Sub-Occipital Muscles Inhibition Technique Verses Cranio Cervical Flexion Exercise for Mechanical Neck Pain

Study Overview
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Brief Summary
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The aim of this research is to determine the Effects of Sub-Occipital Muscles Inhibition Technique and Cranio Cervical Flexion Exercise for Mechanical Neck Pain. A randomized control trail will conduct at Railway general hospital(IIMCT). The sample size will be 68. TheParticipants will bedividing into two groups,34 participants in Group A (receive the Sub-Occipital Muscles Inhibition Technique) and 34 in Group B (receive Cranio Cervical Flexion Exercise). The study duration will 6 months. Purposive non probability sampling technique will be applied. Both male and female participants with mechanical neck pain will be include. Tools use in this study areNumerical Pain Rating Scale (NPRS), Neck Disability Index (NDI),Goniometer, Pressure Biofeedback unit, Digital Camera. Data analyzed through SPSS version 21.

Detailed Description
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Mechanical neck pain (MNP) is generalized neck or shoulder pain with mechanical characteristics (including symptoms provoked by neck postures, neck movement, or palpation of the cervical musculature). It has become an increasing problem causing functional disability in large populations. It is one of the most common musculoskeletal disorders in the neck region. Neck pain of mechanical origin constitutes approximately 45% - 50% of all neck pain. The variation in the prevalence ranges from 43.0% of the Swedish population, 34.4% of Norwegian adult population and In North America (Saskatchewan, Canada) lifetime prevalence of neck pain is 66.7%. The reason for this may lie in the increasing time spent on office and computer work. Also, a significant proportion of mechanical neck disorders consist of whiplash associated disorders (WAD), with a higher prevalence in women (22%) than in men (16%). Strong evidence suggests biomechanical factors, including prolonged computer use, and posture and repetitive movements are associated with the development of neck pain. Cervical joint dysfunction is the main cause of mechanical neck pain. One of the predominant mechanical events causing neck pain, is impaired stability of the cervical spine, which is often attributed to disturbances in motor control over the cervical spine. The stability of the cervical spine is dependent on the deep neck flexor and neck extensor muscles. The longuscolli and capitis are principal deep neck flexor muscles. In contrast, the suboccipital muscles are principal neck extensors of the upper cervical spine and are composed of the rectus capitis posterior major (RCPM), rectus capitis posterior minor (RCPm), obliquuscapitis superior (OCS), and obliquuscapitis inferior (OCI). There are varieties of physiotherapy interventions for the management of Mechanical neck pain such as spinal joint manipulation, mobilization techniques, massage techniques, suboccipital muscle inhibition technique, craniocervical flexion exercise, soft tissue techniques and trigger point [TrP] treatment , needling, active release techniques, stretches (static and isometric ), traction and various electro modalities.A very limited evidence found on comparison on effectiveness of sub occipital muscle release and Cranio-cervical flexion exercise. Previous studies only find out immediate effect (one session) on Cervical ROM and CVA. To fill the gap, this study is formulated to determine the effects of sub occipital muscle release and Cranio-cervical flexion exercise on ROM in the cervical spine and Cranio-vertebral angle (CVA) in mechanical neck pain. Study will find out most effective treatment for management of mechanical neck pain and would contribute to educate and treat the patient with most simple and effective treatment approach.

Official Title
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Effects of Sub-Occipital Muscles Inhibition Technique and Cranio Cervical Flexion Exercise for Mechanical Neck Pain

Conditions
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Cervical Pain, Mechanical Neck Pain

Intervention / Treatment
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* Other: Suboccipital Inhibition Technique
* Other: Cranio Cervical Flexion Exercises.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least five points on the neck disability index (NDI) 3 to 6 points in the numerical pain rating scale (NPRS) pain from more than 3 months Subjects were included if they had FHP as determined by the presence of a CVA < 48 Subjects will include if they have flexion <80°, extension<70°, lateral flexion <20° and rotation <90 Exclusion Criteria: History of traffic accidents History of lower extremity fracture and surgery Acute low back and neck pain History of lumbar and cervical herniated intervertebral disk and spinal stenosis History of cervical spine surgery and trauma History of vascular disease in the head and neck Progressive neuro logical deficits

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 35 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Cervical Rang of Motion Exercises.<br>Cervical exercises for mechanical neck pain. | Other: Suboccipital Inhibition Technique<br>* Suboccipital Inhibition Technique For 2min And Conventional Treatment Hot Pack For 10 To 15 Mints And Muscle Energy Technique(Post Facilitation Stretch) 5 Reps × 1 Set Sessions: 2 TIME A WEEK FOR 4 CONSECUTIVE WEEKS<br>|
| Experimental: Cervical Exercises.<br>Cervical exercises for the management of mechanical neck pain. | Other: Cranio Cervical Flexion Exercises.<br>* Cranio cervical flexion exercises10 repetitions for 10 seconds and conventional treatment hot pack for 10 to 15 mints and muscle energy technique(post facilitation stretch) 5 reps × 1 set Sessions: 2 TIME A WEEK FOR 4 CONSECUTIVE WEEKS<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck disability index | Changes from base line Northwick disability index was developed first in Northwick Park hospital, England. It was designed to measure the neck pain and disability over time. It consists of 10, five parts sections. At the end, score is calculated by dividing the obtained score by total (50) multiplied by 100. | 4th day. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating scale. | Changes from base Line Numeric Pain rating scale is a scale for pain starting from 0-10. Where 0 indicate no pain and 10 indicate severe pain. | 4th day | 
| Cranio vertebral angle | Changes from the Baseline Cranio vertebral angle will taken with the help of digital camera. | 4th day | 
| Rang of Motion of cervical spine. | Changes from the Baseline range of Motion of cervical spine willtake with the Help of Goniometer. | 4th day | 
| Cervical flexion exercise. | Changes from the Baseline cervical flexion exercise will access by pressure biofeedback unit. | 4th day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sub-Occipital Muscles Inhibition Technique, Cranio Cervical Flexion Exercise