The effect of eight weeks of stabilizing exercises on balance, pain and sense of position in female students with chronic non-specific neck pain

Academic Thesis for Master's Degree in Physical Education and Sports Sciences

Strategy of Sports Pathology and Corrective Movements

Kidde:

The purpose of this research is the effect of 8 weeks of stabilizing exercises on balance, pain and neck position sense in girls with non-specific neck pain of Shahid Bahnar University, Kerman

In this study, 30 female students between the ages of 19-28 were randomly divided into two experimental groups (15 people) and control (15 people). In the experimental group, the average age was 23.83 ± 2.29, height was 160.33 ± 4.65, and weight was 56 ± 9.46, and in the control group it was 23.62 ± 1.55, 163.38 ± 6.89, and 55.92 ± 7.88. Balance (overall, anterior-posterior, internal-external) was measured with the Biodex balance meter, neck position sense (rotation to the right, rotation to the left, and flexion) with a laser cap and pain level was measured with the VAS scale. The participants of the experimental group performed stabilization exercises for eight weeks, and during this period the participants of the control group did not participate in physical activity. After this period, a post-test was taken from the people.

The independent t-test was used to compare the results between the control and experimental groups, and the dependent t-test was used to compare the pre-test and post-test in the experimental group, and SPSS 16 was used to analyze the data. The significance level of the data was considered less than 0.05.

The findings of the research showed that stabilizing exercises had a significant positive effect on the sense of neck position, balance (overall and anterior-posterior) and a significant reduction in the amount of pain among girls with non-specific neck pain. The effect of stabilizing exercises between the experimental and control groups on the internal-external balance index did not show a significant difference despite progress.

Key words: non-specific neck pain, position sense, balance, stabilizing exercises, girls

1-1 Introduction

Neck Pain is one of the common diseases (over 67%), especially in industrialized countries, which includes most age groups, even young people (Salehpour et al. 2011).  The prevalence of this complication is spreading alarmingly with the progress of societies. The duration of this condition is prolonged in most cases (at least up to 12 weeks) and after more than 12 weeks it enters the chronic stage, in such cases it is diagnosed as chronic neck pain (Akbari et al. 2018).  In 70% of neck pain patients, there is no defined diagnosis based on the involved structure, and no specific pathological cause is found for the neck pain of these patients, in such cases it is known as non-specific neck pain (Salimi et al. 2013). It is defined as disc herniation, pressure on the nerve root and destructive bone changes. Sensory-motor function changes in this type of neck pain include: pain and inflammation, increase in inflammatory mediators, fatigue, change in movement patterns and muscle dysfunction, which causes changes in the quantity and quality of proprioceptive information in this area and imbalance (Sadat et al. 2012). It plays an important role. The cooperation of these systems leads to the control of stature and balance (Sadeghi et al. 2009). A review of articles shows that following neck discomfort, there is a disturbance in maintaining posture and controlling balance (Salehpour et al. 2011). The neck contains mechanisms that are directly involved in the control of balance, and there are special connections between neck receptors, the visual system, the vestibule, and the sympathetic nervous system. Therefore, the proprioceptive system of the neck plays an important role in maintaining body balance (Cornell [1] 2002).

The proprioceptive sense consists of the sense of position, the sense of movement, and the sense of applying force, which refers to the conscious understanding of the body's position in space (Phil Page [2] 2006).. Proprioceptive receptors together with visual and vestibular sense messages interacting with each other through cervical-ocular, cranial-neck, cervical tonic and vestibular-spinal reflexes, cause coordination between the head and eyes and the stability of the person's position (Saadat 2012, Trillion [3] 2008) and include mechanical receptors in the joints between the neck vertebrae, mechanical receptors in the neck muscles, spindles located in the muscles (Tavani 2013).

The muscles of the neck area have the highest amount of muscle spindles in the body (200 spindles per gram) compared to the number of muscle spindles in the palm area (16 spindles per gram). On the other hand, the placement of spindles in neck muscles is different from other body muscles. The spindles in the muscles are parallel or parallel, the spindles in the neck are mostly parallel. It is believed that these types of spindles are used to increase static information from these muscles, so the high density and specific shape of neck muscle spindles reveal the importance of proprioceptive information and the key role of this area in head position, body balance, and eye movement control (Trillion 2008).                                              

Studies have shown that the prevalence of neck pain in women is higher than in men. 15% of women and 10% of men suffer from chronic neck pain at some point in their lives (Jovanshir 2019). Despite the equal head weight of women and men, the strength of women's neck muscles is about half of men's, which is probably the relatively weak muscles of women, leading to the occurrence of muscle fatigue syndrome and, as a result, a higher prevalence of neck pain (Maarofi et al., 2010). Thus, in the neck region, approximately 20% of the head weight is controlled by the bone-ligamentous structure, and the rest, i.e., most of the head weight, is supported by the paraspinal muscles.  Obviously, with the weakness of these muscles, the stability of the neck spine is disturbed and causes pain (Cha[4] 2010).  Muscle pains can have an inhibitory effect on the muscles that control stability, and because the neck muscles play a major role in maintaining the vertical alignment of the body in connection with the vestibular system and the eyes, it becomes problematic and this affects the anti-gravity muscles, especially the leg muscles, in control strategies (ankle strategy) (Salehpour 2011).  In the presence of pain, the control and stability of the cervical spine is compromised (Salimi et al. 2013).

Therefore, since the neck stabilizing muscles are important in creating a proper position in the neck, it is obvious that these muscles have an effect in creating stability during a dynamic activity. If there is pain, these muscles are atrophied and do not work properly. On the other hand, there is no documentation of a standard therapeutic approach to the treatment of the disease, neither active nor passive conservative approaches, although widely prescribed; Recently, researchers have shown that multifactorial methods (postural correction methods, manual therapies, psychology, relaxation methods) compared to old methods (ultrasonic waves and electrical stimulation) in patients with chronic neck pain, cause a greater reduction in pain and a quick return to work (Akbari et al. 2018). Due to the fact that exercise therapy as an effective method has always been of interest to researchers, stability exercise therapy for spinal disorders has been the subject of many new studies in the field of treating skeletal-muscular complications of this area, and neck stabilization exercise is a method designed to improve the internal mechanisms of the spine and makes the neck vertebrae stable and invulnerable (Akbari 2018). Therefore, since few researches have been done in this field and women are more prone to neck pain than men, the aim of this research will be the effect of 8 weeks of stabilization exercises on the amount of pain, balance and sense of neck position in girls with non-specific neck pain of Shahid Bahonar University of Kerman.                             

1-2 Defining the problem and stating the main research questions

Neck pain is one of the most common and painful musculoskeletal conditions. Its lifetime prevalence ranges from 14% to 71% (Tsakidzidis[5] 2013). Neck pain can be acute, subacute or chronic. Pain or disability up to 4 weeks is called acute, 4-12 weeks subacute and more than 12 weeks chronic (Palmgreen[6] et al. 2009).

Studies have shown that 30% of men and 43% of women experience neck pain once in their lifetime.