Neck Exercise for Sitting Posture With Chronic Neck Pain
From: Physical Therapy Vol. 87, No. 4, April 2007, pp. 408-417
Poor sitting posture has been implicated in the development and perpetuation of neck pain symptoms. This study compares change in cervical and thoracic posture during a distracting task between subjects with chronic neck pain and control subjects and the effects of 2 different neck exercises on the ability of people with neck pain to maintain an upright cervical and thoracic posture during this task.
Fifty-eight subjects with chronic, nonsevere neck pain and 10 control subjects participated in the study.
Change in cervical and thoracic posture from an upright posture was measured every 2 minutes during a 10-minute computer task. Following baseline measurements, the subjects with neck pain were randomized into one of two 6-week exercise intervention groups: a group that received training of the craniocervical flexor muscles or a group that received endurance-strength training of the cervical flexor muscles. The primary outcomes following intervention were changes in the angle of cervical and thoracic posture during the computer task.
Results : Subjects with neck pain demonstrated a change in cervical angle across the duration of the task consistent with a more forward head posture. No significant difference was observed for the change in cervical angle across the duration of the task for the control group subjects. Following intervention, the craniocervical flexor training group demonstrated a significant reduction in the change of cervical angle across the duration of the computer task.
This study showed that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting.
Exercise Regimens
The neck exercises were conducted over a 6-week period and subjects in each group received personal instruction and supervision by an experienced physical therapist once per week for the duration of the trial. None of the exercise sessions were longer than 30 minutes. Subjects were asked not to receive any other specific intervention for their neck pain; however, any medication that a subject was currently taking was not withheld. All subjects were supplied with an exercise diary and requested to practice their respective regimen twice per day for the duration of the trial. The exercise occupied a period of no longer than 10 to 20 minutes per day. The exercises were performed without any provocation of neck pain.
Craniocervical flexor training intervention. Training of the craniocervical flexor muscles followed the protocol described, by Jull et al. (A therapeutic exercise approach for cervical disorders. In: Boyling JD, Jull G, eds. Grieve’s Modern Manual Therapy: The Vertebral Column. 3rd ed. Edinburgh, United Kingdom: Elsevier; 2004.) The exercise targets the deep flexor muscles of the upper cervical region, the longus capitis and longus colli muscles, rather than the superficial flexor muscles, the sternocleidomastoid and anterior scalene, which flex the neck but not the head. In addition, the exercise is a low-load exercise in nature to more specifically train the deep cervical flexors, rather than the neck flexors as a whole, which occurs in a head lift exercise. The neck exercises used an air filled pressure sensor which was placed suboccipitally to monitor the subtle flattening of the cervical lordosis that occurs with the contraction of the longus colli muscle.
The subject was guided by the feedback from the pressure sensor to sequentially reach 5 pressure targets in 2-mm Hg increments from a baseline of 20 mm Hg to the final level of 30 mm Hg. Subjects were instructed to “gently nod their head as though they were saying ‘yes’.” The physical therapist identified the target level that the subject could hold steadily for 10 seconds without resorting to retraction, without dominant use of the superficial neck flexor muscles, and without a quick, jerky craniocervical flexion movement. Contribution from the superficial muscles was monitored by the physical therapist in all stages of the test using observation or palpation.
Training was commenced at the target level that the subject could achieve with a correct movement of craniocervical flexion and without dominant use or substitution by the superficial muscles (sternocleidomastoid, hyoid, and anterior scalene muscles). The subjects were taught to perform a slow and controlled craniocervical flexion action. They then trained to be able to sustain progressively increasing ranges of craniocervical flexion using feedback from the pressure sensor, which was placed behind the neck. For each target level, the contraction duration was increased to 10 seconds, and the subject trained to perform 10 repetitions. At this stage, the exercise was progressed to train at the next target level.
Endurance-strength training intervention. The endurance-strength training regimen consisted of a progressive resistance exercise program for the neck flexors. The exercise was performed in supine position, with the head supported in a comfortable resting position. Subjects were instructed to lift up their head so that cervical flexion occurred while maintaining a neutral upper cervical spine position. The subjects slowly moved the head and neck through as flail a range of motion as possible without causing discomfort or reproducing their symptoms.
This exercise regimen was a 2-stage program. The first stage was of 2 weeks’ duration and the second was of 4 weeks’ duration as recommended (30) for initiating a weight program in previously untrained individuals. In stage 1, the subjects performed 12 to 15 repetitions with a weight that they could lift 12 times (12-repetition maximum [RM]) on the first training session and progressed to 15 repetitions and maintained this level for the remainder of the 2-week period.
In stage 2, the subjects performed 3 sets of 15 repetitions of the initial 12-RM load once per day. One-minute rest intervals were provided between sets. If repetitions were easily achieved, weighted sandbags were applied to the patient’s forehead in 0.5-kg increments. If the subject was unable to perform repetitions of the head lift maneuver then the load on the neck flexors was reduced by allowing the subject to perform the task with the upper body (trunk and neck) inclined up from the horizontal so that the subject could perform the required repetitions of the movement.
