Effect of Lumber Core Stability Exercises on Chronic Non-specific Neck Pain

Study Overview
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Brief Summary
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Chronic non-specific neck pain patients will be enrolled in 3 groups in this study including passive, active control and experimental groups to determine the effect of adding lumbar core stability exercises to patient's advices and cervical and scapular stabilization exercises. For the last two groups, the sessions will be applied 3 times per week for 4 weeks. All the outcomes will be measured after patient's enrollment and at the end of 4 weeks to determine the difference between groups.

Official Title
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Effect of Adding Lumbar Core Stability Exercises to Cervical and Scapular Stabilization Exercises and Advices on Chronic Non- Specific Neck Pain

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Advices
* Other: Cervical and Scapular Stabilization Exercises
* Other: Lumber Core Stability Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with persistent cervical pain for more than 12 weeks without specific diagnosis (chronic non-specific neck pain). BMI less than 30 kg/m2. Pain intensity on VAS should be more than 3. Patient will be able and motivated in completing the study. Psychologically & mentally stable. Exclusion Criteria: Red Flag's symptoms including a history of major trauma, persistent night pain, bladder or bowel dysfunction, and/or lower or upper extremity neurological deficit. Pregnant women. Recent or old fractures at spine or upper limbs. Congenital, or acquired postural deformity. No previous neck or spinal or shoulder surgery. No current pathologies (e.g. Disc lesion, nerve root compression, canal stenosis, spinal tumor, spinal infection, systemic inflammatory diseases, …).

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Advices Group<br>Patients in this group will take only advices about their postures and activities of daily living | Other: Advices<br>* The advices will include patient's reassurance and description of possible causes of neck pain such as poor working ergonomics, common bad postures especially while using electronic devices for long periods and not adjustable sleeping pillows. Also, patient will be educated how to modify these different causes and asked to apply gentle neck range of motion exercises<br>|
| Active Comparator: Cervical and scapular stabilization Group<br>Patients in this group will take advices and stability exercises for neck and scapula | Other: Advices<br>* The advices will include patient's reassurance and description of possible causes of neck pain such as poor working ergonomics, common bad postures especially while using electronic devices for long periods and not adjustable sleeping pillows. Also, patient will be educated how to modify these different causes and asked to apply gentle neck range of motion exercises<br>Other: Cervical and Scapular Stabilization Exercises<br>* Deep neck flexor training will be performed in neurodevelopment stages (supine at first week using pressure biofeedback unit , prone at second week, quadrupedal at third week, bipedal at fourth week). Scapular stabilization exercises will include modified prone cobra, trapezius muscle exercise progression (3 stages), wall press and extension of the thoracic spine using foam roller. The modified prone cobra and the first stage of trapezius muscle exercise progression will be applied during the first two weeks. The second and third stages of trapezius muscle exercise will be applied during the last two weeks of our rehabilitation program. All exercises will be applied for 10 repetitions with 6-10 sec hold for 3 sets with 20 sec rest between each set. While wall press and thoracic extension exercises will be applied throughout the 4 weeks for 3 sets of 10 repetitions with 20 sec rest between each set.<br>|
| Experimental: Neck, scapular and lumber stabilization Group<br>Patients in this group will take advices, and stability exercises for neck, scapula and lumber spine | Other: Advices<br>* The advices will include patient's reassurance and description of possible causes of neck pain such as poor working ergonomics, common bad postures especially while using electronic devices for long periods and not adjustable sleeping pillows. Also, patient will be educated how to modify these different causes and asked to apply gentle neck range of motion exercises<br>Other: Cervical and Scapular Stabilization Exercises<br>* Deep neck flexor training will be performed in neurodevelopment stages (supine at first week using pressure biofeedback unit , prone at second week, quadrupedal at third week, bipedal at fourth week). Scapular stabilization exercises will include modified prone cobra, trapezius muscle exercise progression (3 stages), wall press and extension of the thoracic spine using foam roller. The modified prone cobra and the first stage of trapezius muscle exercise progression will be applied during the first two weeks. The second and third stages of trapezius muscle exercise will be applied during the last two weeks of our rehabilitation program. All exercises will be applied for 10 repetitions with 6-10 sec hold for 3 sets with 20 sec rest between each set. While wall press and thoracic extension exercises will be applied throughout the 4 weeks for 3 sets of 10 repetitions with 20 sec rest between each set.<br>Other: Lumber Core Stability Program<br>* The program will be performed in three stages: activation, dynamic stabilization, and advanced core strengthening stages. Each stage will be applied for 4 sessions. The activation stage will be based on the learning to activate transversus abdominis muscle from crock lying position using pressure biofeedback unit. In the dynamic stabilization stage, the patient will be instructed to slowly raise both arms in the scapular plan then return to the sides while maintaining the transversus abdominis muscle activation. Also, the patient will apply bridging exercise in this stage. The advanced core strengthening stage will include prone plank and side plank (right and left sides). All the exercises will be applied for 10 repetitions with 6-10 sec hold for 3 sets. The rest of 20 sec will be taken between each set.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in pain intensity | Pain intensity will be assessed by using Visual analogue scale (VAS). It is horizontal line with 10 cm length, with Zero marked at one end representing no pain and 10 marked at the other end representing worst imaginable pain. | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change in functional disability | Functional disability will be assessed using Arabic version of neck disability index. The patients will be asked to make a mark in each section which most closely described their problem. Each section consists of six potential responses for each item ranging from no disability (0) to total disability (5). Thus, The NDI score ranges between 0-100, with higher scores indicating greater perceived disability. The score of less than 4 indicates no disability, 5-14 mild disability, 15-24 moderate disability, 25-34 severe disability, and scores greater than 35 complete disabilities. | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in Craniovertebral angle degree (CVA) | To measure CVA, the patient will be captured from the left side after putting landmarks on seventh cervical vertebra (c7) and tragus of the ear. The photograph will be taken and analyzed with kinovea software by drawing a horizontal line passing through C7 and line connecting between the tragus of the ear and C7 and measuring the angle between these lines. As the value of CVA decreases, the degree of FHP increases | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change of of deep neck flexor muscles (DNF) activation | DNF activation will be assessed by Craniocervical flexion test using Pressure biofeedback unit | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change of deep neck flexor (DNF) endurance | DNF endurance will be assessed by Neck flexor endurance test | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change of trunk flexor muscle endurance | Trunk flexor muscle endurance will be assessed by Trunk flexion test (McGill's test) | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change of trunk extensor muscle endurance | Trunk extensor muscle endurance will be assessed by Trunk extension test (Sorenson Test) | This outcome will be assessed at the first day and after 4 weeks following end of treatment | 
| change of lateral trunk muscle endurance | Lateral trunk muscle endurance will be assessed Side plank test for left and right sides | This outcome will be assessed at the first day and after 4 weeks following end of treatment |