Sternocleidomastoideus Muscle
Condition: Neck Pain; Massage; Range of Motion
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Neck pain (NP) is a major public health problem with high prevalence, high cost of health
      expenditure and loss of productivity.The incidence of NP is increasing among adults and it
      has been reported to occur in 12-34% of the total population. Exercise programs applied to
      individuals with NP include craniocervical flexion exercises that focus on the increase in
      activation of deep cervical flexor muscles and a decrease in the activation of superficial
      cervical flexors. Falla et al. noted that people with NP also have reduced ability to relax
      sternocleidomastoideus (SCM) muscle. Although there are many studies indicating that the
      activation of the SCM muscle should be reduced by activating deep cervical flexors when the
      literature on NP is examined, there are no studies examining the effect of the inhibition of
      the SCM muscle.
    

Detailed description: 
      Patients with NP who were directed to a physiotherapy and rehabilitation program by a
      specialist physician and meeting the inclusion criteria were included in the study. Criteria
      for inclusion in the study; NP complaint persists for at least 3 months and is between the
      ages of 18-55. Exclusion criteria are; Having a history of cervical spine surgery, being
      included in the physiotherapy and rehabilitation program due to NP in the last 6 months,
      having a diagnosis of vertebrobasilar artery failure, being diagnosed with cervical stenosis,
      torticollis, scoliosis, and diagnosing serious pathology such as malignancy, infection and
      inflammatory disorders.

      Outcome measures:

      Pain: Visual analog scale (VAS) was used to detect the patients pain intensity. VAS is a
      simple and common method to evaluate pain intensity. Subjects were instructed to indicate the
      intensity of their pain by marking a 10-cm line anchored with terms describing the extremes
      of pain intensity in the last 24 hours. VAS has been shown to be reliable and valid in
      measuring pain.

      Disability: Neck Disability Index (NDI) was applied in order to evaluate how the patient's NP
      affects their daily life. Total point changes between 0 and 35, with a high score indicating
      a higher level of disability.

      Degree of Cervical Range of Motion (ROM): A universal goniometer was used to assess the Range
      of Motion of the cervical vertebrae. Cervical flexion, extension, right and left lateral
      flexion, and right and left rotation movements were measured 3 times in an active manner
      while the patients were in a comfortable sitting position. The average value of the
      measurements was recorded as ROM. The pain-free maximum degree of movement for each range was
      measured in degrees. This method has demonstrated good reliability.

      Depressive Symptoms: Participants' level of depression was assessed using Back Depression
      Inventory that consists of 21 categories with 4 options in each category. Each item has a
      score between 0 and 3, and total score varies from 0 to 63. Score ranges are interpreted as
      0-9 points = minor depression, 10-16 points = mild depression, 17-29 points = moderate
      depression, and 30-63 points = severe depression.

      Kinesiophobia: Tampa scale of kinesiophobia (TSK): The scale was used to assess fear of pain
      or re-injury that may occur because of any movement. Consisting of 17 items, the scale
      assesses the parameters of injury/re-injury and fear/avoidance in various activities. Total
      points may vary between 17 and 68, with a high score indicating a higher level of
      kinesiophobia.

      Evaluation of the static endurance of the neck muscles: Neck extensors and neck flexors
      endurance test were used to evaluate the static endurance of the neck muscles. Each
      measurement will be taken 2 times and the best measurement was recorded. Time was given to
      rest the person for 3 minutes between measurements. The time in which the patient can
      maintain the position was recorded in seconds.

      Neck ﬂexors endurance test; Patients were lying down in the hook lying position with the
      therapist's hand placed under their head. The patients were then asked to bring their chin
      closer to their chest in the Chin Tuck position lifting their head about 2.5 cm and to then
      hold that position. The test was terminated if the patient experienced any pain or fatigue,
      or if their head touched the therapist's hand. Two measurements were taken and the longest
      duration was recorded.

      Neck extensors endurance test; Patients were lying with their heads bent downwards and their
      arms resting at their sides. They were asked to approach the edge of the bed so that their
      head and chest would be hanging from the bed. A sandbag weighing of 2 kg was placed at the
      back of the neck (between the ears) and the patients were asked to lift their head to the
      neutral position and then hold it there. The test was terminated in case of any pain or
      fatigue experienced by the patients, or a 5˚ deterioration in the position of the head. Two
      measurements were taken and the highest score was recorded.

      Randomization: The patients were divided into two groups, according to their age and duration
      of disease by using matched randomization.

      Intervention:

      First Group: Traditional physiotherapy (TP) program was applied to patients with NP in the
      first group. TP program consists of hot-pack, ultrasound, transcutaneal electrical nerve
      stimulation (TENS) and exercises.

      Second Group: The individuals who participated in the second group were applied classical
      massage and stretching exercises suitable for the SCM muscle together with TP. The treatment
      program applied to the patient in the first group was applied in the same way. The Classic
      massage procedure was applied to the SCM for 5 minutes using the Swedish technique. The
      classic massage was performed by a trained physiotherapist. The procedure included 3 strokes,
      3 kneads, and 3 strokes to the upper back and neck area. The application was supported by
      face cradle and carried out in a semi-horizontal position in which the neck was relaxed. The
      patient was lying in supine position.
    

Intervention name(s): Classic Massage (Swedish Technique)
Intervention type(s): Other
Intervention description(s): Classic Massage (Swedish Technique); The massage was applied to the paitents with NP in the second group. Massage procedure included 3 strokes, 3 kneads, and 3 strokes to the upper back and neck area. The application was supported by face cradle and carried out in a semi-horizontal position in which the neck was relaxed. The patient was lying in supine position.
Other intervention name(s): Exercise, transcuteneal electric stimulation, ultrasound, hot pack
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A Single- Blind Randomized Controlled Trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment