JIBI PAUL1, THENMOZHI S 2
2BPT Intern, Faculty of Physiotherapy, DR.MGR.Educational and Research Institute, Velappanchavadi, Chennai,India
Corresponding Author:1Professor, Faculty of Physiotherapy, ACS Medical College and Hospital, Dr M.G.R. Educational and Research Institute University, Chennai. Mail id: email@example.com
Back and objective of the study: Individual with neck pain that lack an identifiable patho-anatomic cause for their symptoms are usually classified as having mechanical neck pain. Stretching is believed to provide many physical benefits including improved flexibility, injury prevention, improved muscle or athletic performance.Aim of the study was to find out the effects of static stretching and dynamic stretching on mechanical neck pain and also to compare the effectiveness between static and dynamic stretching on mechanical neck pain.
Methodology: Comparative study withQuasi Experimental design conducted at ACS Medical College and hospital, Chennai. Both genders of thirty patients were selected for the study. Convenient sampling method used to select the samples on the basis of selection criteria. Visual analogue scale and neck disability index were used as measurement tools for data collection. The study conducted for duration of four weeks.
Results: The results shows significant difference in neck pain and neck function between static stretching and dynamic stretching with F value 1733 and <0.0001. Static stretching found more effective than and dynamic stretching with more mean difference of VAS and NDI scores 5.33 and 22.8 compared to 1.73 and 12 respectively.
Conclusion: The static stretching is more effective than dynamic stretching in improving pain and functional disability in patients with mechanical neck pain.
Keywords: Mechanical neck pain, Neck Disability Index, Static stretching, Dynamic stretching
Received on 11th February 2019, Revised on 24th February 2019, Accepted on 28th February 2019
Mechanical neck pain is one the common musculoskeletal disorder. Roughly two thirds of the general population has neck pain at some time in their lives and the prevalence is highest in middle age.
Neck pain as defined by Mersky is the pain “anywhere within the region bounded superiorly by superior nuchal line, inferorly by an imaginary line through the tip of the first thoracic spinous process and laterally by sagital plane tangential to the lateral borders of the neck 1,2.
Individuals with neck pain that lack an identifiable pathoanatomic cause for their symptoms are usually classified as having mechanical neck pain. This type of pain is also known as non-specific or simple neck pain disorder. Pain prevalence ranges from 6% to 22% and upto 38% of the elderly population, while lifetime prevalence ranges from 14.2 to 71% 3, 4.
It arises insidiously and is generally multifactorial in origin, including poor posture, anxiety, depression, neck strain and sporting or occupational activities. In an estimated 50-80% of cases involving back or neck pain,an underlying pathology cannot be definitively determined. Upper trapezius and levator scapulae are the most common postural muscles that tend to get shorten leading to restricted neck mobility 5, 6.
Stretching is believed to provide many physical benefits including improved flexibility, injury prevention, improved muscle or athletic performance, improved running economy, promotion of healing and possibly decreased onset of muscle soreness 7, 8, 9.
Objectives of the study: The main objective of the study is to compare the effectiveness of static stretching over dynamic stretching among mechanical neck pain patients. The secondary objective of the study was to find the effect of static stretching and dynamic stretching among mechanical neck pain patients.
Comparative study withQuasi Experimental design conducted at ACS Medical College and hospital, Chennai. Both genders with age group between 19 to 30 years of thirty patients were selected for the study. Convenient sampling method used to select the samples on the basis of selection criteria. Visual analogue scale and neck disability index were used as measurement tools for data collection. The study conducted for duration of four weeks.
Procedure: On base of selection criteria 30 mechanical neck pain patients were included for the study and equally divided into two groups. Baseline measurements and post data after the treatment were taken from all the patients for pain intensity (VAS) and NDI score.
Measurement of Pain: Pain intensity was evaluated by means of a Visual Analogue Scale (VAS) ranging from 0 cm to 10 cm, wherein the patient marked a point according to her level of pain, a higher score corresponded to more intense pain 10.
Measurement of neck function: Neck Disability Index used to collect data for neck function from the patients. The NDI questionnaire was filled by patients them self 11.
Group A: Consists of 15 patients with mechanical neck pain. Patients in Group A received static stretching for upper trapezius and levator scapulae muscle, 3 times a week. Dosage for stretch was 5 repetition held for 30 seconds followed by 10 seconds rest for each session.
1.Static stretching of upper trapezius: Ask the patient to put the right hand behind lower back/ tilt head to left, followed by slow deep breaths.
2.Static Stretching of Levator Scapulae: Ask the patient to rotate the head 45 degree to left. Place the left hand behind the head and gently pull it an angle toward knee for 30 sec.
Group B: Consists of 15 patients with mechanical neck pain. These patients received dynamic stretching for upper trapezius and levator scapulae muscle, 3times a week.
1.Dynamic stretching of upper trapezius: Ask the patient to bring the chin down to the chest, and bring the head to neutral.
2.Dynamic stretching of levator scapulae: The patient inSitting or standing with upright position and shrugging your shoulders toward your ears. Keep your arms straight and at your sides. Begin with a fluid up and down movement and then hold your shoulders at the top of the stretch for a few seconds.
Statistical Analysis: The collected values were tabulated and analyzed using interferential statistics. Dependent t test used to find the effect of static stretching and dynamic stretching among mechanical neck pain patients. ANOVA used to compare the effectiveness of static stretching over dynamic stretching among mechanical neck pain patients.
The results shows significant difference in neck pain and neck function between static stretching and dynamic stretching with F value 1733 and <0.0001. Static stretching found more effective than and dynamic stretching with more mean difference of VAS and NDI scores 5.33 and 22.8 compared to 1.73 and 12 respectively.
The above table 1 shows significant difference in VAS after static stretching exercise with mean difference of 5.33 and P<0.0001among mechanical neck pain patients.
The above table 2 shows significant difference in Neck Disability Index after static stretching exercise with mean difference of 22.8 and P<0.0001among mechanical neck pain patients.
The above table 3 shows significant difference in VAS after dynamic stretching exercise with mean difference of 1.73 and P<0.0013 among mechanical neck pain patients.
The below Table 4 shows there is significant difference in NDI between the pre and post test values (p<0.0001).
Static stretching found more effective than and dynamic stretching with more mean difference of VAS and NDI scores 5.33and 22.8 compared to 1.73 and 12 respectively.
A comparative study with 30 patients with mechanical neck pain was undertaken. Each group consisted of 15 patients. Group A received static stretching and Group B received dynamic stretching. In this study static stretching showed beneficial results in treatment of mechanical neck pain. So Group A has shown improvement than Group B which is proved statistically 12, 13.
The reduction in the pain following static stretching can be explained on the basis of inhibitory effect of GTO (which causes a dampening effect on the motor neuronal discharges, thereby causing relaxation of the musculo-tendinous unit by resulting its resting length and pancinian corpusule modification. These reflexes will allows relaxation in musculotendinous unit tension and decreased pain perception. Most authors suggest that 10-30 seconds is sufficient for increasing flexibility 14, 15, 16.
Ylinen et al found significant decrease in neck pain in the stretching group after 4 weeks. The results show that Static stretching is more effective than dynamic stretching in subjects with mechanical neck pain. In a study conducted by (Mohammad Taghi et.al, 2011) static stretching exercises have a positive impact on the range of motion. The results prove that static stretching exercises are suitable to be used to improve the flexibility and range of motion 17, 18, 19.
Ethical clearance: Ethical clearance has obtained from the Institution to conduct this study with reference number: IV C-026/PHSIO/IRB/2017-18dated 08/01/2018.
Conflict of interest: There was no conflict of interest to conduct this study.
Fund for this study: Self
The study concluded that static stretching is more effective than dynamic stretching in improving pain and functional disability among patients with mechanical neck pain.
Limitations: The study was performed only for age group between 19-30 years. Study sample size was small and conducted for a short duration of two weeks.
1. R. Fejer, K. O. Kyvik, J. Hartivigsen (2006). The prevalence of neck pain the world population; a systematic critical review of the literature. Eur spine J,15, PP.834-848.
2. Andrews JR, Harrelson GL, Wilk K E (2004). Physical Rehabilitation of the injured Athelete 3rd ed.Elsevier; 129-156.
3. Cleland J A,Childs J D Whitman J M. (2008). Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.Arch Phys Med Rehabil. 89:69-72.
5. Muchugh MP, Mafnusson S P, Gleum GW,Nicholas J A (1992).Visoelastic stress relaxation in human skeletal muscle,Med sports Exercise.;24(12):1375-1382.
6. Bandy W D,Irion JM. (1994). The effect of time on static stretch on the flexibility of the hamstring muscles.Phys Ther.sep 74(9):845-850.
7. Law Ry,Harvey LA,Nicholas MK,Tonink L,De sousa M,Finniss DG (2000). Stretch exercise increase tolerance to stretch in patients with chronic musculoskeletal pain;a randomized controlled trial.Phys Ther. 89(10):1016-1026.
8. Binder A I. (2007). Cervical spondylosis and neck pain, BMJ; 334 (7592) :52731.
9. Hakkien A (2007). Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain.Rehab Med:39:575-9.
10. Prince DD, McGrath PA, RafiiA, Buckingham B. (1983).The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.Pain;17:45-56.
11. Dutton M.(2008). Orthopaedic Examination, Evaluation and Intervention. 2nd ed. The McGraw – Hill Companies;:1263-1364.
12. Borstad J D , Ludewig P M. (2006). Comparison of three stretches for the pectoralis minor muscle.J Shoulder Elbow Surg:15:324-30.
13. Herling D, Kessler R M. (1996).Management of common musculo skeletal disorders, physical therapy: principles and practice. 3rd ed. Philadelphia:Lippincott Wilams & Wilkins;:114-210.
14. Power K., Behm D., Cahill F., Carroll M., Young W.(2004) An acute bout of static stretching: effects on force and jumping performance. Medicine and Science in sports and exercise 36, 1396.
15. Frontera W R. (2003). Rehabilitation of Sports Injuries: Scientific Basis. 1st ed. Mayfield publication; 232-257.
16. Leaver A M, Refshayge KM, Maher CG, Latimer J, Herbert RD, Jull G, Mc Auley JH. (2007). Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomized controlled trial. BMC Musculoskeletal Disord; 8:18
17. De Wajer VC, Gorniak GC, Shamus E. (2003).The Effect of Static stretch and Warm-up Exercise on Hamstring Length over the Course of 24 Hours. J Orthop Sports Phys Ther. 33: 727-733.
18. Hush JM, Maher CG, Refshauge KM. (2006). Risk factors for neck pain in office workers: A prospective study.BMC Musculoskelet Disord.; 7: 81.
19. Bovim G, Schrader H, Sand T. (1994). Neck pain in general population. Spine (Phila PA 1976) 19:1307-9.
Jibi Paul, Thenmozhi S (2019).Comparative Study Between Static Stretching And Dynamic Stretching On Mechanical Neck Pain, ijmaes; 5(1); 552-558.