The result of deep neck flexors training on disability and pain over upper back and neck muscles in patients with chronic neck pain

INTERVENTION: All participants received instruction guidelines through written leaflet and digital video disk (duration 17 minutes recorded by the two physiotherapists) with ergonomic advices and exercise guidelines for neck for a fuller understanding of the execution of the therapeutic exercises. All therapeutic interventions from all groups were applied twice per week for 7 consecutive weeks with gradually increasing exercising difficulty depends on the level of each patient. All the Individuals that met the inclusion criteria and signed the consensus form to participate in the study, they received an exercise leaflet guide (what to do at home) and a digital video disk how to performed those exercises at home. More specifically, the leaflet instruction guide and the digital video disk had the following training program for the neck and shoulder region. The program was divided in 3 parts, the warm‐up, the basic part and the ergonomic guidelines with stretching part. In the warm‐up patients were instructed to do: 1. Slow rotations of the head in all directions 10 times/per rotation. 2. Movement of the shoulders and the back in all directions 10 times each movement 3. Rotation of the arms in all directions 10 times each movement Patients were instructed to breath normal during the warm‐up period. Basic Part: Patients were instructed to do: 1. Posterior movement of the neck from sitting position 10 times 2. Posterior movement of the neck with towel or elastic belt from sitting position 10 times 3. Isometric contraction of neck muscles in all directions (flex‐extension, side flexion‐extension, rotation left‐right and forward and backward the neck) by adding resistance with their hand 10 times per movement 4. Very slow rotary motion of the head 10 times Stretching part: The patients were instructed to do: 1. Neck extension‐ flexion stretching 10 sec ‐ 15 sec maximum to avoid possible dizziness 2. Neck side flexion and rotation stretching 10 sec ‐ 15 sec maximum to avoid possible di CONDITION: Chronic neck pain ; Signs and Symptoms ; Chronic neck pain PRIMARY OUTCOME: The Neck Disability Index (NDI) which measures the disability of the neck and the score ranging from 0"no disability" to 50"severe disability"; ; Measured at the beginning and the end of the training programme INCLUSION CRITERIA: 1. All patients that had at least 3 months or more pain in the neck 2. Age range 18‐65 years 3. Both genders SECONDARY OUTCOME: 1. The Numeric Pain Rating Scale (NPRS) an 11‐pain scale which measures the pain intensity from 0"no pain" to 10"maximum pain"; 2. The Short‐Form 12 (SF‐12) questionnaire which measures the quality of life; 3. The Client Satisfaction Questionnaire‐8 (CSQ‐8) an 8 item questionnaire which measures the patient satisfaction ranging from 0"no satisfaction" to 32"maximum satisfaction" ; 4. The craniocervical flexion test (CCFT) tested with Chatanooga pressure biofeedback unit which measures the deep neck flexors muscle endurance; 5. The pain pressure thresholds (PPTs) over Myofascial Trigger points of levator scapulae, upper trapezoid and splenius capitis muscles (both sides), tested with Wagner pressure pain algometer (FDK‐20 model) ; 6. The thoracocervical angle which measures the angle from C‐7‐tragus‐horizontal and tragus‐eye‐vertical for traction of the head with digital photo pictures (Nikon Coolpix p520) and analysis of angles with digital protractor; ; Measured at the beginning and the end of the training programme