Combination of Upper Extremity Proprioceptive Neuromuscular Facilitation and Scapular Stabilization in Nonspecific Chronic Neck Pain with Scapular Dyskinesia

Nonspecific chronic neck pain (NSCNP) affects between 10.4% and 21.3% of office and computer workers, making it one of the most prevalent disorders that physical therapists treat. It frequently has a significant impact on daily living and necessitates the utilization of several healthcare resources.

NSCNP caused by Various factors-such as female sex, older age, high job demands, low social/work support, ex-smoker status, and a history of lower back disorders. Among them, the working conditions of office workers cause postural misalignment in the neck and shoulder regions. Patients with nonspecific chronic neck pain display altered dynamic scapular stability during scapular orientation.

The scapular bone connects the neck and shoulder and plays a very important role in stabilizing the neck and shoulder complex. Helgadottir et al., 2011 reported that patients who suffer from neck pain have malfunctions, such as decreased clavicular retraction and upward rotation. The axioscapular muscles, including the trapezius, serratus anterior, rhomboid major and minor, and levator scapulae, are attached to the scapular bone and can attribute to movement of the neck and shoulder complex. Several studies demonstrated that tightness and weakness of the axioscapular muscles could induce scapular dyskinesia (SD), which refers to abnormal scapular position or movement. Rehabilitation of NSCNP is highly supported by physical therapy with evidence-based interventions. Massage and ischemic compression target the surrounding muscles. These techniques decrease tension build-up, which directly improves spasticity and hyper-tonicity. Scapular stabilization exercises proved to be very advantageous in rectification of mal alignment of the neck. The scapular stabilization (SS) helps to correct muscular imbalances and gives early insight for activating superficial cervical muscles to perform a normal range of motion (ROM) and restores clavicular retraction and normal symmetry of the cervical-scapular region.

However, (Sciascia & Kibler, 2022) reported that the identified maneuvers were often performed in an isolated manner with the body in horizontal (prone or supine) stationary positions could lead to a less than optimal rehabilitation outcome likely due to these exercises focusing on strength and encouragement of inefficient or improper motor patterns. Finally, if strength shouldn't be the focus, then it is possible scapular dysfunction is more likely rooted in issues related to motor control.

Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation concept which is widely used by physiotherapists and described as a comprehensive rehabilitation concept, promoting motor learning, motor control, strength, and mobility. Upper extremity PNF patterns are often included in exercises thought to affect recruitment of the scapular muscles. These patterns improve both muscular strength and flexibility as well as utilize sensory cues such as cutaneous, visual, and auditory stimuli to improve neuromuscular control and function. Incorporation of Upper extremity PNF patterns into shoulder rehabilitation programs may also be effective in treatment of SD.

Up to the authors' knowledge, there are no empirical reports or randomized control trials that have compared a motor control focused program against a program that focuses on strength of scapular muscles. Therefore, the purpose of this study was to study the combined effect of upper extremity PNF patterns and SS exercises on pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.

Inclusion criteria

• 1- Have referred from orthopedic surgeon diagnosed with non specific chronic neck pain (NSCNP) that has been localized to the cervical and periscapular areas for at least three months.

2- Aged from 18-40 years. 3- Having a score more than 10 on the Neck disability index (NDI). 4- Having SD according to Kibler's description. 5- BMI from 18.5 to 29.9 kg/m2.

Exclusion criteria

• History of previous neck surgery.
• Recent or old fractures.
• Cognitive impairment and inability to understand the scale.
• Systematic inflammatory disease e.g., rheumatoid arthritis and ankylosing spondylitis, neck pain with radiculopathy or neuropathy.
• Scapular dyskinesia due to other pathology such as shoulder impingement.
• A score of below 10 or above 40 points out of 50 on the NDI.