Cranio- Cervical Flexion Training With and Without Pressure Biofeedback in Mechanical Neck Pain

Not Applicable

Completed

Interventions: Other: Craniocervical flexion training without pressure biofeedback
Device: Craniocervical flexion training with pressure biofeedback

Brief Summary: The superficial neck flexor musculature has been given considerate amount of attention to explore its effects on the cervical pain in several researches.. This study intends to put through the benefits of deep cervical flexor training for treatment of cervical neck pain patients.This study will also compare the effects of Cranio cervical flexion training with and without pressure biofeedback on neck pain, muscular endurance,forward head posture and cervical mobility in mechanical neck pain.

Detailed Description: The study is Randomized Control Trail, which is being conducted in physical therapy Outpatient department of Pakistan Railway hospital. Sample size of 24 individual was calculated using Epitool with 95% confidence interval (CI) and power 80%. Individual will be screened out according to inclusion criteria. Individuals will be allocated randomly into two groups, 12 in Craniocervical flexion training with pressure biofeedbackgroup and 12 in Craniocervical flexion training without pressure biofeedbackgroup by sealed envelope method.

Deep neck flexor endurance techniquewas used totrain theCraniocervical flexor muscles in control group.Craniocervical flexion technique with Pressure biofeedback unit's was positioned behind the neck just below the occiput was used to train the endurance of the Craniocervical flexor muscle in experimental group.

Assessment will be done on baseline and 4th week. Data will be analyzed on SPSS version 21.

Recruitment & Eligibility

Inclusion Criteria

• Patients with Chronic mechanical neck pain for more than 3 months duration
- subjects with aged 25-40 years
- Numeric pain rating scale (NRPS) greater than 3.
- Patients with Forward neck posture and a Craniovertebral angle less than 48°

Exclusion Criteria

• History of neck surgery, cervical trauma Spinal cord compression, Spinal tumor, Spinal instability
- History of Spinal fracture, inflammatory disease of spine, Spinal infections, significant neurological deficit, Congenital or acquired postural deformity, doing prescribed exercise for cervical spine.
- Neck or shoulder pain from non-musculoskeletal causes, demonstrated neurological signs, or had a history of malignancy, current pregnancy.

Arm && Interventions

Group	Intervention	Description
Group 2	Craniocervical flexion training without pressure biofeedback	This group will receive Cranio cervical flexion training without pressure biofeedback protocol
Group 1	Craniocervical flexion training with pressure biofeedback	This group will receive Cranio cervical flexion training with pressure biofeedback protocol.

Primary Outcome Measures

Name	Time	Method
CROM-Flexion	Post 6th Week	A cervical range of motion (CROM) goniometer will be used to assess cervical range of motion in flexion, extension. Participants will be seated upright and asked to actively move their neck in each direction.
CROM-Extention	Post 6th Week	A cervical range of motion (CROM) goniometer will be used to assess cervical range of motion in flexion, extension. Participants will be seated upright and asked to actively move their neck in each direction.
Deep neck Flexor endurance	Post 6th Week	Deep neck flexor endurance test: (Clinical test of endurance for control group)
Numeric pain rating scale (NPRS)	Post 6 week	Numeric pain rating scale (NPRS) is an 11 point (0-10) Scale used to measure pain. Patient verbally select value between (0-10) on the basis of intensity of pain. (0) means No pain and (10) means maximum pain experienced at baseline.
Craniocervical flexion test (Clinical test of endurance for experimental group)	Post 6th week	The cranio cervical flexion test (CCFT) is used to assess endurance of the deep cervical flexors. A pressure biofeedback unit is inflated to 20 mmHg and is placed behind the neck. While keeping the back of the head stable, the patient performs cranial cervical flexion in a graded fashion in 5 increments (22, 24, 26, 28, and 30 mmHg). Each position is held for 10 seconds with 10 seconds rest between increments.. The test is ended when the pressure decreases \>20% or when substitution occurs during the head nod.

Secondary Outcome Measures

Name	Time	Method
Cranio-vertebral angle	Post 6th week	On protractor tool was used to measure forward head posture through a craniovertebral angle (CVA).. It has excellent reliability value (ICC 0.991).Participants were asked to sit on a stool and concentrate at a specific point on their eye level.Then we used three markers: one on C7, the other on tragus and the third on canthus. The angle between the line connecting C7 to tragus and a vertical line extending from C7 was calculated and images were taken. Patients having a Craniovertebral angle less than 48°were considered in category of forward head posture.