Effect of Proprioceptive Training Using Head Mounted Laser in Chronic Mechanical Neck Pain

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to compare the effect of conventional physical therapy with and without cervical proprioceptive training using head-mounted laser system on cervical joint position sense error, pain, cervical range of motion and neck disability index. Proprioception disturbs in any function and structural impairments that is mechanical neck pain. Different studies has been done to find out the best therapy for pain management. Aim of the researcher is to give cost-effective, not so time-consuming, most effective physical therapy treatment. A literature gap exists on the effects of proprioceptive training combined with conventional physical therapy, no studies have directly compared the effect of proprioceptive training using head-mounted laser with and without conventional physical therapy. In our clinical setting, proprioceptive training for mechanical neck pain is not used as much as it should be. It would be a new thing to add and it can be cost-effective and better treatment for symptoms resolution

Detailed Description
-----------------
Mechanical neck pain (MNP) is a common condition, affecting 30% to 50% of the general population, and is most prevalent in middle age. It is responsible for reducing the quality of life and one of the leading causes of disability worldwide with annual prevalence of 48.5%. Mechanical neck pain is characterized by several structural and functional features. The causes of MNP include structural and functional impairment of cervical muscles, degenerative changes of cervical spine, arthritis, inflammation, and trauma, abnormal posture, and movements. Current studies have found that one of the main problems in patients with MNP is the impairment of cervical proprioception. decreased range of motion (ROM) and functional ability, greater muscle fatigability and a reduction in the strength and endurance capacity of the muscles. Despite neck disorders being so common in the population, little evidence supporting effective interventions has been identified. Conservative treatments used to help manage MNP are numerous and include usual medical care various forms of exercise, massage, and acupuncture. Medications, manual therapies, and exercise are the most widely used treatment modalities for MNP. 33% of individuals with neck pain sought care from physical therapy. Physical therapy improves pain, function and patient satisfaction in adults suffering from MNP, improves neck disability index. Physical therapy treatment includes cervical and thoracic spine mobilization/manipulation techniques active and passive exercise, ultrasound, transcutaneous electrical nerve stimulation, patient education. Spinal manipulative therapy (SMT), trigger point dry needling and trigger point manual therapy. Proprioception is the sense of perceiving self-movement, action of parts of the body and location. It is a term commonly used to describe the ascending information by the afferent receptors towards the central nervous system contributing to the neuromuscular control of movement and encompasses the sensation of joint movement (kinaesthesia) and joint position (joint position sense). Cervical spine has a very delicate proprioceptive system, which signals the position of the head relative to the trunk, coordinates the vestibular and visual systems and it plays a crucial role in controlling posture and balance and is of great importance for spatial orientation. The deficits of Proprioception of cervical spine have been associated with age, pain muscle fatigue, forward head posture, cervical spondylosis, reduced balance control and abnormal posture, decreased neck muscle strength and altered motor control in the cervical spine. In last two decades the interest in the assessment and treatment of proprioception of the cervical spine has increased exponentially. Cervical joint position sense (JPS) is a major component of proprioception and mainly reflects the ascending input (afferent) of cervical muscle, disc, capsule, and ligament receptors. Proprioception is evaluated using the Joint Position Sense Error (JPSE), which reflects a person's ability to accurately return his head to a predefined target after a cervical movement. Evidence to date suggests that the management of sensorimotor control disturbances due to chronic neck pain may need to address the primary causes and secondary effects of alterations in proprioceptive activity. A variety of treatments are available for cervical spine proprioception. It includes proprioception training, retraining of deep cervical flexor and extensor muscles, and etiological management of pain, strength training, cervical manipulation and acupuncture and many other conventional therapy protocols. Cervical proprioception training not only improves patient-perceived pain and disability but also has an effect on other aspects of neuromuscular function, specifically the coordination between the deep and superficial cervical flexors and balance.

Official Title
-----------------
Effect of Proprioceptive Training Using Head Mounted Laser in Chronic Mechanical Neck Pain

Conditions
-----------------
Mechanical Neck Pain

Intervention / Treatment
-----------------
* Other: Proprioceptive training using head mounted laser
* Other: Conventional Physical therpay


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Both genders Age: 45 to 55 years Mechanical neck pain more than 3 months (chronic stage) Individuals having cervical radiculopathy (Spurling Test A and Spurling test B +ve) Decreased Range of motion (Flexion 80 to 90*) (Extension 70*) (Lateral Flexion 20 TO 45*) (Rotation 90*) Numeric Pain Rating Scale: 5 to 08 Cervical spondylosis on Xray Exclusion Criteria: Individuals having vascular pathology of neck. Previous surgery related to cervical spine. Individuals having structural deformity of spine (Adam's forward bend test) Spinal Cord Injury /Cervical Myelopathy Malignancy and tumor Infection Previous history of Cervical spine fractures

Ages Eligible for Study
-----------------
Minimum Age: 45 Years
Maximum Age: 55 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: the participants are divided into two groups, control group will recieve conventional physical therapy and experimental group will recieve proprioceptive training with conventional physcial therapy.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Conventional Physical Therapy + Proprioceptive Training Using Head Mounted Laser<br>Conventional physical therapy along with proprioceptive training, head relocation practice that is relocating the head back to the natural head posture and to pre determined postions in range with eyes open. Tracing figure of eight with eyes open. 3 days per week for 4 weeks, 15 repititions, 1 set. | Other: Proprioceptive training using head mounted laser<br>* Exercises include head relocation practice, i.e., relocating the head back to the natural head posture and to pre-determined positions in range with eyes open using feedback from a laser attached to their head. And then tracing the figure of eight with the help of laser.<br>Other: Conventional Physical therpay<br>* Conventional physical therapy for mechanical neck pain which includes cervical range of motion (flexion, extension, lateral rotation, and rotation), neck isometric exercises, stretching's (scalene, trapezius, SCM) and TENS with heating pad.<br>|
| Other: Conventional Physical Therapy only<br>Conventional physical therapy, cervical range of motion (flexion, extension, lateral flexion and rotation), isometric exercises of neck muscles, stretching (scalene, trapezius, sternocleidomastoid), TENS, heating pad. 3 days per week for 4 weeks, 15 repitions, 1 set. | Other: Conventional Physical therpay<br>* Conventional physical therapy for mechanical neck pain which includes cervical range of motion (flexion, extension, lateral rotation, and rotation), neck isometric exercises, stretching's (scalene, trapezius, SCM) and TENS with heating pad.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cervical joint position sense error | use to assess proprioception | 4 weeks | 
| bubble inclinometer | use to assess cervical range of motion | 4 weeks | 
| numerical pain rating scale | used for assessment of pain in which 0 means no pain and 10 means severe pain | 4 weeks | 
| neck disability index | used for pain related disability in which 0-4 means no disability 5-14 means mild disability 15-24 means moderate disability, 25-34 means severe disability and 35-50 means complete disability | 4 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
proprioception, joint position sense error, head mounted laser, cervical range of motion