The relative effectiveness of using Pilates exercises to obtain scapula stabilisation as an adjunct to cervical manipulation in the treatment of chronic mechanical neck pain

It has been noted that in many recent research studies mechanical neck pain is a serious problem in the world today. There are epidemiological and statistical studies documenting the high incidence and prevalence of mechanical neck pain, which effects people’s daily living (Drew, 1995; Ferrari and Russell, 2003; Cote et al., 2000, Venketsamy, 2007 and Haldeman et al., 2008). Background: Treatments for chronic neck pain, which are non-surgical, appear to be the most beneficial for patients (Haldeman, 2008). In brief, the presentation of chronic mechanical neck pain is defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). The muscular dysfunction known as the upper cross syndrome is defined as tightness of the upper trapezius, pectoralis major and levator scapulae and weakness of rhomboids, serratus anterior, middle and lower trapezius and deep neck flexors. These muscles are responsible for stabilizing the scapula and the patient may present with rounded, elevated shoulders and anterior head carriage when diagnosed with this syndrome (Liebenson, 1996). Clinical trials conducted by Cassidy et al., (1992 a, b) concluded that spinal manipulative therapy (SMT) was highly effective in treating mechanical dysfunctions within the cervical spine. However, due to multi systemic involvement of the muscular, neural and passive systems in mechanical neck pain, the treatment may need to target all three of the subsystems of spinal stability to be most effective (Panjabi, 1992 a, b; Lee et al., 1998; Lee 2004 and Richardson et al., 2002). No research has been conducted on the effects and benefits of treatment directed on the cervical spine and upper cross syndromes. This research will compare scapula stabilization training and SMT to SMT in isolation, as a treatment for chronic mechanical neck pain. Objectives: The purpose of this study was to determine the effect that scapula stabilization had on chronic mechanical neck pain. Pilates exercises were used to strengthen and stabilize the scapula muscles (this included stretching out the hypertonic musculature of the upper cross syndrome). The aim was to improve posture as well as to decrease the mechanical stress on the neck. SMT was also concomitantly used to correct any cervical restrictions that were present. These results were then compared to the results of a group that only received spinal manipulative therapy. The null hypothesis was that the intervention group would not respond differently to the treatment protocol in terms of the subjective and objectives measurements. iv Method: This clinical trial was conducted on a sample population of 30 patients with chronic mechanical neck pain. Each patient was assigned to one of two groups (n=15) according to convenience sampling. Both groups received SMT to the cervical spine, while group B (intervention group) also received pilates classes twice weekly for four weeks, which retrained the scapula stabilization muscles to function optimally. The patients each underwent six spinal manipulative treatments over four weeks and a seventh consultation in the fifth week for data collection. Both groups were evaluated in terms of subjective and objective clinical findings. Subjectively the assessment included 2 questionnaires (Numerical Pain Rating Scale and Canadian Memorial Chiropractic College [CMCC] neck disability index). Objective assessment included cervical motion palpation, Cervical Range Of Motion goniometer (CROM) measurements, scapula stabilization tests and a postural analysis with the use of digital photography. The statistics were completed under the guidance of a biostatistician, from the College of Health Science, University of KwaZulu – Natal, (Esterhuizen, 2008) who analyzed the captured data with the use of SPSS version 15. All outcome measures were quantitative. Repeated measures ANOVA testing was used to assess the presence of a different effect for each outcome measure over time between the two treatment groups. A statistically significant time by group effect would indicate a significant treatment effect. The minimum significance level was 0.05. The trends and direction of the effect were assessed via profile plots. Result: According to the statistical analysis, both groups showed improvements - subjectively and objectively - with regards to chronic mechanical neck pain, which is in keeping with the literature. In terms of the inter-group comparison the SMT group (Group A) showed a more constant improvement in range of motion, pain and disability indexes with the SMT only group while the SMT and pilates group (Group B) showed a greater effect in stabilizing the scapula and increasing the functionality of the surrounding musculature. Conclusions and Recommendations: The intervention treatment (Group B) did not have a greater effect on the short-term treatment of chronic mechanical neck pain than the reference group (Group A). It was also evident that the intervention group (Group B) often continued to improve when the SMT (Group A) only group often regressed at the follow up sessions. This improvement was either not significant enough or v the follow up session did not allow for enough time for a true reflection to be noted. It is recommended that more research be carried out to gain conclusive results indicating whether there is a more beneficial long term result to this treatment protocol.

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