Abstract
Purpose: Currently, there is limited research on the effectiveness of rehabilitative exercises for neck pain patients generally, and chronic neck pain patients in particular. Interestingly, recent evidence suggests that dysfunction of cervicocephalic kinaesthesia, as measured by head repositioning accuracy (HRA), is present in many chronic patients, and that active eye-head-neck co-ordination exercises may be useful in terms of patients’ rehabilitation.
The purpose of this study was twofold: i) to determine if there was a difference in HRA in chronic neck pain subjects versus controls; ii) to assess the effect of a rehabilitative exercise programme on chronic neck pain subjects’ HRA and reported levels of pain.
Method: A prospective, intervention study on a convenience sample of chronic neck pain subjects (> 3 months duration) versus age- and gender-matched, asymptomatic control subjects was conducted. Exclusion criteria included any form of active treatment (> 1 per month) for musculoskeletal complaints, including medication, as well as any arthritic, orthopaedic, or neurological disorder.
Both symptomatic and asymptomatic subjects were assigned, via stratified, random allocation, to either a rehabilitative exercise or non-exercise group. This gave rise to 4 groups. Symptomatic and asymptomatic exercise subjects were given a training session as well as written and verbal instructions on how to perform the eye-head-neck co-ordination exercises. Subjects were asked to perform the exercises twice daily over a 4-week period, and to keep a diary of exercise compliance and any associated symptomatology.
Outcomes included HRA for all active cervical range-of-motion, measured by a helmet-mounted laser pointer on a paper target, and pain intensity as measured by a 100 mm visual analogue scale (VAS). Outcomes were measured in all subjects at baseline, end of week 2, and end of week 4.
Results: 63 subjects were recruited, of which 56 completed the 4-week study. 28 chronic neck pain subjects (14 males and 14 females; mean age 22.6 years, range 19–30 years), and 28 asymptomatic controls (14 males and 14 females; mean age 23.9 years, range 19–31 years) were assigned via stratified random allocation, to an exercise or non-exercise group. Each of the 4 groups contained 14 subjects.
Active HRA was found to be significantly reduced in neck pain subjects compared to control subjects (ANOVA, p< 0.001). Whiplash patients (N=17) in particular, were significantly less precise (ANOVA, p< 0.001). A significant reduction in reported pain was experienced by the symptomatic exercise versus symptomatic non-exercise group (ANOVA, p< 0.001). At 4-weeks, the symptomatic exercise group demonstrated significantly improved HRA in all active movements compared to the other groups (ANOVA, p< 0.001).
Conclusions: This study provides evidence that simple, eye-head-neck co-ordination exercises may be helpful in reducing functional impairment in terms of cervicocephalic kinaesthesia as well as reported levels of pain in chronic neck pain subjects.
The abstracts were prepared by Dr P Dolan. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
