Comparison of the Effectiveness of Different Exercise Types in Individuals with Chronic Neck Pain

The aim of this study is to compare the effectiveness of craniocervical flexion, static and dynamic isometric exercise training applied with a conventional physiotherapy program in individuals with chronic neck pain.

Neck pain is a significant musculoskeletal problem that is frequently encountered in society. Pain that cannot be diagnosed with a specific pathology is called "nonspecific" and pain that continues for more than three months is called "chronic pain". Chronic nonspecific neck pain has negative effects on function and quality of life. The importance of the exercise approach in the treatment of neck pain is quite great. Craniocervical flexion and static isometric exercises are frequently used in individuals with chronic neck pain. However, there are very few studies that include dynamic isometric exercises. The aim of this study is to compare the effectiveness of craniocervical flexion, static and dynamic isometric exercise training applied with a conventional physiotherapy program in individuals with chronic neck pain. The intervention groups of the study are deep cervical flexion exercise training, dynamic isometric exercise training and static isometric exercise training and electrotherapy group. The craniocervical flexion exercise training group will receive deep cervical flexor muscle training with Pressure Biofeedback, the dynamic isometric exercise group will receive exercise training with Thera-band, and the static isometric exercise group will receive neck isometric exercises. The electrotherapy group will receive hotpack, tens, and ultrasound applications. At the beginning and end of the study, pain, disability, posture, muscle strength, endurance, range of motion, and body awareness will be assessed in all individuals.TENS (Transcutaneous Electrical Nerve Stimulation) will be applied to all groups for 20 minutes with a TENS device at a strength of 10-30 mA and a frequency of 80 Hz. A pair of surface electrodes will be placed on the painful area of the neck. The intensity of TENS will be adjusted according to the patient's sensory thresholds so that they are not disturbed by a numbness sensation. After TENS, continuous ultrasound will be applied to the cervical region to produce thermal effects. The intensity will be 1.5 W/cm² and the duration will be 5 minutes. Hotpack will be applied to the trapezius muscle for 10 minutes. Chin tuck exercise will be applied to the cervical region.

Eligibility Criteria:
Inclusion Criteria:

* Being between the ages of 18 and 55,
* Scoring 15/50 or less on the Neck Disability Index,
* Having a history of chronic neck pain for at least 3 months,
* Having a pain level of 5/10 or more,
* Showing signs of cervical movement control dysfunction,
* Having cervical muscle tenderness during physical examination.

Exclusion Criteria:

* Being diagnosed with a vascular disease,
* Being diagnosed with a vestibular disease,
* Being diagnosed with hypertension,
* Being diagnosed with fibromyalgia or rheumatoid arthritis,
* Having had spine surgery in the last 12 months,
* Having received an exercise program or standard physiotherapy program involving the cervical region in the last 12 months,
* Having congenital or acquired kyphosis, scoliosis, etc. having postural deformity,
* Having specific neck pain such as cancer,
* Having fractures, instability, inflammatory diseases, history of neck trauma, infections, neurological deficit, having spinal diseases such as radiculopathy, spondylosis.