The effects of an 8-week cervical stability exercise programme on flexion relaxation, pain and disability in people with non-specific chronic neck pain: a single-group, pre-post design
Hasan Shamsi, Khosro Khademi-Kalantari, Maryam Rezaei, Mobina KhosraviBackground/aims
Non-specific chronic neck pain is associated with impaired flexion relaxation phenomenon and neuromuscular dysfunction. The impact of targeted cervical stability exercises on these parameters remains underexplored. The aim of this study was to evaluate the effects of an 8-week craniocervical flexion exercise programme on flexion relaxation phenomenon, pain and disability in patients with non-specific chronic neck pain, hypothesising that craniocervical flexion exercises would enhance the flexion relaxation phenomenon and reduce visual analogue scale and Neck Disability Index scores.
Methods
In a single-group, pre–post study, 25 patients with non-specific chronic neck pain underwent surface electromyography of cervical erector spinae muscles before and after an 8-week craniocervical flexion exercise programme performed lying on their back with knees bent and feet flat on the floor. Flexion relaxation ratio, inverse flexion relaxation ratio, occurrence of the flexion relaxation phenomenon, visual analogue scale, and Neck Disability Index were assessed. Changes were analysed using Wilcoxon tests for visual analogue scale and Neck Disability Index, paired t -tests for flexion relaxation ratio and inverse flexion relaxation ratio, and McNemar's test for the frequency of the flexion relaxation phenomenon.
Results
Post-intervention, the flexion relaxation ratio increased from 2.37 ± 0.68 to 3.02 ± 0.71 (mean change: 0.65, P <0.001), and the inverse flexion relaxation ratio decreased from 45.53% ± 12.71 to 34.93% ± 8.44 ( P <0.001). The occurrence of the flexion relaxation phenomenon improved from 36% to 60% ( P <0.001). Visual analogue scale decreased from 25 mm (interquartile range: 8) to 10 mm (interquartile range: 8) ( P <0.001), and Neck Disability Index scores decreased from 32% (interquartile range: 16) to 12% (interquartile range: 8) ( P <0.001). No associations were found with sex or pain duration ( P >0.05).
Conclusions
A craniocervical flexion exercise programme significantly enhances the flexion relaxation phenomenon and reduces pain and disability in patients with non-specific chronic neck pain, supporting its clinical utility. Larger randomised trials are needed to confirm these findings.
Implications for practice
Allied health professionals (physiotherapists, occupational therapists, and rehabilitation specialists), can easily integrate craniocervical flexion exercises into routine clinical practice using simple pressure biofeedback tools.