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CASE REPORT
Year : 2015  |  Volume : 15  |  Issue : 1  |  Page : 97-99

Efficacy of resisted exercise in straightened cervical lordosis: A case report: ABAB design


Department of Physical Therapy, College of Applied Medical Science, Majmaah University, Al Majmaah, Saudi Arabia

Date of Web Publication19-Jan-2015

Correspondence Address:
Ateef Mahamed
Assistant Professor, College of Applied Medical Science, Majmaah University, Al Majmaah
Saudi Arabia
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DOI: 10.4103/1319-6308.149547

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  Abstract 

The purpose of this study was to evaluate the efficacy of resisted exercise in a patient with a painful straightened cervical lordosis. A 35-year-old male patient was referred by an orthopedist with a complaint of neck ache; he had difficulty in bending backward to see the roof and forward (chin poke) since one and half months. He experienced pain severity of 9 on a visual analog scale (VAS). Neck's active range of motions in all six directions were measured using a universal goniometer; flexion was 20΀, extension 10΀, left and right lateral flexion were 20΀ each side, and rotation was 35΀ each side. The patient was given mild resisted exercise in phoenix position twice a day for two alternative weeks along with initial short wave diathermy for one week for pain relief. At the end of the fifth week, pain was nearly normal on the numeric scale. Hence, an attempt was made to explore the efficacy of resisted exercise in straightened cervical lordosis to correct and prevent painful living and irreversible cervical lordotic deformity.

  Abstract in Arabic 

تهدف هذه الدراسة الى تقييم كفاءة تمارين المقاومة للمرضى الذين يعانون من الم ناتج عن استقامة انحناء الفقرات العنقية. المريض المحول من اخصائى العظام يبلغ خمساٌ وثلاثين عاماٌ يعانى من الم بالرقبة مع صعوبة فى رفع الراس عاليا و تحريك الذقن الى الوراء موازيا لسطح الارض منذ شهر ونصف. ويعانى ايضا من الم شديد يصل الى المستوى التاسع طبقا للمقياس التناظرى البصرى. تم قياس مدى الرقبة النشط في كل الاتجاهات الستة باستخدام مقياس الزوايا الشامل وكانت القياسات كالتالى الانحناء الامامى 20 °، 10 ° للانحناء الخلفى والانحاء الجانبى لليمين واليسار كان 20 درجة لكل جانب، و الدوران كان 35 درجة لكل جانب. تم تطبيق تمرينات مقاومة خفيفة الشدة من وضع فونكس مرتين فى اليوم لمدة اسبوعين مع تطبيق الموجات الحرارية القصيرة لتخفيف الالم لمدة اسبوع. مع نهاية الاسبوع الخامس وصل الالم الى ادى مستوى لقياس الالم. جرت المحاولة لإكتشاف كفاءة تمارين المقاومة فى تصحيح استقامة وتشوه الفقرات العنقية وتخفيف الالام المعيشية الناجمة عنها.

الكلمات الدالة :الم الرقبة - طمس الم الفقرات العنقية - تمارين المقاومة.




Keywords: Neck pain, obliterated cervical pain, resisted exercises


How to cite this article:
Mahamed A. Efficacy of resisted exercise in straightened cervical lordosis: A case report: ABAB design. Saudi J Sports Med 2015;15:97-9

How to cite this URL:
Mahamed A. Efficacy of resisted exercise in straightened cervical lordosis: A case report: ABAB design. Saudi J Sports Med [serial online] 2015 [cited 2019 Jul 19];15:97-9. Available from: http://www.sjosm.org/text.asp?2015/15/1/97/149547


  Introduction Top


The cervical spine is normally curved inward; the curve seen from the side is lordosis. When lordosis decreases, it is described as straightened cervical lordosis. The variable cervical spine curvature depends not only on the tone of the cervical spinal musculature but also on the postural adaptation, where the line of gravity plays a major role. [1] As desk professionals bend their neck downward the cervical lordosis decreases, causing transient straightening of cervical curvature leading to shift of line of gravity forward. A shift of gravity usually causes imbalance between agonists and antagonists. [2] In case of (desk professionals) cervical spine, neck extensors will be in a state of continuous stretch while looking downward, which leads to 'stretch weakness.' This kind of stretch weakness would allow neck flexors to dominate and would cause permanent loss of cervical lordosis leading to straightened cervical lordosis. [2] A change in biomechanical alignment leads to increased anterior disc pressure. [2] The aim of this case study is to show how far the strengthening (resisted) exercises would correct and halt the deformity development.


  Case report Top


Patient history

The patient, a 35-year-old male computer professional, complained of neck ache for 45 days that had started gradually. There was no history of trauma, postsurgical correction of spinal deformities, degenerative joint disease, congenital or acquired kyphosis, ankylosing spondylitis, or any other surgical intervention leading to secondary development of straightened cervical lordosis. The cardinal symptoms were neck pain, with restricted painful movements. He had no history of a similar problem in the past. The symptoms worsened as the day progressed with the sense of fatigue and inability to maintain sitting position for long hours.

Physical examination

On examination, it was found that the patient had decreased cervical lordosis exhibiting painful extension along with inability to see the roof/upward. Restriction of active cervical range of motions (ROMs) in all six directions were measured using a universal goniometer, where extension was more restricted than flexion, measuring 20° flexion and 10° extension, left and right lateral flexion were 20° each side, and rotation was 35° each side (nerve root symptoms were also excluded using different special tests for differential diagnosis). He rated his pain threshold level as 9 on a 0-10 numeric visual analog scale (VAS). Cervical X-rays of the spine was obtained. The lateral view was particularly helpful to view the loss of cervical lordosis.

Treatment methods

The patient was informed about the study and his consent was taken. Prior to the physiotherapy treatment approach, his outcome measure in terms of quantity of pain was taken on a VAS. Ferraz and Aquino have studied the use of pain rating scales previously, especially VAS in various conditions. [3]

In the present study, active movements were measured by universal goniometer method in straightened cervical lordosis. The patient was then educated about his condition and the possible treatment to be given.

Electrotherapeutics

Initially, the patient was treated with continuous short wave diathermy for 15 minutes in supine position for relief of pain with small disc electrodes placed in coplanar arrangement at the cervical region. [4]

Exercise therapeutics

Strengthening

Strengthening exercises for extensors of the cervical spine were administered to maintain the cervical lordosis. The patient was given mild resisted exercise in phoenix position twice a day for four weeks along with initial isometrics to overcome stretch weakness and to facilitate resisted exercises. Resisted exercise was carried out using a minimal weight of 250 mg of sand bag tied to the head of the circumference by emphasizing the weight on occipital area in phoenix position for one week initially to prevent sudden giddiness and aggravation of pain. In the second week, the weight was increased to 350 mg. In the third and fifth weeks, the same weight was continued as the patient was more comfortable to the resisted exercise twice a day, whereas on the fourth and sixth weeks, he was discontinued from the resisted exercise to see the efficacy of the resisted exercise on pain variable as under ABAB design the third and fifth weeks are intervention weeks, whereas the fourth and sixth weeks are control weeks.

Clinical outcomes

At the end of the third week of intervention with consolidated weight of 350 mg, the patient was reassessed; his pain had decreased from 9/10 to 6.5/10 and ROMs of flexion and extension had improved from 20° to 25° and 10° to 15°, respectively. His left and right lateral flexion improved from 20° to 25° each side and rotation from 35° to 40° each side. At the end of the fourth week, without intervention the patient was reassessed; his pain status was same like at the end of third week, 6.5/10 and ROMs of flexion and extension were 25° and 15°, respectively, keeping both the side lateral flexion and rotation same. At the end of the fifth week of intervention with consolidated weight of 350 mg, the patient was reassessed; his pain had decreased from 6.5/10 to 1.5/10 and ROMs of flexion and extension had improved from 25° to 28° and 15° to 17°, respectively. His left and right lateral flexion improved from 25° to 27° each side and rotation from 40° to 43° each side. At the end of the sixth week without intervention, the patient was reassessed; his pain status was same like at the end of the fifth week, 1.5/10 and ROMs of flexion and extension were 28° and 17°, respectively. This case study with ABAB design clearly shows the efficacy of resisted exercise in relieving pain and improving the ROM of flexion and extension, keeping both side lateral flexion and rotation same like at the end of fifth week intervention.


  Discussion Top


Complete or full ROM of flexion, extension, lateral flexion and rotation of cervical spine depends on the normal 'C'-shaped cervical lordosis. All the six movements are the combined motions of atlanto-occipital and atlanto-axial joints along with the cervical spine C5 to C7 intervertebral joints. Any loss of motion at cervical joints would diminish the total and combination of all movements at cervical spine. In case of straightened cervical lordosis, flexion and extension were diminished due to the straightened cervical spine. In lordosis, the spine is already in spasm and in extended position, where extension motion is restricted, if extension restricted flexion automatically diminishes leading to effect all the possible movements such as lateral flexion and rotations as well.

Resisted exercises basically strengthen the cervical extensors causing them to gain and maintain the cervical lordosis back in its position, which in turn creates flexible motion at the cervical intervertebral joints. Straightened cervical lordosis keeps the cervical spinal extensors in constant stretched position, which in the long run causes weakness and increases the load on anterior disc, straining the posterior longitudinal ligaments through which pain develops.

The obvious limitations of this study include difficulty in generalizing the results for other patients, and hence, future research should be done in a case series.


  Conclusion Top


In today's mechanical life, it is obvious that lack of proper postural awareness causes change in underlined normal gravitation mechanics of cervical region, leading to the obliteration of normal cervical curvature. Resisted exercise can be used as an adjunct to regular physiotherapeutic interventions for the relief of neck pain, to increase the cervical spinal mobility and thereby to prevent irreversible cervical spinal deformity.

Clinical implications

Physiotherapists should acknowledge that along with proper assessment and evaluation, documentation of baseline cervical mobility values and resisted exercise interventions are always helpful for better outcomes. It is possible to prescribe impairment-based therapeutic interventions to prevent severity and development of a cervical deformity, which would be the sequel of a chronic painful straightened cervical spine in all desk professionals who are continuously sitting in a forward head-stooping posture.


  Acknowledgement Top


Special thanks to my University Dean for the support.

 
  References Top

1.
Kapandji IA. The cervical vertebral column. The physiology of the joints. 6 th ed. Edinburgh: Churchill Livingstone; 2007. p. 107.  Back to cited text no. 1
    
2.
Wei W, Liao S, Shi S, Fei J, Wang Y, Chen C. Straightened cervical lordosis causes stress concentration: A finite element model study. Australas Phys Eng Sci Med 2013;36:27-33.  Back to cited text no. 2
    
3.
Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment obliterate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990;17:1022-4.  Back to cited text no. 3
    
4.
Delisa JA. Physical medicine and rehabilitation. Principles and Practice. 4 th ed. Lippincott: Williams and Wilkins; 2004. p. 258.  Back to cited text no. 4
    



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[Pubmed] | [DOI]



 

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  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
Acknowledgement
References

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