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Background Tactile discrimination training (TDT) and oculomotor exercises (OEs) have been widely used somatosensory-based interventions for a wide range of chronic pain conditions. There is, however, little evidence for the effectiveness of these approaches in people with chronic neck pain. This study aimed to determine the superiority of one intervention over another on pain outcomes in people with chronic neck pain. Methods Fifty seven participants were randomly divided into three groups: TDT, OEs, and a control group who received no intervention. TDT, OEs groups received either TDT or OEs, respectively, three times per week for four weeks. The control group received no intervention. Pain intensity, neck pain-related disability, pressure pain thresholds (PPTs), mechanical pain of temporal summation (mTSP), and conditioned pain modulation were assessed as pain outcomes. Depending on the normality, a repeated measures ANOVA or F1-LD-F1 design was used to analyse the data. Results A significant group*time interaction and main effects for time were found for pain intensity (p: 0.001, p: 0.001, respectively) and pain-related disability ( p  < 0.019, p  < 0.009; respectively). There was a significant main effect for time for mTSP at the painful side of the neck (p: 0.022). TDT and OEs resulted in a significantly higher improvement in pain intensity ( p : 0.005, p  < 0.001; respectively) and neck pain-related disability ( p : 0.005, p : 0.007; respectively). There was a higher improvement in pain intensity in OEs group compared to TDT group (p: 0.010). A significantly higher improvement in PPT at the painful site after OEs was found (p: 0.038). The control group demonstrated a significantly higher improvement in mTSP in the painful area of the neck (p: 0.048). There were no other significant within- or between-group changes. Conclusion OEs and TDT are effective somatosensory-based interventions for improving pain intensity and pain-related disability. Impact This study demonstrated that sensory retraining interventions improves the subjective pain perception. Trial Registration Trial Registration Number: NCT05605132, Date of trial registration: 10/29/2022, Name of trial registry: Neck Pain.

Background. Neck pain (NP) is a common work-related disorder, with high prevalence in the profession of teaching. The daily duties of a school teacher involve head-down postures while reading and writing, which expose them to the risk of developing NP. Deep cervical flexor (DCF) muscles have been reported to have lower endurance in patients with cervical impairment, which has additionally been associated with disability. There is limited evidence regarding the efficacy of training of DCF muscles in occupational NP. The objective of this study was to investigate the effects of DCF muscle training on pain, muscle endurance, and functional disability using pressure biofeedback in school teachers with NP. Methods. Sixty-five teachers (age, 25-45 years) with more than 5 years of teaching experience participated in this study. They were randomly divided into two groups: the experimental (E) and control (C) groups. In the E group, the subjects underwent DCF muscle training using pressure biofeedback in addition to conventional exercises for neck pain, while those in the C group underwent conventional exercises only. Pain, muscle endurance, and disability were measured at day 0 (before the treatment) and days 14 and 42 after the treatment. Endurance of DCF muscles was measured by the craniocervical flexion test using pressure biofeedback, pain intensity was measured using the numeric pain rating scale, and functional disability was assessed using the neck disability index questionnaire. This study was performed in accordance with CONSORT guidelines. Results. On day 0, there were no significant differences in the age, pain, muscle endurance, and disability levels between the groups. After initiating the intervention, although there were improvements in both groups, there was a statistically significant improvement in muscle endurance, pain, and disability in subjects who received additional training with pressure biofeedback. Conclusions. Besides increasing muscle endurance, specific training of DCF muscles in addition to conventional exercises can improve neck pain and functional disability. These results should be further correlated clinically. A dedicated time for exercises at school could help prevent the development of NP in teachers. This trial is registered with ClinicalTrials.gov NCT03537300 May 24, 2018 (retrospectively registered).

Background This study was conducted to determine the effects of combined exercises applied with supervised and telerehabilitation methods on pain intensity, pain pressure threshold, muscular endurance, grip strength, neck and upper extremity disabilities in dentists with chronic neck pain (CNP). Methods Fifty-five dentists with CNP were included in the study and randomly divided into three groups as supervised group ( n  = 19), telerehabilitation group ( n  = 19) and control group ( n  = 17). The participants had a mean age of 35.20 ± 4.16 years, with ages ranging from 30 to 44 years and of the participants, 43 were female (78%) and 12 were male (22%). Combined exercises consisting of resistance, stretching and postural alignment exercises were applied with supervised and telerehabilitation methods three days a week for 12 weeks. The control group received a non-resistance exercise sheet matching the other protocols. Initially, all patients were assessed for pain intensity (VAS), pain pressure threshold, grip strength (hand, lateral and pinch grip), muscular endurance (deep neck flexors, scapular, static and dynamic core), neck and upper extremity disability. The assessments were repeated after 12 weeks of training. Results The telerehabilitation group demonstrated positive changes in pain intensity, pain pressure threshold, and neck disability that were statistically significant ( p  < 0.05). Supervised group has improved all assessments except dynamic core endurance and grip strength ( p  < 0.05). There was also a decrease in pain intensity and neck disability index in the control group ( p  < 0.05). When the changes resulting from exercise training were compared between the groups, it was seen that the changes in the supervised group were superior ( p  < 0.05). Conclusions The results showed that combined exercises applied under supervision were more effective than telerehabilitation or home exercises in dentists with CNP, and telerehabilitation was more effective than home program. Although the telerehabilitation method is not as effective as supervised exercise training, it can be an alternative method to reduce pain and disability for dentists who cannot participate in a regular exercise program due to their working conditions. Long-term follow-up studies are needed to determine how long the effect of exercise training applied with telerehabilitation continues in dentists with CNP.

Exercise therapy is the most common approach for people with chronic neck pain (CNP). Although well‐established, it remains unknown which type of exercise is the best for treating this condition. Moreover, pain processing can play a role in the persistence of pain and in the response to interventions. Thus, the aim of this randomized controlled trial is to compare the acute and long‐term effects of two exercise protocols (specific and non‐specific) on pain and pain processing in individuals with CNP. One hundred and ten participants aged between 18 and 65 years who have had non‐specific neck pain for more than 3 months will be recruited. They will be randomized and allocated into two groups (specific exercises and non‐specific exercises) and both groups will perform an exercise programme twice a week for 8 weeks. Both programmes are divided into two progressive and individualized phases. The primary outcomes are change in pain intensity after 8 weeks of exercise and exercise‐induced hypoalgesia, and secondary outcomes are pressure pain threshold, temporal summation of pain, conditioned pain modulation, the Neck Disability Index, the Baecke Physical Activity Questionnaire, and the Global Perception of Change Scale. Outcomes will be assessed at baseline, after 8 weeks of intervention, and at 6‐month follow‐up. What is the central question of this study? Chronic neck pain is the second‐most disabling musculoskeletal condition: how do the acute and long‐term effects of specific and non‐specific exercises for chronic neck pain compare? What is the importance of this work? This is the first randomized controlled trial to compare the effects of acute and long‐term effects of specific and non‐specific exercises on pain intensity and pain processing in chronic neck pain.

In contemporary societies, computer use by children is a necessity and thus highly prevalent. Using computers for long hours is related to a higher risk of computer-related muscular disorders like forward head posture (FHP) and neck pain (NP). Deep cervical flexor (DCF) muscles are important head-on-neck posture stabilizers; thus, their training may lead to an improvement in FHP and NP. The aim of this study was to determine if 4 weeks of DCF training is effective in alleviating NP, improving FHP, and functional status in adolescent children using computers regularly, a pretest-posttest experimental group design was used. Subjects were randomly assigned into the experimental group (receiving DCF training and postural education) and the control group (receiving postural education only). 30 subjects with a mean age of 15.7±1.725 years with NP and FHP using computers regularly participated in the study. Dependent variables were measured on day 1 (at baseline) and after 4 weeks of training. Photographic analysis was used for measuring FHP, visual analog scale for NP intensity, and neck disability index for functional status. Data analysis showed that in both groups, no significant improvement occurred in FHP. In both groups, there was a significant improvement in functional status and NP. There was no significant difference between both groups for FHP and NP. There was a significant improvement in functional status in the experimental group in comparison to the control group. Four weeks of DCF training does not cause a significant improvement in FHP in 13 to 18 years old adolescent children using computers regularly.

Background The purpose of this study is to evaluate the effect of a six-week combined manual therapy (MT) and stabilizing exercises (SEs), with a one-month follow-up on neck pain and improving function and posture in patients with forward head and rounded shoulder postures (FHRSP). Methods Sixty women with neck pain and FHRSP were randomized into three groups: Group 1 performed SE and received MT ( n  = 20), Group 2 performed SE (n = 20) and Group 3 performed home exercises (n = 20) for six weeks. The follow-up time was one month after the post test. The pain, function, and head and shoulder angles were measured before and after the six-week interventions, and during a one-month follow-up. Results There were significant within-group improvements in pain, function, and head and shoulder posture in groups 1 and 2. There were significant between-group differences in groups 1 and 2 in head posture, pain, and function favoring group 1 with effect size 0.432( p  = 0.041), 0.533 ( P  = 0.038), and 0.565( P  = 0.018) respectively. There were significant between-group differences in both intervention groups versus the control group favoring the intervention groups. Conclusion These findings suggest that both interventions were significantly effective in reducing neck pain and improving function and posture in patients. However, the improvement in function and pain were more effective in Group 1 as compared to Group 2, suggesting that MT can be used as a supplementary method to the stabilizing intervention in the treatment of neck pain. More researches are needed to confirm the result of this study. Trial registration UMIN000030141 modified on 2018.03.08. This study is a randomized control trial registered at UMIN-CTR website, the trial was retrospectively registered and the unique trial number is UMIN000030141 .

The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP. Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale-NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale-PCS) and kinesiophobia (TSK-11). Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6). The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP. ClinicalTrials.gov: NCT05541848.

Background Nonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual’s poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion. Methods It is a single-blinded randomized clinical trial with 60 patients aged 18–40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant. Results After treatment within-group analysis of both NSE and NDE showed significant ( p  < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences ( p  > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement. Conclusion Between NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP. Trial Registration Registered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

Background and Objectives: It has been seen that jaw opening is associated with neck extension and jaw closing is associated with neck flexion. This natural association between the jaw and neck can be used as a novel approach to treat chronic non-specific neck pain, although the effects of this concept have never been previously evaluated as a treatment strategy. This article intends to study the effects of integrating jaw opening and closing movements along with active neck exercises versus active neck exercises alone in the management of chronic non-specific neck pain. Materials and Methods: A total of 80 patients, aged 20 to 50, with chronic non-specific neck pain were included in a double-blind randomized controlled trial, conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan from 2018 to 2022. The patients were divided into two groups: Group A patients were assigned jaw movements with active neck exercises, while Group B patients were assigned only active neck exercises. Both groups were assigned isometric strengthening exercises and self-resisted strengthening exercises for cervical spine muscles as a home plan. The study used various outcome measures, including the numerical pain rating scale (NPRS), neck disability index (NDI), neck flexion endurance (NFE), neck extension endurance (NEE), the neck proprioception error (NPE): neck flexion proprioception error (NFPE), neck extension proprioception error (NEPE), neck right rotation proprioception error (NRRPE), and neck left rotation proprioception error (NLRPE), with measurements taken at week 1 and week 6, respectively; the mean differences between the groups were measured using a two-way repeated ANOVA. Results: The experimental group showed better improvements compared to the control group, NPRS (73%), NDI (57%), NFE (152%), NEE (83%), NFPE (58%), NEPE (65%), NRRPE (65%), and NLRPE (62%), with a significant difference (p < 0.05). Conclusions: Active neck extension and flexion movements combined with jaw opening and closing are more effective in reducing pain and disability, improving neck muscles endurance and normalizing neck proprioception in patients with chronic neck pain.

Background Altered thickness, cross-sectional area and activity of deep neck muscles have frequently been reported in patients with chronic non-specific neck pain (CNNP). It is claimed that these muscles do not recover spontaneously. These muscles provide a considerable amount of cervical stability. Therefore, various therapeutic exercises have been recommended to recover from resulting complications. However, most exercise protocols do not target deep neck muscles directly. Thus, this might be a reason for long-lasting complications. Accordingly, the purpose of the present study is to discuss a randomized controlled trial (RCT) protocol in which we aim to investigate and compare the effects of neck-specific exercise programmes versus general exercise programmes in patients with CNNP. Methods A 2*2 factorial RCT with before-after design. Sixty-four participants with CNNP will be recruited into the study. They will be randomly divided into two groups, including specific neck exercise and general exercise. Each exercise programme will be carried out three times a week and will last for 8 weeks. Primarily, dorsal and ventral neck muscle thickness, pain and disability and secondarily, muscle strength, quality of life, sleep quality, fear avoidance and neck range of motion will be assessed at the baseline and immediately at the end of the exercise protocol. Discussion The results of this study will inform clinicians on which type of exercise is more beneficial for patients with CNNP. Trial registration IRCT2017091620787N2 , Sep 16 2017.