Neck and Scapula-Focused Exercise Training on Patients With Nonspecific Neck Pain: A Randomized Controlled Trial

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Objectives: The purpose of this study was to investigate the effects of additional 6-week scapular stabilization training in patients with nonspecific neck pain (NNP). Materials and Methods: A total of 30 patients with NNP were randomly allocated to the study. Fifteen participants in the intervention group received neck-focused exercise and scapular stabilization training, whereas 15 participants in the control group received neck-focused exercise training. All groups were evaluated at baseline and after 6 weeks of rehabilitation. The pain intensity on the neck was measured with the visual analog scale (VAS). The self-reported disability status was measured with the neck disability index (NDI). Three-dimensional scapular kinematics were recorded during dynamic shoulder elevation trials using an electromagnetic tracking device, and data were further analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevations. Results: Comparisons revealed that, regardless of the received treatment, after 6 weeks of training both groups showed significant improvements in VAS (P < .001) and NDI (P < .001) scores. Both VAS and NDI outcomes have a large effect size (r = .618 and r = .619, respectively). For scapular kinematics, there were no group differences, especially for scapular upward–downward rotation and anterior–posterior tilt (P > .05). However, in the intervention group, the scapula was more externally rotated at 120° humerothoracic elevation (P = .04). Conclusion: Findings of this study showed that both manual therapy and active interventions, including neck-focused exercise and scapular stabilization training, are effective in decreasing pain and disability level in patients with NNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of scapular stabilization training in patients with NNP.

The authors are with the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.

Yildiz (yldztahaibrahim@gmail.com, tahayildiz@hacettepe.edu.tr) is corresponding author.
  • 1.

    Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009;32(2):46–60. doi:10.1016/j.jmpt.2008.11.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Feng B, Liang Q, Wang Y, Andersen LL, Szeto G. Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China. BMJ Open. 2014;4(12):e006451. PubMed ID: 25526795 doi:10.1136/bmjopen-2014-006451

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52(4):424–427. PubMed ID: 20357682 doi:10.1097/JOM.0b013e3181d44f3b

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998;77(1):1–13. PubMed ID: 9755013 doi:10.1016/S0304-3959(98)00058-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Guzman J, Hurwitz EL, Carroll LJ, et al. A new conceptual model of neck pain: linking onset, course, and care: the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009;32(2):S17–S28. doi:10.1016/j.jmpt.2008.11.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ha SM, Kwon OY, Yi CH, Jeon HS, Lee WH. Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome. Man Ther. 2011;16(6):585–589. PubMed ID: 21705260 doi:10.1016/j.math.2011.05.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Lluch E, Arguisuelas MD, Quesada OC, et al. Immediate effects of active versus passive scapular correction on pain and pressure pain threshold in patients with chronic neck pain. J Manipulative Physiol Ther. 2014;37(9):660–666. PubMed ID: 25282679 doi:10.1016/j.jmpt.2014.08.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon. 2002;33(1):75–84. PubMed ID: 11831210 doi:10.1016/S0003-6870(01)00043-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Helgadottir H, Kristjansson E, Mottram S, Karduna A, Jonsson H Jr. Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash-associated disorder. J Appl Biomech. 2011;27(3):181–191. PubMed ID: 21844606 doi:10.1123/jab.27.3.181

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Helgadottir H, Kristjansson E, Mottram S, Karduna A, Jonsson H Jr. Altered scapular orientation during arm elevation in patients with insidious onset neck pain and whiplash-associated disorder. J Orthop Sports Phys Ther. 2010;40(12):784–791. PubMed ID: 20972341 doi:10.2519/jospt.2010.3405

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Zakharova-Luneva E, Jull G, Johnston V, O’Leary S. Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. J Manipulative Physiol Ther. 2012;35(5):346–353. PubMed ID: 22608287 doi:10.1016/j.jmpt.2012.04.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Behrsin JF, Maguire K. Levator scapulae action during shoulder movement: a possible mechanism for shoulder pain of cervical origin. Aust J Physiother. 1986;32(2):101–106. PubMed ID: 25026444 doi:10.1016/S0004-9514(14)60646-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review. J Electromyogr Kinesiol. 2015;25(2):371–386. PubMed ID: 25683111 doi:10.1016/j.jelekin.2015.01.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004;29(13):1436–1440. PubMed ID: 15223935 doi:10.1097/01.BRS.0000128759.02487.BF

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):S90–S98. doi:10.1016/j.pain.2010.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Van Dillen LR, McDonnell MK, Susco TM, Sahrmann SA. The immediate effect of passive scapular elevation on symptoms with active neck rotation in patients with neck pain. Clin J Pain. 2007;23(8):641–647. PubMed ID: 17885341 doi:10.1097/AJP.0b013e318125c5b6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Cagnie B, Struyf F, Cools A, Castelein B, Danneels L, O’Leary S. The relevance of scapular dysfunction in neck pain: a brief commentary. J Orthop Sports Phys Ther. 2014;44(6):435–439. PubMed ID: 24816504 doi:10.2519/jospt.2014.5038

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48:692–697. PubMed ID: 23687006 doi:10.1136/bjsports-2013-092148

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Celenay ST, Kaya DO, Akbayrak T. Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: a prospective, randomised controlled trial. Man Ther. 2016;21:144–150. PubMed ID: 26211422 doi:10.1016/j.math.2015.07.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142–151. PubMed ID: 12670140 doi:10.5435/00124635-200303000-00008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Macdermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39(5):400–417. PubMed ID: 19521015 doi:10.2519/jospt.2009.2930

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Hartling L, Brison RJ, Ardern C, Pickett W. Prognostic value of the Quebec classification of whiplash-associated disorders. Spine. 2001;26(1):36–41. PubMed ID: 11148643 doi:10.1097/00007632-200101010-00008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Malanga GA, Landes P, Nadler SF. Provocative tests in cervical spine examination: historical basis and scientific analyses. Pain Phys. 2003;6(2):199–206.

    • Search Google Scholar
    • Export Citation
  • 24.

    Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2):2325967115627608. PubMed ID: 26962539 doi:10.1177/2325967115627608

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835–1843. PubMed ID: 12221344 doi:10.1097/00007632-200209010-00004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kennedy C. Therapeutic exercise for mechanical neck pain. In: de las Penas CF, Cleland J, Dommerholt J, eds. Manual Therapy for Musculoskeletal Pain Syndromes: An Evidence and Clinical-Informed Approach. Churchill Livingstone, England: Elsevier Health Sciences;2015:174.

    • Search Google Scholar
    • Export Citation
  • 27.

    Camci E, Duzgun I, Hayran M, Baltaci G, Karaduman A. Scapular kinematics during shoulder elevation performed with and without elastic resistance in men without shoulder pathologies. J Orthop Sports Phys Ther. 2013;43(10):735–743. PubMed ID: 24256172 doi:10.2519/jospt.2013.4466

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques: The Upper Body. Vol 1. Churchill Livingstone, England: Elsevier Health Sciences; 2008.

    • Search Google Scholar
    • Export Citation
  • 29.

    Tuttle N. Do changes within a manual therapy treatment session predict between-session changes for patients with cervical spine pain? Aust J Physiother. 2005;51(1):43–48. PubMed ID: 15748124 doi:10.1016/S0004-9514(05)70052-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Cleland JA, Childs JD, Whitman JM. Psychometric properties of the neck disability index and numeric pain rating scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008;89(1):69–74. PubMed ID: 18164333 doi:10.1016/j.apmr.2007.08.126

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409–415. PubMed ID: 1834753

  • 32.

    Meskers C, Fraterman H, Van der Helm F, Vermeulen H, Rozing P. Calibration of the “Flock of Birds” electromagnetic tracking device and its application in shoulder motion studies. J Biomech. 1999;32(6):629–633. PubMed ID: 10332628 doi:10.1016/S0021-9290(99)00011-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Wu G, Van der Helm FC, Veeger HD, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand. J Biomech. 2005;38(5):981–992. PubMed ID: 15844264 doi:10.1016/j.jbiomech.2004.05.042

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Meskers C, Van der Helm FC, Rozendaal L, Rozing P. In vivo estimation of the glenohumeral joint rotation center from scapular bony landmarks by linear regression. J Biomech. 1997;31(1):93–96. doi:10.1016/S0021-9290(97)00101-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Karduna AR, McClure PW, Michener LA, Sennett B. Dynamic measurements of three-dimensional scapular kinematics: a validation study. J Biomech Eng. 2001;123(2):184–190. PubMed ID: 11340880 doi:10.1115/1.1351892

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Wuensch K. Cohen’s conventions for small, medium, and large effects. 2009. http://core.ecu.edu/psyc/wuenschk/docs30EffectSizeConventions.pdf. Accessed June 04, 2018.

    • Export Citation
  • 37.

    Miller J, Gross A, D’sylva J, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15(4):334–354. PubMed ID: 20593537 doi:10.1016/j.math.2010.02.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1–A34. PubMed ID: 18758050 doi:10.2519/jospt.2008.0303

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    O’Riordan C, Clifford A, Van De Ven P, Nelson J. Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. Arch Phys Med Rehabil. 2014;95(4):770–783. doi:10.1016/j.apmr.2013.11.015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ. 2003;327(7413):475. PubMed ID: 12946968 doi:10.1136/bmj.327.7413.475

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Helgadottir H, Kristjansson E, Einarsson E, Karduna A, Jonsson H. Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. J Electromyogr Kinesiol. 2011;21(6):947–953. PubMed ID: 21889362 doi:10.1016/j.jelekin.2011.07.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Gajdosik RL. Passive extensibility of skeletal muscle: review of the literature with clinical implications. Clin Biomech. 2001;16(2):87–101. doi:10.1016/S0268-0033(00)00061-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Camargo PR, Alburquerque-Sendín F, Avila MA, Haik MN, Vieira A, Salvini TF. Effects of stretching and strengthening exercises, with and without manual therapy, on scapular kinematics, function, and pain in individuals with shoulder impingement: a randomized controlled trial. J Orthop Sports Phys Ther. 2015;45(12):984–997. PubMed ID: 26471852 doi:10.2519/jospt.2015.5939

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Hibberd EE, Oyama S, Spang JT, Prentice W, Myers JB. Effect of a 6-week strengthening program on shoulder and scapular-stabilizer strength and scapular kinematics in division I collegiate swimmers. J Sport Rehabil. 2012;21(3):253–265. PubMed ID: 22387875 doi:10.1123/jsr.21.3.253

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther. 2004;84(9):832–848. PubMed ID: 15330696

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663–694. PubMed ID: 11304107 doi:10.7326/0003-4819-134-8-200104170-00012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001;10(3):269–277. doi:10.1067/mse.2001.112954

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300–305. PubMed ID: 19996329 doi:10.1136/bjsm.2009.058834

  • 49.

    Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am. 2009;91(2):378–389. PubMed ID: 19181982 doi:10.2106/JBJS.G.01483

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Thigpen CA, Padua DA, Michener LA, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20(4):701–709. PubMed ID: 20097090 doi:10.1016/j.jelekin.2009.12.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Crow J, Pizzari T, Buttifant D. Muscle onset can be improved by therapeutic exercise: a systematic review. Phys Ther Sport. 2011;12(4):199–209. PubMed ID: 22085715 doi:10.1016/j.ptsp.2010.12.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain. 2010;14(8):832–839. PubMed ID: 20181504 doi:10.1016/j.ejpain.2010.01.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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