Effects of Transverse Thoracic Mobilization With and Without Lower Trapezius Strengthening Exercises

Study Overview
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Brief Summary
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Mechanical neck pain is a common musculoskeletal problem, worldwide. Patients with neck pain often have subjective complaints of muscle stiffness, tension, or tightness in addition to their pain located between the occiput and the third thoracic vertebra Approximately 68% of the total population has experienced neck pain at least once in their lifetime, and it easily transforms into a chronic state (that persists for more than 3 months). In today's society, this is conspicuous in many laborers due to the increased use of computers, where the neck and shoulders are maintained in static abnormal postures to look at the computer screens and become vulnerable to cause neck pain. The aim of the study is to determine the comparative effects of transverse thoracic mobilization with and without lower trapezius strengthening exercises on pain, disability and range of motion in patients with mechanical neck pain.

Detailed Description
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A Randomized controlled trial will be conducted in physiotherapy outpatient department of Syed Medical Complex and Islam Hospital, Sialkot. Non-probability consecutive sampling will be used to collect the data. Sample size of 20 subjects with age group between 18 to 40 years will be taken. Data will be collected by using tools Numeric Pain Rate Scale (NPRS) for pain, Neck Disability Index (NDI) for disability and Universal Goniometer (UG) for range of motion of neck. An informed consent will be taken. A total of 20 subjects will be selected by following inclusion and exclusion criteria and will equally divided in to two groups by random number generator table. Both groups will come thrice per week for a total of 4 weeks. The data will be analyzed using SPSS software version 25. After assessing normality of data by Shapiro-Wilk test, it will be decided either parametric or non-parametric test will be used within a group or between two groups

Official Title
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Effects of Transverse Thoracic Mobilization With and Without Lower Trapezius Strengthening Exercises on Pain, Disability and Range of Motion in Patients With Mechanical Neck Pain

Conditions
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Mechanical Neck Pain

Intervention / Treatment
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* Other: Lower Trapezius Strengthening Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males and females between the age range of 18-40 years with mechanical neck pain for at least 3months. Examination- Symptoms provoked by neck movement and/or palpation of neck musculature. Trapezius Strength Test -To assess lower trapezius muscle strength, patient in prone with shoulder 120 degree abducted and resist the shoulder extension diagonally. Exclusion Criteria: Osteoporosis Tumors Vertebral fractures Diagnosed psychological disorders Neck pain associated with vertigo History of cervical and thoracic spine injury Cervical radiculopathy Traumatic neck injury Shoulder surgery

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A: Lower Trapezius Strengthening Exercises<br>Hot pack at neck area, upper trapezius stretching neck isometrics transverse mobilization glide and Lower Trapezius strengthening exercise includes: Latissimus pull down Prone V- raise Modified Prone Cobra and Standardized Physical Therapy treatment will be given as Hot pack at neck area, upper trapezius stretching, neck isometrics and transverse mobilization glide. | Other: Lower Trapezius Strengthening Exercises<br>* Lower Trapezius strengthening exercise includes: Latissimus pull down Prone V- raise Modified Prone Cobra<br>* Other names: Standardized Physical Therapy;|
| No Intervention: Group B: Standardized Physical Therapy<br>Hot pack at neck area, upper trapezius stretching neck isometrics transverse mobilization glide Group B given Standardized Physical therapy management | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rate Scale (NPRS) | The Numeric Pain Rating Scale (NPRS) is a unidimensional measure of pain intensity in adults, including those with chronic pain. The NPRS is a segmented numeric version in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable). The NPRS takes <1 minute to complete The NPRS is a valid and reliable scale to measure pain intensity. | follow up at 4th week | 
| Universal Goniometer (UG) | A goniometer is an instrument that measures the available range of motion at a joint. To measure the range of motion physical therapists most commonly use a goniometer. It is necessary that a single notation system is used in goniometry. The neutral zero method (0 to 180- degree system) is the most widely used method. The same goniometer should always be used to reduce the chances of instrumental error. | follow up at 4th week | 
| Neck Disability Index (NDI) | This questionnaire has been designed to give information about neck pain and the ability to manage it in everyday life. Participants will answer every section and mark only the one box that applies in each section. If two or more statements are in any section related to the participant, mark only one box that is relevant closely. The questionnaire has 10 items concerning pain and activities of daily living, including personal care, lifting, reading, headaches, concentration, work status, driving, sleeping and recreation. Each item is scored out of 5 (with the 'no disability' response given a score of 0), giving a total score of for the questionnaire 50. Higher scores represent more significant disabilities. The result can be expressed as a percentage or raw scores (out of 50). | follow up at 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neck Pain, Trapezius muscle, Muscle strength, Range of Motion