Recently, I finished my PhD on Fisioterapia Manual at the University of Alcalá (Madrid, Spain). This PhD comprises five manuscripts related to neck pain, cervical movement control dysfunction and the influence of scapula on neck pain.
The first conclusion from this PhD is that both cranio-cervical flexion exercises to train deep neck flexors and passive mobilisation techniques applied to the upper cervical spine produced an immediate pain relief and reduced pressure pain sensitivity of the cervical spine in patients with chronic neck pain. However, despite a reduction of pain after both interventions, only the deep neck flexors training intervention improved the neuromuscular coordination between the cervical flexor muscles (deep and superficial neck flexors), as reflected in better performance on the cranio-cervical flexion test. These findings highlight the importance of applying specific exercises to restore altered cervical motor control. (Lluch et al. 2014)
Secondly, deep neck flexors training and proprioception training had a comparable positive effect altering the neuromuscular coordination between the cervical flexor muscles (deep and superficial neck flexors) as reflected by a better performance on the cranio-cervical flexion test. These results indicate that proprioception training not only may have beneficial effects on proprioception but also on deep neck flexors function. Pressure pain sensitivity over myofascial trigger points in cervical superficial muscles was not affected by either intervention. (Izquierdo et al. 2016)
Thirdly, deep neck flexors training for six weeks in people with chronic neck pain was followed by a reduction in neck pain and disability, but didn’t produce any change in pressure pain sensitivity of myofascial trigger points in cervical superficial muscles. These findings suggest that multimodal treatment programmes combining specific myofascial trigger points treatment techniques along with cervical motor control training might be necessary in the management of patients with both altered motor control and myofascial pain syndrome in the neck region. (Lluch et al. 2013)
The fourth conclusion is that an active scapular correction exercise induced an immediate reduction of pain and pressure pain sensitivity over the most cervical symptomatic segment in patients with chronic neck pain and scapular dysfunction. However, no effect was observed when passive correction of the scapula was performed. These results highlight the importance of incorporating (active) scapular exercise in the management of patients with neck pain for pain relief. (Lluch et al. In press)
Finally, we demonstrated that physiotherapists can achieve substantial to excellent intra- and inter-tester reliability when analyzing cervical movement control dysfunction using a battery of tests of cervical movement control. However, when used in isolation, this battery of tests did not distinguish between subjects with and wthout neck pain. (Segarra et al. 2015)
Enrique Lluch
2015 Pain in Motion
References and further reading:
Lluch E, Schomacher J, Gizzi L, Petzke F, Seegar D, Falla D. Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test.Man Ther. 2014 Feb;19(1):25-31.
http://www.ncbi.nlm.nih.gov/pubmed/25282679
Izquierdo TG, Pecos-Martin D, Girbés EL, Plaza-Manzano G, Caldentey RR, Melús RM, Mariscal DB, Falla D. Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial. J Rehabil Med. 2016;48(1):48-55.
http://www.ncbi.nlm.nih.gov/pubmed/26659920
Lluch E, Arguisuelas MD, Coloma PS, Palma F, Rey A, Falla D. Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain. J Manipulative Physiol Ther. 2013 Nov-Dec;36(9):604-11.
http://www.ncbi.nlm.nih.gov/pubmed/24152997
Lluch Girbés E, Arguisuelas Martínez MD, Calvente Quesada O, Martínez Noguera E, Peiró Puchades M, Pérez Rodríguez JA, Falla D. Immediate effects of active versus passive scapular correction in patients with chronic neck pain: randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. In Press.
Segarra V, Dueñas L, Torres R, Falla D, Jull G, Lluch E. Inter-and intra-tester reliability of a battery of cervical movement control dysfunction tests. Man Ther. 2015 Aug;20(4):570-9.
