Effects of Cervical Proprioception Training Versus Strengthening Exercise of the Deep Neck and Lower Trapezius Muscle Combined with Cranio-Cervical Flexion Training (CCFT) to Improve Postural Control of the Neck in Office Workers with Chronic Neck Pain: A Single-Blind, Parallel-Group Randomized Controlled Trial
Keywords:
chronic neck pain, cervical proprioception, strength training, cranio-cervical flexion training, lower trapeziusAbstract
Objectives: To compare the effects of cervical proprioception training versus strengthening exercises of the deep cervical flexor and lower trapezius muscles, each combined with cranio-cervical flexion training (CCFT) on postural control of the neck in office workers with chronic neck pain
Study design: A single-blind, parallel-group randomized controlled trial
Setting: Outpatient Department (OPD), Physical Therapy Clinic, Ramathibodi Chakri Naruebodindra Hospital, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
Subjects: Thirty-three office workers with neck pain lasting more than 3 months were included. After three participants were excluded prior to the first assessment, twenty-eight people remained in the study (average age 31.2 years; 11 men, 17 women).
Methods: All treatments lasted 45-60 minutes per session, twice a week for 6 weeks (total of 12 sessions). Group 1 did CCFT plus neck position training (n = 10). Group 2 did CCFT plus neck and shoulder muscle strength training (n = 9). The control group did only CCFT (n = 9).
Cervical joint position error (JPE), cervical range of motion (ROM), pain intensity (VAS), and the Neck Disability Index (NDI). Outcomes were assessed at baseline, at 4- and 6-weeks post-intervention, and at the 12-week follow-up.
Results: All groups showed significant within-group reductions in mean JPE error angles across all directions by T3 (p < 0.05). Group 2 exhibited the earliest improvement, with a significant reduction in JPE at T1 (week 4), whereas Group 1 reached signi-ficance at T2 (week 6). Between-group comparisons revealed that both intervention groups (groups 1 and 2) demonstrated significantly greater improvements in JPE than the control group. Cervical ROM increased over time in all groups. group 1 showed greater improvements in right/left lateral flexion than group 2, with no differences compared to the control group. Pain intensity (VAS) and NDI scores decreased significantly from baseline in every group (p < 0.05). However, the magnitude of reduction did not differ significantly between groups for VAS, while NDI reduction was greatest in Group 2.
Conclusions: Combining CCFT with deep cervical flexor and lower trapezius strengthening exercises yielded the most rapid and pronounced improvements in proprioceptive accuracy, postural control (ROM), and neck disability. All combinations of interventions were more effective than CCFT alone in reducing JPE, pain, and disability.
References
Janwantanakul P, Pensri P, Jiamjarasrangsri V, Sinsongsook T. Prevalence of self-reported musculoskeletal symptoms among office workers. [Internet] 2008 Sep [cited 2021 March 12];58(6): Available from: doi: 10.1093/occmed/kqn072
Côté P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. [Internet] 2008 Feb 15 [cited 2021 Jul 20];33(4 Suppl): Available from: doi: 10.1097/BRS.0b013e3181643ee4
Chen X, O’Leary S, Johnston V. Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study. [Internet] 2018 Jul-Aug [cited 2021 May 02];22(4): Available from: doi: 10.1016/j.bjpt.2018.03.003
Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. [Internet] 2017 Aug 14 [cited 2021 April 10];358(Available from: doi: 10.1136/bmj.j3221
Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. [Internet] 2016 Jan [cited 2021 June 04];73(1): Available from: doi: 10.1136/oemed-2015-102992
Falla D, Farina D. Neural and muscular factors associated with motor impairment in neck pain. [Internet] 2007 Dec [cited 2025 June 15];9(6): Available from: doi: 10.1007/s11926-007-0080-4
Reddy RS, Tedla JS, Dixit S, Abohashrh M. Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis. [Internet] 2019 Oct 15 [cited 2021 April 01];20(1): Available from: doi: 10.1186/s12891-019-2846-z
Sremakaew M, Jull G, Treleaven J, Barbero M, Falla D, Uthaikhup S. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial. [Internet] 2018 Feb 13 [cited 2021 May 03 ];19(1): Available from: doi: 10.1186/s12891-018-1964-3
de Vries J, Ischebeck BK, Voogt LP, van der Geest JN, Janssen M, Frens MA, et al. Joint position sense error in people with neck pain: A systematic review. [Internet] 2015 Dec [cited 2021 May 18];20(6): Available from: doi: 10.1016/j.math.2015.04.015
Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck Pain: Revision 2017. [Internet] 2017 Jul [cited 2021 Feb 24];47(7): Available from: doi: 10.2519/jospt.2017.0302
Kashfi P, Karimi N, Peolsson A, Rahnama L. The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: protocol for a randomized clinical trial (RCT). [Internet] 2019 Nov 14 [cited 2021 May 10];20(1): Available from: doi: 10.1186/s12891-019-2880-x
Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. [Internet] 2013 Oct [cited 2021 March 12];18(5): Available from: doi: 10.1016/j.math.2013.05.009
O’Leary S, Jull G, Kim M, Vicenzino B. Specificity in retraining craniocervical flexor muscle performance. [Internet] 2007 Jan [cited 2021 Feb 24];37(1): Available from: doi: 10.2519/jospt.2007.2237
Gallego Izquierdo T, Pecos-Martin D, Lluch Girbés E, Plaza-Manzano G, Rodríguez Caldentey R, Mayor Melús R, et al. Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial. [Internet] 2016 Jan [cited 2022 May 14];48(1): Available from: doi: 10.2340/16501977-2034
Petersen SM, Wyatt SN. Lower trapezius muscle strength in individuals with unilateral neck pain. [Internet] 2011 Apr [cited 2021 May 08];41(4): Available from: doi: 10.2519/jospt.2011.3503
Petersen SM, Domino NA, Cook CE. Scapulothoracic muscle strength in individuals with neck pain. [Internet] 2016 Aug 10 [cited 2021 June 11];29(3): Available from: doi: 10.3233/bmr-160656
Falla DL, Jull GA, Hodges PW. Patients With Neck Pain Demonstrate Reduced Electromyographic Activity of the Deep Cervical Flexor Muscles During Performance of the Craniocervical Flexion Test. [Internet] 2004 [cited 2025 June 15];29(19): Available from: https://journals.lww.com/spinejournal/fulltext/2004/10010/patients_with_neck_pain_demonstrate_reduced.5.aspx doi: 10. 1097/01.brs.0000141170.89317.0e
Chuachan S, Kaewmunee W, Thongnun K, Prom-in J, Saelao T, Assawawongsawat N. The effects of modified scapular exercises in participants with neck, scapular and shoulder pain: a randomized trial. Thai J Phys Ther. 2021;43(1):31-44. [Internet]. [cited 2025 Nov 10]. Available from: https://he02.tci-thaijo.org/index.php/tjpt/article/download/224054/170270/886375
Sakinepoor A, Letafatkar A, Mazidi M. Effect of sensorimotor training on proprioception, pain, and posture in participants with chronic non specific neck pain. [Internet] 2021 09/02 [cited 2025 May 30];7 Available from: doi: 10.22034/IJRN.7.4.61
Park SH, Lee MM. Effects of Lower Trapezius Strengthening Exercises on Pain, Dysfunction, Posture Alignment, Muscle Thickness and Contraction Rate in Patients with Neck Pain; Randomized Controlled Trial. [Internet] 2020 Mar 23 [cited 2025 May 12];26 Available from: doi: 10.12659/msm.920208
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