Effectiveness of eye-cervical re-education versus motor imagery therapy on chronic neck pain: A randomized controlled trial
Abstract
The aim of this study was to investigate the effect of adding eye cervical re-education exercises (ECRE) versus motor imagery therapy (MIT) to conventional physical therapy (CPT) on pain, functional disability, and cervical range of motion (ROM) in subjects with chronic neck pain (CNP). The study employed a randomized controlled trial design with 60 patients with CNP. Participants were selected from the outpatient clinics of the Faculty of Physical Therapy at Cairo University and were randomly assigned to three groups: conventional physical therapy only (CPT) (Group I, N = 20), eye-cervical re-education exercises plus CPT (Group II, N = 20), and motor imagery therapy plus CPT (Group III, N = 20). All participants received 3 sessions per week for 4 weeks. Visual Analogue Scale (VAS), Neck Range of Motion (ROM) and Neck Disability Index (NDI) were measured at baseline and after 4 weeks of intervention. In terms of pain intensity, neck disability index, neck flexion and extension, right and left lateral flexion, and right and left rotation ROM outcome measures, the results revealed statistically significant differences between groups (p < 0.05). Group II showed statistically significant improvement compared to both Group I and Group III in all measured outcomes (p < 0.05). Additionally, Group III showed statistically significant improvement compared to Group I in all measured outcomes (p < 0.05). Adding eye-cervical re-education exercises or motor imagery therapy to conventional physical therapy resulted in notable improvements. Eye-cervical re-education exercises, in particular, showed greater benefits in reducing pain, enhancing cervical ROM, and decreasing disability compared to conventional physical therapy alone in patients with chronic neck pain.
Downloads
References
Asiri, F., Reddy, R. S., Tedla, J. S., ALMohiza, M. A., Alshahrani, M. S., Govindappa, S. C., & Sangadala, D. R. (2021). Kinesiophobia and its correlations with pain, proprioception, and functional performance among individuals with chronic neck pain. PloS One, 16(7), 1-12. https://doi.org/10.1371/journal.pone.0254262
Audette, I., Dumas, J. P., Côté, J. N., & De Serres, S. J. (2010). Validity and between-day reliability of the cervical range of motion (CROM) device. The Journal of Orthopaedic and Sports Physical Therapy, 40(5), 318–323. https://doi.org/10.2519/jospt.2010.3180
Balbaa, A., & Ayad, K. (2006). Cervical Proprioceptive Training in Treatment of Chronic Mechanical Neck Pain. Bull. Faculty of Physical Therapy Cairo University, 11(2), 257-267.
Bobos, P., Billis, E., Papanikolaou, D. T., Koutsojannis, C., & MacDermid, J. C. (2016). Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial. Rehabilitation Research and Practice, 2016, 1-8. https://doi.org/10.1155/2016/6480826
Boyd-Clark, L. C., Briggs, C. A., & Galea, M. P. (2002). Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine, 27(7), 694–701. https://doi.org/10.1097/00007632-200204010-00005
de-la-Puente-Ranea, L., García-Calvo, B., La Touche, R., Fernández-Carnero, J., & Gil-Martínez, A. (2016). Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study. Journal of Exercise Rehabilitation, 12(4), 346–354. https://doi.org/10.12965/jer.1632636.318
Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2011). Validity of four pain intensity rating scales. Pain, 152(10), 2399–2404. https://doi.org/10.1016/j.pain.2011.07.005.
Flynn, D., Van Schaik, P., & Van Wersch, A. (2004). A comparison of multi-item Likert and visual analogue scales for the assessment of transactionally defined coping function. European Journal of Psychological Assessment, 20(1), 49-58.
Fritz, J. M., & Brennan, G. P. (2007). Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain. Physical Therapy, 87(5), 513–524. https://doi.org/10.2522/ptj.20060192
Gallego Izquierdo, T., Pecos-Martin, D., Lluch Girbés, E., Plaza-Manzano, G., Rodríguez Caldentey, R., Mayor Melús, R., Blanco Mariscal, D., & Falla, D. (2016). Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial. Journal of Rehabilitation Medicine, 48(1), 48–55. https://doi.org/10.2340/16501977-2034
Garra, G., Singer, A. J., Leno, R., Taira, B. R., Gupta, N., Mathaikutty, B., & Thode, H. J. (2010). Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Academic Emergency Medicine, 17(5), 484–489. https://doi.org/10.1111/j.1553-2712.2010.00735.x
Ghamkhar, L., Kahlaee, A. H., Nourbakhsh, M. R., Ahmadi, A., & Arab, A. M. (2018). Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants. Journal of Manipulative and Physiological Therapeutics, 41(2), 129–136. https://doi.org/10.1016/j.jmpt.2017.08.006
Hardwick, R. M., Caspers, S., Eickhoff, S. B., & Swinnen, S. P. (2018). Neural correlates of action: Comparing meta-analyses of imagery, observation, and execution. Neuroscience and Biobehavioral Reviews, 94, 31–44. https://doi.org/10.1016/j.neubiorev.2018.08.003
Javdaneh, N., Molayei, F., & Kamranifraz, N. (2021). Effect of adding motor imagery training to neck stabilization exercises on pain, disability and kinesiophobia in patients with chronic neck pain. Complementary Therapies in Clinical Practice, 42, 1-32. https://doi.org/10.1016/j.ctcp.2020.101263
Jull, G. A., Falla, D., Vicenzino, B., & Hodges, P. W. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy, 14(6), 696–701. https://doi.org/10.1016/j.math.2009.05.004
Kääriä, S., Laaksonen, M., Rahkonen, O., Lahelma, E., & Leino-Arjas, P. (2012). Risk factors of chronic neck pain: a prospective study among middle-aged employees. European Journal of Pain, 16(6), 911–920. https://doi.org/10.1002/j.1532-2149.2011.00065.x
Khan, M., Soomro, R. R., & Ali, S. S. (2014). The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain. Pakistan Journal of Pharmaceutical Sciences, 27(5), 1719–1722.
Kilintari, M., Narayana, S., Babajani-Feremi, A., Rezaie, R., & Papanicolaou, A. C. (2016). Brain activation profiles during kinesthetic and visual imagery: An fMRI study. Brain Research, 1646, 249–261. https://doi.org/10.1016/j.brainres.2016.06.009
Kristjansson, E., & Treleaven, J. (2009). Sensorimotor function and dizziness in neck pain: implications for assessment and management. The Journal of Orthopaedic and Sports Physical Therapy, 39(5), 364–377. https://doi.org/10.2519/jospt.2009.2834
Lindstrøm, R., Schomacher, J., Farina, D., Rechter, L., & Falla, D. (2011). Association between neck muscle coactivation, pain, and strength in women with neck pain. Manual Therapy, 16(1), 80–86. https://doi.org/10.1016/j.math.2010.07.006
Lluch, E., Arguisuelas, M. D., Coloma, P. S., Palma, F., Rey, A., & Falla, D. (2013). Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain. Journal of Manipulative and Physiological Therapeutics, 36(9), 604–611. https://doi.org/10.1016/j.jmpt.2013.08.004
Lukasiewicz, A. C., McClure, P., Michener, L., Pratt, N., & Sennett, B. (2000). Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. The Journal of Orthopaedic and Sports Physical Therapy, 29(10), 574–586. https://doi.org/10.2519/jospt.1999.29.10.574.
Morales Tejera, D., Fernandez-Carnero, J., Suso-Martí, L., Cano-de-la-Cuerda, R., Lerín-Calvo, A., Remón-Ramiro, L., & La Touche, R. (2020). Comparative study of observed actions, motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial. Somatosensory & Motor Research, 37(3), 138–148. https://doi.org/10.1080/08990220.2020.1756244
Özcan, Ö., Karaali, H. K., Ilgin, D., Gündüz, Ö. S., & Bilge, K. A. R. A. (2019). Effectiveness of motor imagery training on functionality and quality of life in chronic neck pain: a randomized controlled trial. Journal of Exercise Therapy and Rehabilitation, 6(1), 1-9.
Park, G. H., Kim, E. B., & Song, H. S. (2017). The Effect of Action Observation with Deep Neck Flexors Muscle Strengthening Exercise on Pain and Function: Patients with Chronic Neck Pain. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 23(1), 53-58.
Perez-Cabezas, V., Ruiz-Molinero, C., Chillon-Martinez, R., Aguilera-Santacruz, J., Jimenez-Rejano, J. J., & Viñolo-Gil, M. J. (2015). Effectiveness of a program of reeducation oculo-cervical procedures for chronic neck pain. Physiotherapy, 101, 1-38.
Pérez-Cabezas, V., Ruiz-Molinero, C., Jimenez-Rejano, J. J., Chamorro-Moriana, G., Gonzalez-Medina, G., & Chillon-Martinez, R. (2020). Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial. Evidence-Based Complementary and Alternative Medicine, 2020, 1-9. https://doi.org/10.1155/2020/2760413
Proske, U., & Gandevia, S. C. (2012). The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological Reviews, 92(4), 1651–1697. https://doi.org/10.1152/physrev.00048.2011
Reddy, R. S. Y., Maiya, A. G., Rao, S. K., Alahmari, K. A., Tedla, J. S., Kandakurti, P. K., & Kakaraparthi, V. N. (2021). Effectiveness of kinaesthetic exercise program on position sense, pain, and disability in chronic neck pain patients with cervical spondylosis–A randomized comparative trial. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 31(4), 242-250.
Röijezon, U., Clark, N. C., & Treleaven, J. (2015). Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Manual Therapy, 20(3), 368–377. https://doi.org/10.1016/j.math.2015.01.008
Sherman, K. J., Cherkin, D. C., Hawkes, R. J., Miglioretti, D. L., & Deyo, R. A. (2009). Randomized trial of therapeutic massage for chronic neck pain. The Clinical Journal of Pain, 25(3), 233–238. https://doi.org/10.1097/AJP.0b013e31818b7912
Tousignant, M., Smeesters, C., Breton, A. M., Breton, E., & Corriveau, H. (2006). Criterion validity study of the cervical range of motion (CROM) device for rotational range of motion on healthy adults. The Journal of Orthopaedic and Sports Physical Therapy, 36(4), 242–248. https://doi.org/10.2519/jospt.2006.36.4.242
Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy, 13(1), 2–11. https://doi.org/10.1016/j.math.2007.06.003
Vernon H. (2008). The Neck Disability Index: state-of-the-art, 1991-2008. Journal of Manipulative and Physiological Therapeutics, 31(7), 491–502. https://doi.org/10.1016/j.jmpt.2008.08.006
Zangrando, F., Paolucci, T., Vulpiani, M. C., Lamaro, M., Isidori, R., & Saraceni, V. M. (2014). Chronic pain and motor imagery: a rehabilitative experience in a case report. European Journal of Physical and Rehabilitation Medicine, 50(1), 67–72.
The works and papers that are published in this Journal are subject to the following terms:
1. The Publication Service of the University of Murcia (the publisher) has the Publication Rights (Copyright) to the published papers and works, and favors and permits the reusing of the same under the license indicated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2013
2. The papers and works are to be published in the digital edition of the Journal under the license Creative Commons Reconocimiento-No Comercial-Sin Obra Derivada 3.0 España (legal text). The copying, using, spreading, transmitting and publicly displaying of the papers, works or publication are permitted as long as: i) the authors and original sources (Journal, publisher and URL of the publication) are quoted; ii) it is not used for commercial benefit; iii) the existence and specifications of this users license are mentioned.
3. Conditions of Self-Archiving. It is permitted and encouraged that the authors spread electronically the pre-print (before printing) and/or post-print (the revised, evaluated and accepted) versions of their papers or works before their publication since this favors their circulation and early diffusion and therefore can help increase their citation and quotation, and also there reach through the academic community.
The works and papers that are published in this Journal are subject to the following terms:
1. The Publication Service of the University of Murcia (the publisher) has the Publication Rights (Copyright) to the published papers and works, and favors and permits the reusing of the same under the license indicated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2013
2. The papers and works are to be published in the digital edition of the Journal under the license Creative Commons Reconocimiento-No Comercial-Sin Obra Derivada 3.0 España (legal text). The copying, using, spreading, transmitting and publicly displaying of the papers, works or publication are permitted as long as: i) the authors and original sources (Journal, publisher and URL of the publication) are quoted; ii) it is not used for commercial benefit; iii) the existence and specifications of this users license are mentioned.
3. Conditions of Self-Archiving. It is permitted and encouraged that the authors spread electronically the pre-print (before printing) and/or post-print (the revised, evaluated and accepted) versions of their papers or works before their publication since this favors their circulation and early diffusion and therefore can help increase their citation and quotation, and also there reach through the academic community.
