The purpose of this study was to apply the joint mobilization technique to the level of segments with pain and to the level of segments with hypomobility respectively and compare the immediate effects of the joint mobilization technique on the pain, the active cervical range of motion (ROM), and treatment satisfaction of patients with acute mechanical neck pain. After the baseline assessment, forty-two patients were randomized into two groups: a painful group (n1=21) that received joint mobilization at the most painful cervical spine level and a hypomobile group (n2=21) that received joint mobilization at the most hypomobile cervical level. The patients received an intervention that applied unilateral posterior-anterior gliding for 5 minutes and two repetitions of 10 times of active extension motion with distraction. In the Wilcoxon signed-rank test, the painful group and the hypomobile group were improved significantly in all pain variables (p<.001), while the painful group was improved significantly in the active cervical flexion (p<.001), extension (p<.001), left side-bending (p<.01), right side-bending (p=.001), left rotation (p<.001), and right rotation (p<.001). The hypomobile group was significantly improved in active cervical flexion (p=.001), extension (p<.001), left side-bending (p<.05), right side-bending (p=.001), left rotation (p=.001), and right rotation (p<.01) after intervention. In the Mann-Whitney U test, there was no significant difference in any of the dependent variables after the intervention between the two groups, but the painful group was slightly superior to the hypomobile group in all variables except for the right lateral flexion ROM and treatment satisfaction. These outcomes suggest that the cervical joint mobilization may be applied to either the level of painful segments or the hypomobile segments for the treatment of patients with acute mechanical neck pain.

This study aimed to determine the effect of lower trapezius muscle strengthening exercises on pain, neck disability index (NDI), cervical range of motion (ROM), and lower trapezius muscle strength in patients with unilateral neck pain. Following baseline measurements, the subjects (N=40) with unilateral neck pain were randomized into one of two 5 weeks exercise intervention groups: a experimental group (EG, n1=20) that received strength training of the lower trapezius muscles or a control group (CG, n2=20) that received routine physical therapy program. Each group participated in the intervention for 30 minutes, 3 times a week, for 5 weeks. All participants performed 2 repetitions of each intervention per day. The numeric pain rating scale for pain, NDI, ROM, and lower trapezius strength were recorded both pre- and post-intervention for both groups. Paired t-tests were used to determine significant changes post-intervention compared with pre-intervention and independent t-tests were used to analyze differences in the dependent variables between the 2 groups. After the 5-weeks intervention, both groups experienced significantly decreased pain and disability level (p<.05) and significantly increased cervical flexion, extension, lateral flexion, and rotation ROM (p<.05). The EG that received strength training of the lower trapezius muscles showed greater improvements in pain and functional disability level, cervical rotation, and lower trapezius strength than the CG (p<.05). These results suggest that a lower trapezius strengthening exercises reduce neck pain and neck disability level and enhance cervical ROM and lower trapezius strength level in patients with unilateral neck pain.

Violinists tend to position the neck asymmetrically to hold the violin between the chin and the left shoulder. Asymmetrical neck posture may induce unilateral neck pain. Previous studies have suggested that individuals with unilateral neck pain exhibit reduced muscle strength of the lower trapezius, but no study has investigated violinists with unilateral neck pain. To this end, we recruited 18 violinists with unilateral neck pain for the present study in which the side on which neck pain was experienced, pain duration, and intensity were recorded. Lower trapezius strength was measured bilaterally in each subject using a handheld dynamometer. Significant differences in lower trapezius strength were evident between the ipsilateral and contralateral sides of neck pain (p＜.05). No significant association between neck pain intensity or duration, and the extent of a deficit in lower trapezius strength, was evident (both p＞;.05). The association between the sides of weakened lower trapezius strength and neck pain was significant (p＜.05). In conclusion, violinists with unilateral neck pain exhibited significantly less lower trapezius strength on the ipsilateral compared to the contralateral side of the pain. Unilateral neck pain more frequently involved the left side of the neck, which is used to stabilize the violin during playing. Thus, our study suggests that a possible relationship exists between muscle weakness in the lower trapezius and neck pain.

The purpose of this study was to investigate the effects of smartphone use on muscle fatigue and tenderness in the cervical erector spinae (CES) and the upper trapezius (UT) and on the cervical range of motion among subjects with and without neck muscle pain. The subjects were 30 smartphone users in their 20 s who -were assigned to either an experimental group with neck muscle pain or a control group without neck muscle pain. Muscle fatigue and tenderness in the CES and the UT as well as the subjects’ cervical range of motion were measured before and after 20-min smartphone sessions in a sitting position. In a between-group comparison of muscle fatigue, the experimental group showed a significantly greater decrease in median frequency in the CES and the right UT after smartphone use (p<.05). Regarding the assessment of muscle tenderness after smartphone use, the experimental group showed a statistically significant decrease in the pressure-pain threshold (PPT) in all muscles (p<.05), whereas the control group showed a significantly decreased PPT in the right CES and the UT (p<.05). The assessment of the cervical range of motion revealed a statistically significant reduction in the cervical flexion-extension and left lateral flexion in the experimental group (p<.05) after smartphone use. However, there was no significant change in the cervical range of motion in the control group (p>.05) after smartphone use. When compared with the control group, the experimental group demonstrated greater changes in cervical extension, lateral flexion, and rotation, except for cervical flexion (p<.05). In conclusion, when smartphone users have pre-existing neck muscle pain, the use of a smartphone further increased muscle fatigue and tenderness in the neck and reduced PPT and the cervical range of motion.

The purpose of this study was to compare the immediate effects of upper trapezius muscle stretching in more tensed position (MTP) and less tensed position (LTP) on the change of range of motion (ROM) for neck rotation, and the ROM for conjunct neck motions at end-range of neck rotation toward the painful side in patients with unilateral neck pain. Eighteen patients with unilateral neck pain were recruited for the study's MTP group, and 18 age-, weight- and gender-matched patients with unilateral neck pain were recruited for LTP group. The ROM changes in active neck primary and conjunct motions were measured using a cervical ROM inclinometer in the sitting position. Our results showed that both upper trapezius stretching method in MTP and LTP were significantly effective in increasing the ROM of neck rotation toward painful side in patients with unilateral neck pain. However, a significantly greater increase in the ROM for neck rotation and a further decrease in conjunct neck extension during neck rotation toward the painful side were shown in MTP group, compared to LTP group. The upper trapezius stretching in MTP is useful in increasing the ROM of neck rotation and decreasing the range of conjunct neck extension during neck rotation toward the painful side in patients with unilateral neck pain.

This study aimed to determine the usefulness of classifying patients with neck pain on the basis of the results of passive scapular elevation test. We classified 21 patients with neck pain into positive (n=12) and negative (n=9) groups on the basis of passive scapular elevation test; the 2 groups then equally performed scapular stabilization exercise program for 30 min, 3 times a week, for 4 weeks. Visual analogue scale (VAS), neck disability index (NDI), and range of motion (ROM) were recorded both before and after the intervention for both groups. Paired t-test was used to determine that there were significant changes between before and after the intervention, and independent t-test was used for analyzing changes between two groups of dependent variables. After 4 weeks of training, we observed significant decrease in pain and disability (p<.05) and a significant increase in rotation, flexion, extension, and side-bending ROM (p<.05) in both groups. Further, between pre- and post-intervention evaluations, we observed a significant decrease in pain and disability and a significant increase in rotation and flexion ROM in the positive group than in the negative group (p<.05). These results indicate that passive scapular elevation test may be used to identify mechanical disorders of the cervicoscapular muscle in patients with neck pain. Therefore, we recommend the use of passive scapular elevation test to determine appropriate treatment intervention when treating patients with neck pain.

This study compared the stability of the cervical spine according to the presence of neck pain and deep neck flexor performance. Thirty subjects with neck pain, and thirty subjects without neck pain were recruited for this study. The Cranio-cervical flexion (CCF) test was applied using a pressure biofeedback unit to classify the subjects into four subgroups; no cervical pain and good deep neck flexor performance (NG group), no cervical pain and poor deep neck flexor performance (NP group), cervical pain and good deep neck flexor performance (PG group), and cervical pain and poor deep neck flexor performance (PP group). The head sway angle was measured using a three-dimensional motion analysis system. A 3-kg weight was used for external perturbation with the subject sitting in a chair in the resting and erect head positions with voluntary contraction of the deep neck flexors. A one-way analysis of variance (ANOVA) was performed with a Bonferroni post hoc test. The deep neck flexor performance differed significantly among the four groups (p<.05). The NG group had significantly greater deep neck flexor performance than NP and PP groups. The stability of the cervical spine also differed significantly among the four groups in the resting head position (p<.05). The head sway angle was significantly smaller in NG group as compared with the other groups. The PP group had the greatest head sway angle in the resting head position. However, there was no significant difference in the stability of the cervical spine among the groups in the erect head position with voluntary contraction of deep neck flexors (p=.57). The results of this study suggest that the deep neck flexor performance is important for maintaining the stability of cervical spine from external perturbation.

The purpose of this study was to establish reliability and validity of the Northwick Park Neck Pain Questionnaire (NPQ) translated into Korean for neck pain patients. Sixty-two subjects (35 males, 27 females) with neck pain enrolled in the study. They completed a standardized self-administered questionnaire that included pain intensity, sleeping, sensory at night, duration of symptoms, carrying, reading and watching television, working, social activities, and driving. Reliability was determined by intraclass correlation coefficient (ICC) and Cronbach's alpha by internal consistency. Validity was examined by correlating the NPQ scores to the Visual Analog Scale (VAS) score. Test-retest reliability of the translated versions of the NPQ was good ICC(2,1)=.83 (95%CI=.85~.95). Cronbach's alpha value for NPQ was found to be .87 and this was statistically significant (p<.05). The criterion-related validity coefficients was .75 (p<.01). We concluded that the Korean version NPQ was shown to be a reliable and valid instrument for the assessment of neck pain.

This study compared the effect of therapeutic exercise with conservative treatment in women with chronic neck pain. Subjects were allocated to control, neck isometric exercise, and cervical stabilization exercise groups consisting of 29, 32, and 31 patients, respectively. The conservative treatment for the control group consisted of hot packs, ultrasound, interferential current therapy, and intermittent cervical traction. The neck isometric exercise group performed a neck isometric exercise and the cervical stabilization exercise group performed a cervical stabilization exercise. To compare the three groups, the levels of perceived pain, neck disability, and psychological depression were assessed on admission, at discharge, and one month after discharge. On admission and at discharge, the pain and neck disability scores did not differ significantly among the groups. However, one month after discharge, both the neck isometric and cervical stabilization exercise groups had significantly improved perceived pain levels as compared to control (p<.05). The improvement in the degree of neck disability was most significant in the cervical stabilization exercise group (p<.05). On comparing the changes in the variables at the three assessments for each group, there was a significant difference between the control and cervical stabilization exercise groups (p<.05). The findings indicate that therapeutic exercises, especially cervical stabilization exercises, are more effective for improving pain and neck disability than conservative treatment.

The self-report measure is a useful tool for evaluating self-recognized disability and difficulty in daily living activities. Although many studies and clinics used the Neck Pain and Disability Scale (NPDS) for measuring neck pain and functional impairment, there has not been much adaptation of this for use with Korean patients. The purpose of this study was to establish the reliability and validity of NPDS among Korean neck pain patients. Fifty-five subjects (32 males, 23 females) with neck pain enrolled in this study. They completed standardized self-administered questionnaires. The NPDS measures pain intensity; its interference with vocational, emotional, recreational, social, and functional aspects of living; and the presence and extent of associated factors. Reliability was determined by the intraclass correlation coefficient (ICC) and Cronbach's alpha for internal consistency. Validity was examined by correlating the NPDS scores to the Visual Analog Scale (VAS) score. The test-retest reliability of the translated versions of the NPDS was good ICC (2,1)=.86 (95%CI .76~.92). Cronbach's alpha value for NPDS was found to be .93, and this was statistically significant (p<.05). The criterion-related validity coefficient was .79 (p<.Oll. We conclude that the Korean version of NPDS has been shown to be a reliable and valid instrument for the assessment of neck pain. Successful linguistic and cultural translation will admit appropriate cross-cultural comparison for clinical analysis. Therefore, this study can be expected to be used as an adequate evaluation scale for neck pain related studies and treatments.

The purpose of this study was to investigate the effects of serratus anterior strengthening exercises on scapular position and Visual Analog Scale (VAS) pain measurements taken at the resting position in young adults with adducted scapular. The exercise program included stretching of the scapular retractor and strengthening of the serratus anterior muscle. We measured the distance from the midline of the thorax to the vertebral border of the scapular with a tape line (Superior Kibler), and the distance from the 7th cervical spinous process to the acromial angle with 3-dimension motion analysis system, to compare the resting scapular position before and after exercise. Fifteen subjects with adducted scapular were recruited to compare the resting scapular position and VAS. The distance from 7th cervical spine process to acromial angle of the scapular and VAS decreased significantly (p<.01) after exercise, while the distance from the midline of the thorax to vertebral border of the scapular increased (p<.05). The conclusion is that the serratus anterior exercise program altered the resting scapular position and decreased VAS.

The purpose of this study was to determine reliability and validity of the Neck Disability Index (NDI) now in use for the first time in neck pain patients of Korea. Fifty subjects (26 males and24 female) with neck pain enrolled in the study. They completed a standardized self-administered questionnaire that include pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation. Reliability was determined by intra-class correlation coefficient (ICC) and Cronbach's alpha by internal consistency. Validity was examined by correlating the NDI scores to the Visual Analog Scale (VAS) score. The Test-retest reliability of the translated versions of the NDI was good ICC (2,1) = .90 (95%CI .85 .95). Cronbach's alpha value for NDI was found to be .95 and this was statistically significant (p<.05). The criterion-related validity coefficients was .72 (p<.01). We conclude that the Korean version of NDI has shown to be a reliable and valid instrument for the assessment of neck pain.