Saudi Journal of Sports Medicine

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 18  |  Issue : 2  |  Page : 63--66

The effect of stretching versus strengthening exercise to reduce neck pain in asymptomatic adults


Venkata Nagaraj Kakaraparthi1, Vamsi Krishna Gannamaneni2,  
1 Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
2 Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Hail University, Hail, Kingdom of Saudi Arabia

Correspondence Address:
Venkata Nagaraj Kakaraparthi
Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha
Kingdom of Saudi Arabia

Abstract

Purpose of the Study: Neck pain (NP) is one of the most common musculoskeletal complaints, with 30%–50% of the population affected every year and two out of every three individuals experiencing NP in their lifetime. Stretching has been recommended as one of the treatment techniques for patients with NP. Strengthening and fitness exercises have shown to be effective at preventing NP and reducing its severity. Neck movement is dictated by the sternocleidomastoid, longus colli, and longus capitis for flexion, a concerted effort of the splenius capitis, semispinalis, suboccipital, and trapezius for extension, and the scalenes, sternocleidomastoid, and fibers from the trapezius to control lateral bending (Jenkins, 2002). Therefore, the study attempts to compare the effect of stretching and strengthening exercises on individuals with NP in asymptomatic adults in long-term duration. Materials and Methods: The study consisted of 40 male individuals of the age group 18–35 years, who are willing to participate in the study. These individuals were divided 20 in each group. Group A received stretching exercises and Group B received strengthening exercises for a period of 4 weeks. Pain was assessed at the end of every week for 4 weeks. Results: From the results, Group A shows more significant improvement than Group B. Conclusion: The results showed that both stretching exercises and strengthening exercises had significant effect on asymptomatic NP. A highly significant statistical difference was seen in week 4 of the study in favor of Group A. Group A dominated over Group B in all the weeks of the study thus showed that stretching exercises were more beneficial than strengthening exercise in relieving NP.



How to cite this article:
Kakaraparthi VN, Gannamaneni VK. The effect of stretching versus strengthening exercise to reduce neck pain in asymptomatic adults.Saudi J Sports Med 2018;18:63-66


How to cite this URL:
Kakaraparthi VN, Gannamaneni VK. The effect of stretching versus strengthening exercise to reduce neck pain in asymptomatic adults. Saudi J Sports Med [serial online] 2018 [cited 2019 Jul 17 ];18:63-66
Available from: http://www.sjosm.org/text.asp?2018/18/2/63/243353


Full Text



 Introduction



Neck pain (NP) is one of the most common musculoskeletal complaints, with 30%–50% of the population affected every year and two out of every three individuals experiencing NP in their lifetime.[1]

NP is particularly prevalent in office workers due to the increasing use of computers. More than 50% of workers reported a relationship between their occupation and NP, while 14% experienced activity limitations due to NP each year. As a result of the significant societal and health burden associated with NP, there is increasing focus on treatments to alleviate NP.[2]

Some possible factors are sedentary work, increase in activities such as use of personal computers and Internet, use of motor vehicles, and changes of work type. Some psychosocial factors are considered as the strongest prognostic factors for NP and contributing factors for slower or less complete recovery and persistent pain. Moreover, these factors influence the perception of pain and disability and decrease the self-efficacy perception.[3]

According to various studies, in many cervical conditions such as whiplash-associated disorders or cervicogenic headache, a dysfunction of deep cervical flexors such as longus colli and longus capitis can be found. Other studies also describe the deep cervical extensors as being dysfunctional especially semispinalis, suboccipital, and multifidus muscles.[3]

Stretching has been recommended as one of the treatments for patients with NP. According to some authors stretching alone found significant effect to reduce the pain than other interventions. Muscular performance exercises include those that address characteristics of strength, endurance, and motor control.[1]

Strengthening and fitness exercises have shown to be effective at preventing NP and reducing its severity. Neck movement is dictated by the sternocleidomastoid, longus colli, and longus capitis for flexion, a concerted effort of the splenius capitis, semispinalis, suboccipital, and trapezius for extension, and the scalenes, sternocleidomastoid, and fibers from the trapezius to control lateral bending (Cheung J, 2013).[4]

From the literature, it seems that muscular dysfunction in the cervical spine refers to changes in structure and function. Moreover, the following deficiencies have been observed in people affected by NP reductions in maximal strength, in accuracy of head position during dynamic movements and repositioning, in efficiency of contraction, and in muscle endurance.[5]

Therefore, the study attempts to compare the effect of stretching and muscle performance exercises on individuals with NP in asymptomatic adults in long-term duration. Different authors have suggested many exercises for the treatment of asymptomatic NP. No study has been developed a protocol for the treatment of acute NP. Therefore, the primary aim of this study was to develop a preliminary clinical prediction rule to determine which patients with NP may benefit from a standardized program of stretching and muscle performance exercise based on patient-perceived improvement of symptoms.[1]

The hypothesis states that stretching exercises may have an effect on NP in asymptomatic adults. Strength and endurance exercises may have an effect on NP in asymptomatic adults. Stretching exercises may be more effective on NP compared to strength and endurance exercises.

 Materials and Methods



Subjects

The study consisted of 40 male individuals of the age group 18–35 years, who are willing to participate in the study. The individuals were randomly divided into two groups. Individuals were explained about the measurement and the experimental procedures and were asked to sign consent form for their voluntary participation. After screening each subject with the inclusion and exclusion criteria selected, the individuals were grouped randomly into two groups (Group A and Group B) of 20 individuals in each group. Both the groups received muscle stretching exercises as shown in [Figure 1] and strengthening exercises as shown in [Figure 2]. All these exercises performed once a day, 6 days a week for 4 weeks.{Figure 1}{Figure 2}

Only male participants of asymptomatic were included in the study. Any presence of tumor, recent fracture, infection, evidence of central nervous system involvement, spasmodic torticollis, previously diagnosed migraines, previously diagnosed fibromyalgia, congenital abnormalities, ankylosing spondylitis, peripheral artery diseases, hernia/visceral problems, prior surgery to the neck or thoracic spine have been excluded from the study.

The study setting is done in the Department of Physical Therapy, King Khalid Hospital, Hail, Saudi Arabia. All individuals were selected with regression probability purposive sampling. All individuals were explained thoroughly about the study and their consent was obtained. The demographic data including age, weight, and height were documented. The associated problems such as diabetes mellitus, hypertension, and asthma and the history included the medical and surgical history of the patient were noted on the assessment sheet. Sitting posture was subjectively described by Kendall et al. and assessed by viewing the patient from a lateral position with the dominant side toward the examiner. Measurement was taken by neck disability index scale.

 Results



Independent test

[Figure 1] shows a comparison between the Group A and Group B. P value for the Group A and Group B before treatment is 0.10 and posttreatment is 0.29. On analyzing the P values, a highly significant difference was observed between the groups. Thus, taking the mean values into consideration, it can be concluded that Group A (stretching exercises) shows more significant improvement than Group B (strengthening exercises).

Paired test

[Figure 2] shows a comparison between the Group A and Group B of paired t-test. P value for the Group A and Group B pre- and post-treatment is 1.29 and 1.22, respectively. On analyzing the P values, a highly significant difference was observed between the groups. Thus, taking the mean values into consideration, it can be concluded that Group A (stretching exercises) shows more significant improvement than Group B (strengthening exercises).

The standard deviation in Group A showed a significant variation in comparison with Group B.

 Discussion



NP is one of the most common musculoskeletal complaints, with 30%–50% of the population affected every year and two out of every three individuals experiencing NP in their lifetime.

The use of exercises has shown to improve muscular strength, thereby correcting imbalances, and also increase the stability of the neck. Although most clinicians agree that different types of cervical exercises do indeed reduce asymptomatic NP, among all commonly used exercises are stretching exercises and strengthening exercises.

Different authors have suggested many exercises for treatment of asymptomatic NP. Therefore, the study attempts to compare the effect of stretching and muscle performance exercises on individuals with NP in asymptomatic adults in long-term duration.

According to the data analysis and statistical interference, both the groups showed decrease in asymptomatic NP following a 4-week exercise intervention program. However, on analysis of the P values, Group A showed a statistically significant (P ≤ 1.29) improvement in decreasing NP than Group B. This suggests that probably stretching exercises were more beneficial than strengthening exercises.

Analyzing the week-wise results, stretching exercises were more effective than strengthening exercises.

Thus, based on the results obtained from the study, it can be concluded that stretching exercises were found to be more effective than strengthening exercises. This could be due to stretching exercises which helped improve the range of motion and also stretch the anterior-tightened structures along with strengthening of the posterior neck muscles whereas as compared to the strength training which only helped improve the strength and stability of the cervical spine.

 Conclusion



This study was done to compare the effectiveness of stretching exercises over strengthening exercises on asymptomatic NP. Forty individuals were selected after considering the selection criteria and randomly divided into two groups of twenty each (Group A and Group B). Group A received stretching exercises and Group B received strengthening exercises for 6 days a week for 4 weeks. Initial measurements were taken before beginning the treatment regimen. Posttreatment measurements were taken at the end of each week.

The results showed that both stretching exercises and strengthening exercises had a significant effect on asymptomatic NP. A highly significant statistical difference was seen in week 4 of the study in favor of Group A. Group A dominated over Group B in all the weeks of the study thus showing that stretching exercises were more beneficial than strengthening exercise in reliving NP.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Parazza S, Vanti C, O'Reilly C, Villafaíe JH, Tricás Moreno JM, Estébanez De Miguel E, et al. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain. Chiropr Man Therap 2014;22:10.
3Hush JM, Michaleff Z, Maher CG, Refshauge K. Individual, physical and psychological risk factors for neck pain in Australian office workers: A 1-year longitudinal study. Eur Spine J 2009;18:1532-40.
4Cheung J, Kajaks T, Macdermid JC. The relationship between neck pain and physical activity. Open Orthop J 2013;7:521-9.
5Lavallee AV, Ching RP, Nuckley DJ. Developmental biomechanics of neck musculature. J Biomech 2013;46:527-34.