Effects of Chiropractic and Exercise on Wrist Proprioception and Grip Strength in Individuals With Mechanical Neck Pain

The aim of this study is to compare the effectiveness of chiropractic and different physiotherapy applications on bilateral hand grip strength, grip sensitivity, two-point separation and joint position sense in individuals with mechanical neck pain (NPMO). It is known that the decrease in grip strength and hand functions, especially with increasing age, causes disability in daily life activities and even death. The planned study aims to improve hand functions in individuals with NPMO.

48 individuals diagnosed with mechanical neck pain were included in the study. The 48 individuals were randomly divided into 4 groups via the Randomizer.org website.

* The first group is the control group (n=12); transcutaneous electric nerve stimulation, ultrasound and appropriate neck exercises are planned to be applied every day for 4 weeks.
* The second group is the chiropractic group and will be applied twice a week for 3 weeks by me, a Bahcesehir University Chiropractic Masters graduate (2017), targeting the lower cervicals.
* Classic hand-wrist exercises such as ROM, stretching and strengthening were applied to the third group in all directions of the wrist.
* In the fourth group, proprioceptive exercises such as joint approximation, traction and mobilization, similar to the classic hand-wrist exercise group, will be performed every day for 4 weeks.

The researcher will compare the effects of chiropractic and other physiotherapy techniques with the control group. Measurements will be repeated 4 weeks after the end of the treatment to measure whether the effects after the treatment continue. As a result of the evaluations recorded in a total of 8 weeks, statistical analyses will be performed first for the changes within the four groups and then for the changes between the groups.

The basic questions it aims to answer are as follows:

1. Is there a difference between the control group and chiropractic application, classic hand-wrist exercises and proprioceptive exercises in terms of the effects on grip strength, grip sensitivity, joint position sense and two-point discrimination test in individuals with NPMO?
2. Is there an improvement in the pain levels and functional disabilities of the participants?
3. Are the short-term results of the treatments sufficient?

The brains primary means of survival is to receive and interpret sensory input. Therefore, it needs functional afferent inputs that can adapt to changing internal and external environmental conditions and update themselves. Most of this occurs through joint-based proprioceptive and muscle spindle information coming to the spinal code. The spinal cord is not only a center responsible for transmitting sensations coming to the dorsal horn to the brain, but also responsible for regulating these sensations. Due to the continuous afferent firing of the neck pain of mechanical origin (NPMO), the sensory-motor integration of the spinal cord decreases. When the afferent input of the spinal cord changes, it will not be possible to perceive correctly what is happening in the relevant region. It can be said that this situation affects itself in a cycle by changing sensory processing, sensory filtering and sensory integration. It can also cause the vertebral column to be exposed to microtrauma. With the decrease in the firing of the existing altered sensory inputs, joint position sense and motor control reach an optimum level, and increases have been observed in the regulation of developmental and physiological processes, especially in postural strength and upper extremity muscle strength. It is aimed to examine the relationship between the improvement of proprioceptive input with treatment methods and the elimination of abnormal motor control and abnormal neuronal processing with improved proprioceptive input. In this context, it was planned to evaluate the superiority of chiropractic, classical hand-wrist exercises and proprioceptive exercises against each other and against the control group in individuals with NPMO by applying grip strength, grip sensitivity, wrist joint position sense and 2-point discrimination test. It was planned to use visual analog scale and neck pain and disability score to assess pain in NPMO and Copenhagen neck functional disability scale to assess functionality.

With this study;

1. Ensuring normal integration in individuals with NPMO,
2. Ensuring sensory-motor integration by keeping the internal and external body schemas of the brain working healthily and up-to-date,
3. Increasing the pain and disability in daily activities and increasing the functionality by improving the strength and proprioception parameters of the hand and wrist,
4. Obtaining information about the general health of the individual by evaluating the grip strength and proprioception,
5. Providing higher quality health services with the findings obtained,
6. Guiding patients with evidence during the treatment process,
7. Providing the most appropriate treatment to patients is aimed.

Eligibility Criteria:
Inclusion Criteria:

* Individuals diagnosed with mechanical neck pain
* Presence of mechanical neck pain that has been ongoing for at least 14 days
* Newly starting conservative treatment for mechanical neck pain
* Age range 18-50 Exclusion criteria for the study

Exclusion Criteria:

* Individuals wanting to withdraw from the study
* Not signing the informed consent form
* Using painkillers for neck pain of mechanical origin pain during the application period
* Presence of upper extremity trauma that may affect grip strength and proprioceptive sense in the last 3 months
* Vertebrobasilar artery insufficiency
* Presence of mental retardation and/or inability to communicate
* Having undergone surgery in the cervical region
* Presence of neck pain of neurological origin such as stenosis and herniation of cervical segments
* Presence of sensory deficit in the hand