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Objective: To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors., Design: A prospective cohort study with a 6-month follow-up between January 2020 and March 2023., Setting: 30 physiotherapy primary care practices., Participants: Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset., Baseline Measures: Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude., Outcome Measures: Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain., Results: 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R 2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer-Lemeshow test yielded a p-value of 0.7167, indicating a good model fit., Conclusion: This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Chronic neck pain has a significant impact on the patient's quality of life. Specific outcome measures like Copenhagen Neck Functional Disability Index (CNFDI), Neck Bournemouth questionnaire (NBQ), and Spine Functional Index (SFI) are reliable and valid measures that have been used for comprehensively evaluating neck-related disabilities. However, responsiveness has not yet been investigated. The aim of this study was to examine the responsiveness and clinically meaningful changes of the CNFDI, NBQ, and SFI for Persian patients with chronic neck pain., Methods: Prospective recruitment of 145 patients with chronic neck pain was conducted. Participants completed the Persian versions of CNFDI, NBQ, and SFI at baseline and after 4 weeks of physical therapy. Also, the Global Rating of Change Scale (GRCS) was completed in the post-intervention assessment. The Receiver Operating Characteristics (ROC) curve and correlational analysis were used for evaluating the responsiveness. In addition, the Minimal Clinically Important Change (MCIC) was determined., Results: All selected outcome measures revealed an area under the curve of 0.96. The MCICs of 10, 7, and 10 points were found for the CNFDI, NBQ, and SFI, respectively. The results showed an excellent Gamma correlation coefficient of the CNFDI ( γ  = 0.98), NBQ ( γ  = 0.99), and SFI ( γ  = 0.99) with the GRCS., Conclusion: The Persian versions of the CNFDI, NBQ, and SFI have acceptable responsiveness properties for evaluating the changes in health status in patients with chronic neck pain following physical therapy interventions.

Background: Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term., Objective: To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises., Methods: This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of "quite a bit better" (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment., Results: NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover., Conclusion: The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms.

Background: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP., Methods: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%., Discussion: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis., Trial Registration: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27., (© 2024. The Author(s).)

Purpose: Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C 0 )., Methods: CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint., Results: Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C 0 , CA-M participants had statistically significant reductions in pain-related disability at 3-months (-3.4, 95%CI = [-5.8, -1.0]; p = .006) and 6-months (-4.6, 95%CI = [-7.0, -2.1]; p < .001) and pain severity at 3-months (-1.3, 95%CI = [-1.9, -0.8]; p < .001) and 6-months (-1.0, 95%CI = [-1.6, -0.4]; p = .007), respectively., Conclusion: In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C 0 , despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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BACKGROUND The purpose of this study was to investigate the effects of eyeball exercise and cervical stabilization programs to patients with chronic neck pain, tension-type headache (TTH), and forward head posture (FHP). MATERIAL AND METHODS The design of this study was a randomized controlled trial. A total of 40 participants were randomly divided into 2 groups: the experimental group (n=20) and the control group (n=20). Both groups received cervical manual therapy and biofeedback-guided stabilization exercises (30 min/session, 3 sessions/week, 6 weeks). In addition to the regular treatments, the participants in the experimental group also performed eyeball exercises for 20 minutes per session, 3 sessions per week, for a total of 6 weeks. Changes in neck pain (numeric rating scale, NRS), neck disability index (NDI), quality of life (Short Form-12 Health Survey Questionnaire, SF-12), headache impact test-6 (HIT-6), craniovertebral angle (CVA), cranial rotation angle (CRA), and muscle tone were measured. RESULTS Both groups showed significant improvements in NRS, NDI, SF-12, HIT-6 scores, CVA, CRA, and muscle tone (p<0.05). The experimental group had significant differences in NDI, SF-12, HIT-6 scores, and suboccipital muscle tone compared to the control (p<0.05). CONCLUSIONS Combining the eyeball exercise program with commonly used manual therapy and stabilization exercises for patients with chronic neck pain can help reduce nerve compression and promote muscle relaxation in the eye and neck areas. The method is thus proposed as an effective intervention to enhance function and quality of life in patients with chronic neck pain patients, TTH, and FHP.

Purpose of Review: This systematic review and network meta-analysis aims to compare the efficacy of different mind-body exercise (MBE) interventions, including Yoga, Pilates, Qigong, and Tai Chi, in managing chronic non-specific neck pain (CNNP). We searched randomized controlled trials in PubMed, Embase, Web of Science and Cochrane Library. After screening eligible studies and extracting relevant data, risk of bias of included studies was assessed by the Cochrane Risk of Bias assessment tool, and network meta-analysis was performed by the Stata software version 16.0., Recent Findings: Of the 1019 studies retrieved, 18 studies with 1442 subjects were included. Fourteen studies were graded as high quality. Yoga plus hot sand fomentation was the most effective in reducing pain intensity and functional disability, and improving the quality of physical life in patients with CNNP. Yoga achieved the most improvement in cervical mobility. And Pilates was the best MBE intervention for improving the quality of mental life. Overall, Yoga, Pilates, Qigong, and Tai Chi demonstrated considerable effectiveness in improving pain intensity, functional disability, cervical mobility, and quality of life in patients with CNNP. Yoga or Yoga plus heat therapy was the most effective method for patients with CNNP. Additional high-quality, large-scale, multi-center, long-term follow-up studies are necessary to fully understand the comparative effectiveness of different MBE interventions for CNNP, and to recognize the potential benefits of each MBE intervention and the need for individualized treatment approaches., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups., Methods: Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months., Results: 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group., Conclusion: For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention.

Background: Randomized clinical trials (RCTs) are the gold standard for assessing treatment effectiveness; however, they have been criticized for generalizability issues such as how well trial participants represent those who receive the treatments in clinical practice. We assessed the representativeness of participants from eight RCTs for chronic spine pain in the U.S., which were used for an individual participant data meta-analysis on the cost-effectiveness of spinal manipulation for spine pain. In these clinical trials, spinal manipulation was performed by chiropractors., Methods: We conducted a retrospective secondary analysis of RCT data to compare trial participants' socio-demographic characteristics, clinical features, and health outcomes to a representative sample of (a) U.S. adults with chronic spine pain and (b) U.S. adults with chronic spine pain receiving chiropractic care, using secondary data from the National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS). We assessed differences between trial and U.S. spine populations using independent t-tests for means and z-tests for proportions, accounting for the complex multi-stage survey design of the NHIS and MEPS., Results: We found the clinical trials had an under-representation of individuals from health disparity populations with lower percentages of racial and ethnic minority groups (Black/African American 7% lower, Hispanic 8% lower), less educated (No high school degree 19% lower, high school degree 11% lower), and unemployed adults (25% lower) with worse health outcomes (physical health scores 2.5 lower and mental health scores 5.3 lower using the SF-12/36) relative to the U.S. population with spine pain. While the odds of chiropractic use in the U.S. are lower for individuals from health disparity populations, the trials also under-represented these populations relative to U.S. adults with chronic spine pain who visit a chiropractor., Conclusions: Health disparity populations are not well represented in spine pain clinical trials. Embracing key community-based approaches, which have shown promise for increasing participation of underserved communities, is needed., (© 2024. The Author(s).)

This study explored the application of machine learning in predicting post-treatment outcomes for chronic neck pain patients undergoing a multimodal program featuring cervical extension traction (CET). Pre-treatment demographic and clinical variables were used to develop predictive models capable of anticipating modifications in cervical lordotic angle (CLA), pain and disability of 570 patients treated between 2014 and 2020. Linear regression models used pre-treatment variables of age, body mass index, CLA, anterior head translation, disability index, pain score, treatment frequency, duration and compliance. These models used the sci-kit-learn machine learning library within Python for implementing linear regression algorithms. The linear regression models demonstrated high precision and accuracy, and effectively explained 30-55% of the variability in post-treatment outcomes, the highest for the CLA. This pioneering study integrates machine learning into spinal rehabilitation. The developed models offer valuable information to customize interventions, set realistic expectations, and optimize treatment strategies based on individual patient characteristics as treated conservatively with rehabilitation programs using CET as part of multimodal care., (© 2024. The Author(s).)

Objective: To determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome., Design: Cohort study., Methods: Sixty-three patients with NSCNP, comprising 79% female, with a mean age of 45.8 years (standard deviation: 14.3), received four treatment sessions (once a week) of manual therapy including articular passive mobilizations, soft tissue mobilization and trigger point treatment. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and temporal summation of pain (TSP) were evaluated at baseline and after treatment completion. Therapy outcome was measured using the Global Rating of Change Scale (GROC), the Neck disability Index (NDI), intensity of pain during the last 24 hours, Tampa Scale of Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS). Two sets of generalized linear mixed models with Gaussian response and the identity link were employed to evaluate the effect of the intervention on clinical, psychological and psychophysical measures and the association between psychophysical and clinical outcomes., Results: Following treatment, an increased CPM response (Coefficient: 0.89; 95% credibility interval = 0.14 to 1.65; P = .99) and attenuated TSP (Coefficient: -0.63; 95% credibility interval = -0.82 to -0.43; P = 1.00) were found, along with amelioration of pain and improved clinical status. PPTs at trapezius muscle on the side of neck pain were increased after therapy (Coefficient: 0.22; 95% credibility interval = 0.03 to 0.42; P = .98), but not those on the contralateral trapezius and tibialis anterior muscles. Only minor associations were found between normalization of TSP/CPM and measures of clinical outcome., Conclusion: Clinical improvement after manual therapy is accompanied by restoration of CPM and TSP responses to normal levels in NSCNP patients. The existence of only minor associations between changes in central pain processing and clinical outcome suggests multiple mechanisms of action of manual therapy in NSCNP., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mata et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Previous systematic reviews have identified the benefits of exercise for chronic neck pain on subjective reports of pain, but not with objective measures such as quantitative sensory testing (QST). A systematic review was conducted to identify the effects of neck specific exercise on QST measures in adults with chronic neck pain to synthesise existing literature and provide clinical recommendations., Methods: The study protocol was registered prospectively with PROSPERO (PROSPERO CRD42021297383). For both randomised and non-randomised trials, the following databases and trial registries were searched: AMED, CINAHL, Embase, Google Scholar, Medline, PEDro, PubMed, Scopus, SPORTDiscus, Science Citation Index and Social Science Citation Index from Web of Science Core Collection, clinicaltrials.gov, GreyOpen, and ISRCTN registry. These searches were conducted from inception to February 2022 and were updated until September 2023. Reference lists of eligible studies were screened. Study selection was performed independently by two reviewers, with data extraction and quality appraisal completed by one reviewer and independently ratified by a second reviewer. Due to high heterogeneity, narrative synthesis was performed with results grouped by exercise type., Findings: Three trials were included. Risk of bias was rated as moderate and the certainty of evidence as low or moderate for all studies. All exercise groups demonstrated statistically significant improvement at an intermediate-term follow-up, with progressive resistance training combined with graded physical training demonstrating the highest certainty of evidence. Fixed resistance training demonstrated statistically significant improvement in QST measures at a short-term assessment., Interpretation: Fixed resistance training is effective for short-term changes in pain sensitivity based on low-quality evidence, whilst moderate-quality evidence supports progressive resistance training combined with graded physical training for intermediate-term changes in pain sensitivity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Osborne et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Exercise is recommended for office workers with neck pain. However, recent reviews evaluated the effectiveness of workplace interventions only., Objectives: To evaluate the effect of exercise on pain, disability, and quality of life (QoL) in office workers with chronic neck pain., Design: Systematic review with meta-analysis., Methods: Electronic databases were searched from inception to April 30, 2022, to identify studies in which participants were adults aged ≥18 years undergoing any form of neck exercises (e.g., strengthening, motor control) or physical activity (e.g., aerobic exercise) performed for a minimum of two-weeks without any other additional treatment besides advice or education. Two reviewers independently screened papers and determined the certainty of the evidence., Results: Eight randomised controlled trials met the eligibility criteria. Seven studies reported a significant decrease in Visual Analogue Scale (VAS) scores for neck pain intensity and five studies reported a significant decrease in Neck Disability Index (NDI) scores following strengthening exercises. Only one study assessed the effect of strengthening exercises on QoL and reported no significant effect. All eight included studies had a high risk of bias and the overall certainty of evidence was low. Meta-analyses demonstrated a significant decrease of neck pain intensity and disability for strengthening exercises compared to a control (p < 0.01)., Conclusion: There is low certainty of evidence that strengthening of the neck, shoulder and scapular musculature is effective at reducing neck pain and disability in office workers. Further research evaluating the effect of exercise on QoL is required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP., Methods: Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023., Results: A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment., Conclusion: Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study., (© 2024. The Author(s).)

Aim: The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months., Settings and Design: This was a randomized controlled trial., Materials and Methods: Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control., Statistical Analysis Used: The mean pain scores were statistically analyzed using one-way analysis of variance and posthoc test., Results: The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain., Conclusion: TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain., (Copyright © 2024 Copyright: © 2024 The Journal of Indian Prosthodontic Society.)

Background: Illness perceptions can affect the way people with musculoskeletal pain emotionally and behaviorally cope with their health condition. Understanding patients illness perceptions may help facilitate patient-centered care. The purpose of this study was to explore illness perceptions and the origin of those perceptions in people with chronic disabling non-specific neck pain seeking primary care., Methods: A qualitative study using a deductive and inductive analytical approach was conducted in 20 people with persistent (> 3 months) and disabling (i.e., Neck Disability Index ≥ 15) neck pain. Using a semi-structured format, participants were interviewed about their illness perceptions according to Leventhal's Common Sense Model. Purposive sampling and member checking were used to secure validity of study results., Results: Participants reported multiple symptoms, thoughts and emotions related to their neck pain, which continuously required attention and action. They felt trapped within a complex multifactorial problem. Although some participants had a broader biopsychosocial perspective to understand their symptoms, a biomedical perspective was dominant in the labelling of their condition and their way of coping (e.g., limiting load, building strength and resilience, regaining mobility, keep moving and being meaningful). Their perceptions were strongly influenced by information from clinicians. Several participants indicated that they felt uncertain, because the information they received was contradictory or did not match their own experiences., Conclusion: Most participants reported that understanding their pain was important to them and influenced how they coped with pain. Addressing this 'sense making process' is a prerequisite for providing patient-centered care., (© 2024. The Author(s).)

Background: In 2020, 203 million people experienced neck pain, with a higher prevalence in women. By 2050, it is predicted that neck pain will affect 269 million people, representing a 32.5% increase. Physical rehabilitation is often employed for the treatment of chronic non-specific neck pain (CNSNP) and the associated functional loss. Taping is frequently used as an adjunct treatment alongside primary physical rehabilitation. Unlike kinesio tape (KT), the therapeutic benefits of dynamic tape (DT) have not been thoroughly explored and documented in non-athletic conditions. Therefore, the aim of this trial was to determine the effects of DT on pain, disability, and overall well-being in individuals experiencing CNSNP., Methods: A prospective parallel-group active controlled trial was conducted at a single center, involving 136 patients with CNSNP, randomly allocated in a 1:1 ratio. The sham taping group (STC) received standard physiotherapy care ( n  = 67) alongside DT without tension, while the dynamic taping group (DTC) ( n  = 69) underwent standard cervical offloading technique with appropriate tension in addition to standard physiotherapy care. Demographic information and three patient-reported outcome measures (PROMs), namely the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and the World Health Organization-Five Well-Being Index (WHO-5), were collected for each participant at three time points (baseline, four weeks post-taping, and four weeks follow-up)., Results: At baseline, no significant differences were observed between the STC and DTC for any outcome measure. Notably, all three PROMs exhibited a significant improvement from baseline to four weeks post-intervention, with moderate to small effect sizes (NDI ηp 2  = 0.21, VAS ηp 2  = 0.23, and WHO-55 ηp 2  = 0.05). The WHO-5 scores for both groups demonstrated improvement from baseline through follow-up ( p  < 0.001). The NDI and VAS scores ameliorated from baseline to the four weeks post-taping period, with marginal improvements observed during the four weeks follow-up., Conclusion: The incorporation of DT as an adjunct to standard physiotherapy care yielded enhancements in pain levels, functional disability, and well-being among patients with CNSNP when compared to the sham group. However, the sustainability of these improvements beyond the taping period lacks statistical significance and warrants further validation., Competing Interests: Faizan Zaffar Kashoo is an Academic Editor for PeerJ., (©2024 Sidiq et al.)

Background: Chronic neck and low back pain are very common and have detrimental effects for people and society. In this study, we explore the experiences of individuals with neck and/or back pain using a written narrative methodology. Materials & methods: A total of 92 individuals explained their pain experience using written narratives. Narratives were analyzed through thematic analysis and text data mining. Results: Participants wrote about their experience in terms of pain characteristics, diagnosis process, pain consequences, coping strategies, pain triggers, well-being and future expectations. Text data mining allowed us to identify concurrent networks that were basically related with pain characteristics, management and triggers. Conclusion: Written narratives are useful to understand individuals' experiences from their point of view.

Purpose: This study aimed to compare the effects of basic body awareness therapy (BBAT) and conventional treatments (CT) on balance in patients with chronic neck pain., Methods: Thirty-five patients with neck pain participated in this randomised two-period crossover trial. Patients were divided into A (BBAT/CT) ( n  = 17) and B (CT/BBAT) ( n  = 18) groups. Group A received BBAT twice a week for 6 weeks, whereas Group B received CT within the same parameters. After a 5-week washout period, the treatments received by the groups were changed. The primary outcome was balance, assessed via the sensory organisation test (SOT) using the computerised dynamic posturography device. The secondary outcome was pain assessed by the visual analogue scale. Assessments were performed before and after primary and secondary treatments., Results: In Group A, the SOT conditions 4, 5, 6; composites score; and visual and vestibular system scores increased after BBAT; however, only condition five scores and vestibular system scores increased ( p  < .05) in Group B, which started with CT. Within the groups, both treatments were effective for easing pain ( p  < .05)., Conclusions: Although patients who started the therapy with BBAT showed more improvement in balance, no differences were observed between the therapies.

BACKGROUND Active release technique (ART) and strain-counterstrain (SCS) have been reported to be beneficial for patients with trigger point pain. Therefore, this study of 45 patients with chronic neck pain aimed to compare the effects of 4 weeks of physical therapy with the ART and SCS manipulation with massage alone, evaluated before and after treatment, using the visual analog scale (VAS) for pain, the neck disability index (NDI), and the pressure pain threshold (PPT). MATERIAL AND METHODS The participants were 45 adults with neck pain lasting >12 weeks, divided into the ART group (n=15), SCS group (n=15), and control group (n=15). All groups received clinical massage (CM) for 15 min twice a week for 4 weeks. The control group received only CM, the ART group received CM and ART for 15 min twice a week for 4 weeks, and the SCS group received CM and SCS for 15 min twice a week for 4 weeks. VAS, NDI, and PPT were measured before and after the interventions. RESULTS In all groups, there were significant changes in VAS, NDI, and PPT after the interventions (P<0.05), and there was a significant difference among groups in the difference before and after intervention (P<0.05). VAS and NDI showed the greatest difference among before and after intervention in the ART group (VAS pre-post 3.38±0.76, NDI pre-post 5.69±2.78). PPT showed the greatest difference among before and after intervention in the SCS group (PPT pre-post 1.75±0.62). CONCLUSIONS The ART technique and the SCS technique effectively reduced neck pain and neck disorders in adults with chronic neck pain.

Background: Existing systematic reviews and meta-analyses have only focused on patients with chronic non-specific neck pain (NNP), analyzing exercise therapy (ET) only as therapeutic exercise. Therefore, it is necessary to comprehensively review the effects of ET through a meta-analysis comprising a wide range of ETs that are not limited to therapeutic exercise., Objectives: This study aimed to investigate the effects of ET on pain and disability in patients with NNP., Design: Systematic review and meta-analysis., Method: The studies selected for this study were based on the PICO-SD tool as follows: P (patient)-acute, subacute, and chronic NNP patents, I (intervention)-ET, C (comparison)-control and other therapy groups, O (outcome)-pain and disability, and SD (study design)-randomized controlled trial., Results: Twenty-one studies were included. The effects of ET on pain and disability in patients with chronic NNP were significantly different (pain: SMD -1.47, 95% CI: -1.89 to -1.06, I 2 : 94%; disability: SMD -1.79, 95% CI: -2.31 to -1.27, I 2 : 94%). The effects of ET on pain (ET vs control: SMD: -1.60, 95% CI: -2.09 to -1.11, I 2 : 94%; ET vs sham therapy: SMD: -8.75, 95% CI: -10.71 to -6.79) and disability (ET vs control: SMD: -2.16, 95% CI: -2.80 to -1.52, I 2 : 94%; ET vs sham therapy: SMD: -1.73, 95% CI: -2.42 to -1.05) in NNP patients were significantly different., Conclusions: This study verified the efficacy of ET in improving pain and disability in patients with chronic NNP. However, evidence supporting the efficacy of ET in patients with acute and subacute NNP is still lacking., Competing Interests: Declaration of competing interest There are no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study aimed to investigate the effect of extracorporeal shockwave therapy on the anterior surface line of the fascia meridian, including the oblique muscle, combined with sling exercise, on the stability of the spine in the neck disability index (NDI), neck joint range of motion (ROM), craniovertebral angle, neck alignment, and posture control. A total of 20 office workers with chronic neck pain were randomly assigned to an experimental group that combined extracorporeal shock wave therapy and sling exercise (n = 10) and a control group (CG) consisting of sling exercise (n = 10) performed twice weekly for 4 weeks. All subjects were evaluated using the NDI, ROM, neck alignment, and spine stability tests. Following the intervention, there were significant differences in the For example, NDI, craniovertebral angle, Cobb's angle, Centaur data, and ROM. Except for Cobb's angle and Centaur data (-90 degrees), all variables showed significant differences in the CG. Comparing changes before and after the intervention, The For example, showed significantly more significant changes in all variables than the CG. The combination of extracorporeal shockwave therapy and sling exercises improved NDI, ROM, and neck and spine alignment in office workers with chronic neck pain more effectively than the sling exercise alone. This study could be recommended as a new approach to enable individuals with chronic neck pain to perform better., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Neck pain is a common musculoskeletal problem in adults. Clinical pilates exercises can be beneficial managing the pain and improving the risk factors., Aims: The aim of this study was to investigate the effects of clinical pilates exercises on pain and disability, deep neck flexor endurance (DNFE), posture, cervical range of motion (CROM), and proprioception in patients with chronic nonspecific neck pain., Methods: Fifty patients with chronic nonspecific neck pain were randomized into two groups. The clinical pilates exercise group (CPEG) received clinical pilates exercises for 6 weeks. The control group (CG) received posture education. Pain and disability, DNFE, forward head angle (FHA) and forward shoulder angle (FSA) degrees, CROM, and joint position error (JPE) were measured before and after 6 weeks., Results: Clinical pilates exercises improved pain, Neck Disability Index (NDI), DNFE, posture, CROM (except extension), and JPE (p < 0.05). We found significant differences between CPEG and CG in the comparisons for the change of pain, NDI, DNFE, FSA, CROM (except extension), and JPE (except left rotation) (p < 0.05). NDI, FSA, and rotational JPE also improved in CG (p < 0.05). However, these improvements were significantly better in CPEG than CG (p < 0.05) except JPE in left rotation (p = 0.118)., Conclusion: In patients with chronic nonspecific neck pain, clinical pilates exercise is a safe and effective method to improve pain and disability, DNFE, posture, ROM, and proprioception., Clinical Trial Registration: NCT03782584 retrospectively registered December 20 2018., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Objective: The purpose of this study was to investigate the effects of virtual reality (VR) on postural control, posture, and kinesiophobia in patients with chronic neck pain (CNP)., Methods: Forty-one participants with CNP were randomly allocated to the VR and control groups. The VR group experienced VR with glasses for 20 minutes and then performed motor control (MC) exercises for 20 minutes. The control group received only MC exercises for 40 minutes. Both groups received 18 sessions over 6 weeks. Computerized dynamic posturography outcomes, including sensory organization test (SOT), limits of stability, and unilateral stance tests, gait speed, forward head posture (FHP), shoulder protraction (SP), cervical lordosis angle, kinesiophobia, and exercise compliance were recorded., Results: The VR group had more effects regarding composite equilibrium (Cohen's d = 1.20) of SOT and kinesiophobia (Cohen's d = -0.96), P < .05). Also, the VR group was more effective in exercise compliance (P < .05). Contrary to these results, the control group was more effective in correcting FHP and SP (Cohen's d > 0.7, P < .05)., Conclusion: Virtual reality seemed to have an effect on postural control, posture, and kinesiophobia in patients with chronic neck pain., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To explore the effects of myofascial release (MFR) on pain and dysfunction in individuals with chronic mechanical neck pain (MNP)., Data Sources: PubMed, Embase, Medline, Wiley Online Library, Web of Science, CNKI, VIP, WanFang Data, and the Cochrane Library were searched until 12 September 2022., Review Methods: This study was registered in PROSPERO (CRD42022302485). Methodological quality was assessed using Cochrane risk of bias assessment, and the quality of the evidence followed the GRADE recommendation. The outcomes pain, cervical mobility (Flexion, Extension, Rotation, lateral flexion), trapezius and suboccipital pressure pain thresholds (PPT), neck disability index (NDI), and adverse effects were extracted., Results: After screening of 346 studies, 13 studies and 601 participants met the inclusion criteria. All studies were of moderate methodological quality. Compared with the control group, the participants in the MFR group showed significantly greater improvements trapezius PPT SMD 0.41 (95% CI 0.11-0.72), suboccipital PPT SMD 0.47 (95% CI 0.21-0.72), respectively. The differences were not significant to support the MFR treatment on pain, flexion, extension, rotation, lateral flexion angle, and NDI. None of the studies reported any adverse events., Conclusion: This systematic review suggests that MFR is an effective treatment for the improvement of PPT of trapezius and suboccipital muscle in patients with chronic MNP. However, there is low to moderate evidence and may change over time.

Purpose: There are conflicting reports in the literature regarding the effectiveness of motor imagery (MI) and action observation (AO) in individuals with chronic non-specific neck pain (CNSNP). This study sought to systematically investigate whether mental practice has any impact on pain, functionality and quality-of-life in individuals with CNSNP., Methods: This is a systematic review. Randomized controlled trials (RCTs) that explored the effects of mental practice on pain, functionality and quality-of-life in individuals with CNSNP were searched using databases PubMed, Cochrane library, Medline via Ovid, Scopus, and PEDro from inception to July 2022. Two reviewers independently extracted data and evaluated the quality of the studies utilizing the PEDro scale., Results: Six high-quality RCTs with 128 participants with CNSNP in the MI and AO groups, and 93 participants with CNSNP in the control group, were included in this review. Both AO and MI were effective in improving pain response and cervical joint position sense. However, AO was more efficient than MI and its effects were retained longer. Improvements in the visual analogue scale and neck disability index were retained when MI training lasted for 6 weeks. The pain and general health sub-parameters of the short form-36 health survey improved after MI training., Conclusion: Mental practice, particularly AO, can improve neck pain intensity, joint position sense, functional disability, and some aspects of quality-of-life in individuals with CNSNP. These improvements dissipated over time. Although mental practice can be an alternative to exercise when pain exists, it can be more efficient when prescribed with simple movements and exercises., Registration: The protocol of this review was registered with PROSPERO (CRD42022330240) Available from: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42022330240., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Both spinal manipulation (SM) and Integrated Neuromuscular Inhibition Technique (INIT) have a positive effect in individuals with chronic neck pain (CNP), especially when they are combined with therapeutic exercise (TE). However, it has not been determined which of the above combinations is more effective in patients with CNP., Objective: To compare the efficacy of two different manual techniques (SM and INIT), when combined with the same TE program in the management of CNP., Methods: Eighty women with CNP, allocated into four groups of 20 persons each. The first group followed a 10-week TE program, the second TE and INIT, the third TE and SM, and the fourth was the control group. The Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), Pressure Pain Threshold (PPT) of the neck muscles, neck active Range of Motion (ROM), Maximum Isometric Strength (MIS) of the neck muscles, craniocervical flexion test (CCFT) and SF-36 questionnaire scores were evaluated before, during and after the treatment period, with a six-month follow-up., Results: There was between groups differences between the three intervention groups and the control group (p< 05), with the positive effects being maintained until the six-month follow-up. However, this improvement occurred earlier in the "TE + INIT" and "TE + SM" groups than in the "TE" group. Differences between the "TE + INIT" and the "TE + SM" groups were noticed only in the neck muscles PPT values, in which the "TE + INIT" group showed greater improvement. Furthermore, some non-statistically significant indications for further improvement of "TE + SM" were noted in the left lateral flexion ROM., Conclusion: The addition of INIT as well as SM in the same TE program can further increase the beneficial effect of exercise in women with CNP. In most measurements both combinations seem to be equally effective. However, INIT improved more local muscle tenderness, whereas SM aided more in the neck lateral flexion ROM.

Background: The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients., Objective: To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain., Methods: Twenty-five patients with chronic neck pain were randomly assigned to the SET group (n= 12) or the control group (n= 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test., Results: At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p< 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p< 0.05). There were no within-group differences in the control group (p> 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p< 0.05)., Conclusion: 4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck.

Importance: Both tuina therapy and yijinjing exercise were beneficial to patients with nonspecific chronic neck pain, but the evidence for this combination is limited., Objective: To investigate the effectiveness of tuina therapy combined with yijinjing exercise compared with tuina therapy alone for patients with nonspecific chronic neck pain., Design, Setting, and Participants: A 12-week, open-label, analyst-blinded randomized clinical trial (8-week intervention plus 4-week observational follow-up) was conducted from September 7, 2020, to October 25, 2021. A total of 102 participants with nonspecific chronic neck pain were recruited, and data were analyzed from December 10, 2021, to March 26, 2022., Interventions: Participants in the tuina group or tuina combined with yijinjing group received 3 sessions of tuina therapy per week for 8 weeks, for a total of 24 sessions. Participants in the tuina combined with yijinjing group practiced yijinjing 3 times a week for 8 weeks, including an instructor-guided exercise at the hospital and 2 self-practice exercises at home., Main Outcomes and Measures: The primary outcome was change in visual analog scale (VAS) score from baseline to week 8. Secondary outcomes included Neck Disability Index scores, Self-rating Anxiety Scale scores, tissue hardness, and active range of motion., Results: This randomized clinical trial recruited 102 patients (mean [SD] age, 36.5 [4.9] years; 69 [67.6%] female) who were randomized to 2 groups. All 102 patients (100%) completed all the outcome measurements. The mean difference in VAS scores from baseline at week 8 for the tuina combined with yijinjing group was -5.4 (95% CI, -5.8 to -5.1). At week 8, the difference in VAS score was -1.2 (95% CI, -1.6 to -0.8; P < .001) between the tuina group and the tuina combined with yijinjing group. The effectiveness of tuina combined with yijinjing in treating nonspecific chronic neck pain remained at the 12-week follow-up., Conclusions and Relevance: In this randomized clinical trial, for patients with nonspecific chronic neck pain, tuina combined with yijinjing was more effective than tuina therapy alone in terms of pain, functional recovery, and anxiety at week 8, and effectiveness remained at week 12. A combination of tuina and yijinjing should be considered in the management of nonspecific chronic neck pain., Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000036805.

Objective: To systematically evaluate the impact of manual soft tissue therapy (MSTT) on the degree of pain in patients with chronic neck pain (CNP)., Methods: Trials included in the meta-analysis were identified by searching 5 English databases, including the PubMed, Embase, Cochrane Library, Web of Science and U.S. Clinical Trial Registry databases. The search was conducted with the subject terms neck pain, soft tissue treatment, massage, and myofascial release. We assessed the included trials using the Cochrane risk-of-bias tool. STATA statistical software version 16.0 was used for statistical analysis. Additionally, subgroup analysis and sensitivity analysis were performed to analyze the sources of heterogeneity and assess the stability of the research results. Begg's funnel plot and Egger's publication bias plot were used to assess potential publication bias., Results: This systematic review included a total of 12 randomized controlled trials (566 patients in total). The participants were between 18 and 85 years old. Most of the included studies were of medium quality. This meta-analysis validated the effectiveness of MSTT in alleviating pain symptoms in patients with CNP (ES: 0.83; 95% CI: 1.15 to -0.51; P = 0.001). Egger's publication bias plot and Begg's funnel plot indicated that there may be potential publication bias., Conclusion: This meta-analysis found that MSTT has a significant effect on alleviating the pain of patients with CNP. In addition, the use of different pain measurement tools may influence effect of the intervention, but more clinical studies are needed in the future to determine the specific effect., Competing Interests: Declaration of competing interest There are no conflicts of interest to declare., (Copyright © 2022. Published by Elsevier Ltd.)

Purpose: To pilot feasibility and assess preliminary effectiveness of standard and culture-sensitive Pain Neuroscience Education (PNE) among Hausa-speaking patients with Chronic Neck Pain (CNP)., Methods: Adverts (online & clinic-based) were used to recruit Hausa-speaking patients with nonspecific CNP in Kano, Nigeria. Selected participants were randomized to culture-sensitive PNE (CSPNE), standard PNE (PNE), or control groups. Each group received bi-weekly sessions of exercise therapy for 6 weeks. Two sessions of PNE plus a home-based session were administered before exercise therapy in the PNE groups. Primary (pain-intensity and disability) and secondary (pain-knowledge, pain catastrophizing, and quality of life) outcomes were measured. The study was pre-registered (PACTR201902788269426)., Results: Fifty-three (out of 64) participants met the inclusion criteria. The majority of them were recruited through radio adverts (83%). Interventions were successfully administered and data collection was completed for the participants. About 15% and 17% drop-out rate was recorded before intervention (post-randomization) and during follow-up, respectively. Main results indicated that significant within-group improvements in disability and pain knowledge scores were found in favor of the PNE groups., Conclusion: Culture-sensitive and standard PNE plus exercise therapy are feasible for Hausa patients with CNP, and current findings indicate support for reducing disability and increasing pain knowledge among them.Implications for rehabilitationBoth standard PNE and culture-sensitive PNE are feasible for administration as interventions for Hausa-speaking patients with CNP.Radio adverts may be necessary for patients recruitment in addition to specialists' referrals.Culturally sensitive PNE materials may be more desirable as an intervention option due to the low literacy level among the Hausa population.

The present study evaluated the effectiveness of breathing re-education with routine physical therapy. This mixed method study was conducted at the District Headquarter Hospital Faisalabad, Faisalabad from April 2020 to July 2020. Fourteen participants (6men and 8 women) with chronic neck pain were recruited over a 16-week period and were equally divided into breathing re-education and routine physical therapy groups. The mean age of the patients was 38.48±5.92 years. Feasibility outcomes were recruitment, randomisation and retention rates of the participants. Clinical outcomes assessed for full trial were neck pain, cervical ROM, strength and endurance of neck muscles, quality of life and pulmonary functions. Outcomes were measured at baseline, fourth and eighth weeks. All the participants completed all the treatment sessions. No adverse events were reported. The breathing re-education group showed significant improvement in clinical outcomes. The results of this feasibility study provide supporting evidence for a future large-scale trial. Breathing re-education appears to be an effective treatment for chronic neck pain.

Objective: The purpose of this randomized controlled trial was to study effects of breathing reeducation in the treatment of patients with non specific chronic neck pain., Methods: A total of sixty eight eligible patients with chronic neck pain were randomly allocated to breathing reeducation (BR) group (n = 34) and routine physical therapy (RPT) group (n = 34). Clinical outcomes were neck pain measured through visual analogue score, cervical active range of motion through CROM device, strength of neck muscles through hand held dynamometer and endurance of neck muscles measured through craniocervical flexion test. The neck disability was measured through neck disability index (NDI) and pulmonary outcomes such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were measured through Spirolab 4. The outcomes were assessed at baseline and at 4 and at 8 weeks from baseline., Results: There were significant improvements in the BR group compared with the RPT group (P = 0.002) for cervical flexion, extension (P = 0.029), endurance (P = 0.042), strength of neck flexors (P <0.001), neck extensors (P = 0.034). Likewise there was a significant change in NDI (P = 0.011), FEV1 (P = 0.045), FVC (P <0.001), and FEV1/FVC ratio (P <0.001) in the BR group compared with the RPT group. The cervical side flexion and rotation showed no significant difference in breathing reeducation group with p > 0.05., Conclusion: Breathing reeducation combined with routine physical therapy is an effective treatment in patients with non specific chronic neck pain., Trial Registration: IRCT 20200226046623N1, https://www.irct.ir/trial/46240., Competing Interests: The authors have declared that no competing interests exist.

The objective of this study was to determine the effects of cervical stabilisation exercises on respiratory strength in chronic neck pain patients with forward head posture. The study was conducted from August 2020 to February 2021, at the Jinnah Hospital, Lahore; 44 patients who fulfilled the eligibility criteria were randomly assigned to two groups-experimental group and control group-. Baseline measurement was taken for numeric pain rating scale, neck disability index, craniovertebral angle, single breath count, and spirometry and all the measurements were retaken at the completion of the fourth week. Results were not significant (p>0.05) before the treatment in both groups but post-intervention results revealed significant differences in both the groups (p<0.05), with the experimental group showing more improvement. Four weeks of cervical stabilisation with isometric exercises is more effective in the management of pain, forward head posture, neck disability and respiratory strength as compared with the four weeks of isometric exercises programme alone.

Background: Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors., Objectives: To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain., Methods: Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention., Results: Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = -6.09; 95% Confidence Interval [CI]: 7.75, -4.42 and -4.73; 95%CI: 6.57, -2.91 respectively) and at the 6-months follow-up (-4.47; 95%CI: 6.41, -2.53 and -4.74; 95%CI: 6.50, -2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = -20.87 mm; 95% CI: 28.55, -13.19 and -18.00 mm; 95%CI: (-26.24, -9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference., Conclusions: A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP)., Methods: A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up., Results: There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found., Conclusion: Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: There are limited reports about the reliability of measuring neck extensor muscle strength using a portable dynamometer in neck pain patients. The aims of the current study were 1) to investigate intra- and inter-rater reliability of neck extensor isometric strength measurement using a portable dynamometer in patients with chronic nonspecific neck pain (CNSNP) and 2) to compare neck extensor isometric strength in participants with and without CNSNP., Methods: Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were followed. Two examiners received a 15-minute training before enrollment. Inter-rater reliability was assessed with a 10-minute interval between measurements, and intra-rater reliability was assessed with a 10-day interval. Three trials were assessed and examiners were blind to the strength values (in Newtons) from other sessions of 20 individuals with CNSNP (mean±SD= 37.9 ± 9.8y; Neck Disability Index 29.2 ± 7.4%) and 20 individuals with other musculoskeletal disorders (mean ± SD = 32.8 ± 46.2y)., Results: Intra-rater reliability was excellent with intraclass correlation coefficient (ICC)(3,1) of 0.95 (CI:0.90-0.97) and inter-rater reliability was good to excellent with ICC(2,1) of 0.88 (CI:0.77-0.94) in CNSNP. No significant difference of neck extensor strength was found between CNSNP (93.27N±31.94) and Individuals without CNSNP (111.43N±40.11) (p > 0.05)., Conclusion: A portable dynamometer is a reliable tool for measuring maximal isometric neck extension strength in individuals with CNSNP. Slightly but no significant differences of neck extensor strength values between individuals with and without CNSNP. Future studies are needed to assess the generalizability of the findings in patients with other muscle deconditioning.

Objective: This study investigated the impact of McKenzie exercises against deep neck flexor (DNF) combined with scapulothoracic exercises on improving pain severity, cervical mobility, and functional disability., Patients and Methods: Fifty-five subjects suffering from chronic neck pain participated in this randomized controlled study. They were randomly assigned to three groups; the DNF group, which was treated by traditional physical therapy (i.e., physical therapy agents, stretching, and isometric exercises), combined with DNF, and scapulothoracic exercises; the McKenzie group, treated by traditional physical therapy, combined with McKenzie exercises; and finally, a control group, treated by traditional physical therapy. Before and after 6 weeks of treatment, they were assessed for neck pain severity, cervical range of motion (ROM), and functional disability using a visual analog scale (VAS), a gravity-reference goniometer, and the Copenhagen neck functional disability scale (CNFDS), respectively., Results: Compared to baseline, all groups showed a significant decrease in neck pain severity and disability (p <0.05), and there was a significant increase in neck flexion/extension, lateral right flexion/left flexion, and right/left rotation ROMs (p<0.05). The improvement of the McKenzie group was significantly higher than the DNF group, and control group. Moreover, the improvement of the DNF group was significantly higher than the control group (p<0.05)., Conclusions: The McKenzie exercises were better than DNF combined with scapulothoracic exercises to treat neck pain, functional disability, and mobility.

Objectives: To study the addition of feedback-guided neck strength home exercise to physical therapy as an enhanced rehabilitation programme in the treatment of patients with chronic neck pain., Design: A prospective randomised controlled trial., Setting: Rehabilitation department of an academic hospital., Subjects: Patients with chronic neck pain., Interventions: The patients in both groups received supervised physical therapy sessions 3 times a week for 12 weeks. Patients in Group A ( N  = 38) used the neck strengthening exerciser device for 20 min daily at home for 6 weeks and patients in Group B ( N  = 20) performed 20 min of daily regular neck exercise at home for 6 weeks., Outcome Measures: Neck disability index, pain visual analogue scale, active range of motion of the neck, Patient Global Assessment and patient evaluation of treatment effect. All subjects were assessed at baseline as well as at 6- and 12-week follow-ups., Results: At the 6-week follow-up, Group A exhibited significantly greater improvements ( P  < 0.05) in pain Visual Analogue Scale (Group A: 2.97 ± 1.57; Group B: 4.20 ± 1.82), neck disability index (Group A: 13.95 ± 8.07; Group B: 20.07 ± 9.14) and active cervical extension (Group A: 65.26 ± 12.76; Group B: 51.45 ± 11.78). At 12-week follow-up, Group A also exhibited significantly greater active cervical extension (Group A: 67.74 ± 11.94; Group B: 53.85 ± 14.09; P  < 0.05)., Conclusion: Adding neck strengthening exerciser home training to physical therapy was demonstrated to be more effective than physical therapy alone for patients with chronic neck pain.

Background: Chronic non-specific neck pain is the most prevalent neck pain with notable impacts on the quality of life in the elderly., Objective: The impacts of the neck, core, and combined stabilization practices on pain, disability, and improvement of the neck range of motion in the elderly with chronic non-specific neck pain were examined., Method: A quasi-experimental (open label) study was carried out through a cluster sampling in two phases in Tehran-Iran in 2017. Totally, 102 patients were randomly allocated to three groups of specific neck stabilization, specific core stabilization, and combined practices through envelope method. The intervention took 12 weeks. To measure the severity of pain and neck disability, the visual analog scale (VAS), neck disability index (NDI), and neck pain and disability scale (NPDS) was used. A goniometer was used to measure the range of the motion. To examine data, used SPSS (v.20)., Result: The results, confirmed a significant decrease in pain over the time in the three therapeutic groups (p = 0.000). In addition, there was a significant difference between neck, core, and combined stabilization groups. Moreover, there was a significant increase in the angle of motion in all treatment groups with different treatment duration (P = 0.000). The highest increase in the angle of motion was after 12 weeks of practice in right lateral flexion (RLF) (p = 0.000)., Conclusion: Twelve sessions of the neck, core, and combined stabilization practices can alleviate the pain and improve the strength in the elderly with chronic non-specific neck pain. In addition, compared to two other methods, the combined method was a more efficient way to improve the range of motion in patients.

Objective: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions., Design: Randomized controlled trial., Setting: Outpatient setting., Subjects and Interventions: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 ( n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 ( n = 37) deep cervical flexor motor control training alone, and group 3 ( n = 38) passive treatment and education., Main Outcome Measures: Pain, neck disability, deep cervical flexor muscular endurance, and health status., Results: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone ( d = 2.03, 95% confidence interval (CI): -2.8 to -1.27, P = 0.021) for pain ( d = -0.99, 95% CI = -1.75 to -0.23, P = 0.023), disability ( d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and ( d = -2.75, 95% CI = -8.81 to -1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes., Conclusion: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

Purpose: The aim of this study was to compare the effects of scapular stabilization exercise with and without cognitive functional therapy (CFT) on disability and scapular kinematics in people suffering from chronic neck pain., Methods: A total of 72 patients with chronic non-specific neck pain were randomized into scapular stabilization exercise alone, n = 24, combined (scapular stabilization exercise + CFT), n = 24, and a control group, n = 24. Scapular kinematic and disability were measured at baseline and after the intervention., Results: Statistically significant differences in neck pain and disability scale (NPAD) were found when the multimodal physiotherapy group including a cognitive functional approach was compared with stabilization exercises group at 6 weeks (effect size (95%CI) = -1.63 (-2.55, -.71); P = 0.019)). Regarding the neck disability index (NDI), a significant between-group difference was observed at six-week (effect size (95%CI) = -2.69 (-3.80, -1.58); P = 0.007), with the superiority of effect in multimodal physiotherapy group. A significant between-group difference was observed in the scapular upward rotation and scapular osterior tilt at 30°, 60°, 90° and 120° of shoulder adduction., Conclusions: A group-based multimodal rehabilitation program including scapular stabilization exercise plus cognitive functional therapy was superior to group-based stabilization exercises alone for decreasing disability and, improving scapular kinematic in patients with chronic neck pain.

Background: Chronic neck pain is a prevalent health condition and a leading cause of disability worldwide. Prompt therapeutic measures are required to overcome this condition., Objectives: To evaluate the efficacy of incorporation of scapular stabilization and upper limb proprioceptive exercises to cervical stabilization exercises in patients with chronic neck pain (CNP)., Design: A single-blinded randomized controlled design., Methods: A sample of convenience was deployed to recruit twenty-eight patients having CNP (18-45 years) and was randomized into two groups: group A (cervical stabilization exercises group) and group B (scapular stabilization and upper limb proprioceptive exercises group + cervical stabilization exercises). Pain intensity, disability, sleep quality, quality of life, scapular muscles strength and proprioception were assessed at 4 weeks follow up to determine the efficacy of the intervention., Results: A mixed model ANOVA was used. A statistically significant (p < 0.05) group by time interaction for pain intensity (p = 0.000), scapular muscles strength of all muscles (p = 0.000) was observed. Significant group interaction for absolute error (p = 0.00), for pain (p = 0.001), disability (p = 0.04) and scapular muscle's strength (p = 0.000) was also demonstrated., Conclusion: The results indicated that scapular stabilization and upper limb proprioceptive exercises when combined with cervical stabilization exercises are more beneficial in alleviating pain and disability and improving scapular muscle strength and proprioception in patients with CNP., Competing Interests: Declaration of competing interest No author has any financial interest or received any financial benefit from this research., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Increasing emphasis on guidelines and prescription drug monitoring programs highlight the role of healthcare providers in pain treatment. Objectives of this study were to identify characteristics of key players and influence of opioid prescribers through construction of a referral network of patients with chronic pain. A retrospective cohort study was performed and patients with commercial or Medicaid coverage with chronic back, neck, or joint pain were identified using the Arkansas All-Payer Claims-Database. A social network comprised of providers connected by patient referrals based on 12-months of healthcare utilization following chronic pain was constructed. Network measures evaluated were indegree and eigen (referrals obtained), betweenness (involvement), and closeness centrality (reach). Outcomes included influence of providers, opioid prescribers, and brokerage status. Exposures included provider demographics, specialties and network characteristics. There were 51,941 chronic pain patients who visited 8,110 healthcare providers. Primary care providers showed higher betweenness and closeness whereas specialists had higher indegree. Opioid providers showed higher centrality compared to non-opioid providers, which decreased with increasing volume of opioid prescribing. Non-pharmacologic providers showed significant brokerage scores. Findings from this study such as primary care providers having better reach, non-central positions of high-volume prescribers and non-pharmacologic providers having higher brokerage can aid interventional physician detailing. PERSPECTIVE: Opioid providers held central positions in the network aiding provider-directed interventions. However, high-volume opioid providers were at the borders making them difficult targets for interventions. Primary care providers had the highest reach, specialists received the most referrals and non-pharmacological providers and specialists acted as brokers between non-opioid and opioid prescribers., (Copyright © 2021 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Chronic nonspecific neck pain is the most frequent form of neck pain. It is more prevalent in women, and a costly public health issue. It is commonly associated with biomechanical, functional, proprioceptive, and postural impairments. The aim of this trial is to compare the effects of global postural exercises versus specific therapeutic exercises on neck pain, disability, mobility, pressure pain threshold, kinesiophobia, pain catastrophizing, postural control, and neuromuscular efficiency in women with chronic nonspecific neck pain. Methods and analysis: This study is a randomized, parallel-group and single blinded clinical trial. Sixty-two women with nonspecific chronic neck pain were recruited from the community of Guarda, Portugal, and randomly assigned to one of two intervention groups: (1) global postural reeducation (GPR group), (2) specific therapeutic exercises (STE group). The intervention was carried out over 4 weeks, with two sessions per week (eight sessions), and applied by a physiotherapist and paired with a daily individual at-home-exercise program. Primary outcomes are neck pain intensity and disability (Numerical Pain Rating Scale, Neck Disability Index). Secondary outcomes are cervical mobility and pressure pain threshold (CROM, algometry), attitude to pain (kinesiophobia, pain catastrophizing), standing postural control (Center of Pressure (COP) displacements), and neuromuscular efficiency (electromyography). There are four points of evaluation where the outcomes were assessed twice before the intervention, 1 week apart, and the two post-intervention assessments will be carried out after four and eight sessions. The objective was to increase scientific knowledge of different exercise modalities, such as global postural reeducation, in musculoskeletal disorders., Trial Registration: ClínicalTrials.gov (NCT04402463), prospectively registered (data 22 May 2020).

Background: Non-specific chronic neck pain (NCNP) is a common musculoskeletal disorder which has caused a huge economic burden due to its expensive health costs and high re-occurrence rate. Yijinjing and Tuina are widely used for non-specific chronic neck pain in China. But there is little scientific evidence to evaluate their efficacy for NCNP. The aim of this research is to compare the efficacy of Yijinjng combined with Tuina versus Tuina for patients with NCNP., Methods/design: A randomized controlled trial in which 102 patients with non-specific chronic neck pain will be recruited and randomly allocated to either the Tuina group or the Yijinjng combined with Tuina group in a 1:1 ratio. The interventions for both groups will be carried out three times a week for 8 weeks. The patients in the two groups will receive follow-up 1 month after the intervention. The primary outcome will be the changes in the visual analog scale (VAS). Secondary outcomes will be measured by the Neck Disability Index (NDI), Self-Rating Anxiety Scale (SAS), and Tissue Hardness and Active Range of Motion (AROM). The data will be analyzed at the baseline, 4 weeks during the intervention, at the end of the intervention, and 1 month after the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session., Discussion: The purpose of this trial is to determine whether Yijinjing combined with Tuina is not inferior to Tuina for patients with NCNP. This study will provide clinicians and stakeholders much-needed knowledge for a complementary and alternative therapy for patients with non-specific chronic neck pain., Trial Registration: ChiCTR registry (ChiCTR) 2000036805 . Registered on August 25, 2020., (© 2021. The Author(s).)