Neck muscle function in violinists/violists with and without neck pain

Electromyographic Activity of Cervical Muscles in Patients with Neck Pain and Changes After Dry Needling: A Narrative Review

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention.

Forearm muscles activity of harp players

The practice of a musical instrument requires fine dexterity, repetitive, fast, and precise movements, as well as important efforts to set the instrument into vibration, while adopting postures often unnatural for the human body. As a result, musicians are often subject to pain and musculoskeletal disorders. In the case of plucked string instruments and especially the concert harp, the plucking force is directly related to the strings' tension. Consequently, the choice of the strings has to be made based on both, the musician feel while playing, and the musculoskeletal consequences. This paper investigates how the string properties and the playing dynamics affect the finger and wrist muscle activity during harp playing. This study first emphasized the noteworthy recruitment of the flexor and extensor muscles (42% and 29% of MVC, respectively). Findings outlined further that the fingering choice, the adopted playing dynamics and the string's material govern the muscular activity level and the playing control. Such results are a first step to better understand how the harp ergonomics may affect the player's integrity and help them decide the most suitable stringing for their practice.

Development and Initial Validation of the First Questionnaire to Evaluate Performance-related Pain Among Musicians with Different Backgrounds: Performance-related Pain Among Musicians Questionnaire (PPAM)

AIM

To develop and perform the expert's content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds.

METHODS

The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts' panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain. Four expert panel meetings and three pilot tests were performed, with a total of 94 musicians.

RESULTS

From the 1154 articles initially found in the literature search, 153 were included (65 related to pain tools and 88 related to predictive factors) and a pool of 115 items were created. After expert panel evaluation and pretesting, a final self-report questionnaire was defined, comprising 33 core items to evaluate 3 constructs (pain intensity, pain interference in general activities and pain interference in performance), as well as 32 additional items (optional module - predictive factors).

CONCLUSIONS

The PPAM Questionnaire is specifically designed and validated for musicians and can be applied for all types of musicians (professional, amateur and music students), allowing the development of comparative studies between musicians. It is a new enriched tool, easy to respond and disseminate to large, multicentre, and international samples. PPAM is suitable for research and clinical practice purposes and will allow the improved assessment and monitoring of pain in this occupational context.

Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability

Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.

Effect of sling exercise therapy on surface electromyography and muscle thickness of superficial cervical muscle groups in female patients with chronic neck pain

BACKGROUND

The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients.

OBJECTIVE

To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain.

METHODS

Twenty-five patients with chronic neck pain were randomly assigned to the SET group (n= 12) or the control group (n= 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test.

RESULTS

At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p< 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p< 0.05). There were no within-group differences in the control group (p> 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p< 0.05).

CONCLUSION

4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck.

Reliability, Validity, and Responsiveness of the Craniocervical Flexion Test in People Who Are Asymptomatic and Patients With Nonspecific Neck Pain: A Systematic Review and Meta-Analysis

OBJECTIVE

Among the tests designed to evaluate neck neuromuscular function, the craniocervical flexion test (CCFT) assesses the function of the deep cervical flexor muscles (DCFs). The purpose of this study was to conduct a review and meta-analysis of published articles about all measurement properties of the different CCFT versions (CCFT Activation Score [CCFT-AS], CCFT Performance Index [CCFT-PI], CCFT Cumulative Performance Index [CCFT-CPI], and CCFT alternative procedures for measuring activation level (CCFT1) or endurance (CCFT2) in people who were asymptomatic and people with nonspecific neck pain.

METHODS

PubMed Central, MEDLINE, CINAHL, Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2020. Studies were selected if they reported data on reliability, validity, and/or responsiveness of the CCFT in adults who were asymptomatic or who had nonspecific neck pain. Two reviewers independently selected the studies, conducted quality assessment, and extracted the results. All meta-analyses used a random-effects model.

RESULTS

Twenty-one studies met the inclusion criteria. The rating of interrater reliability (assessed for CCFT-AS and CCFT-CPI) was positive only for using the test at a group level. The same rating was ascribed to the intrarater reliability of CCFT-AS, CCFT1, and CCFT2, whereas CCFT-PI and CCFT-CPI showed positive intrarater reliability for assessment of individuals as well. CCFT validity was rated as positive for expressly assessing DCF action when measuring DCF activation through electromyography-not through ultrasonography-or craniocervical flexion motion as well as for differentiating patients who were asymptomatic and patients who had nonspecific neck pain (only the AS version). CCFT validity was rated as negative for investigating the CCFT performance correlation with the severity of nonspecific neck pain. CCFT responsiveness was rated as negative.

CONCLUSIONS

The CCFT is a potentially useful tool for detecting impairment in DCF control and identifying patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the limited reliability affects its suitability for that purpose. Further research on the reliability of different CCFT versions in which the raters are thoroughly trained is strongly recommended.

IMPACT

The CCFT might help to detect impairment in DCF control and identify patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the poor reliability of most versions of the test greatly limits its application in clinical practice. Only CCFT-PI and CCFT-CPI seem reliable enough to help in clinical decision-making at the individual level.

Multiple Factors Influencing Healthy Performance for Pre-professional and Professional Classical Violinists: An Exploratory Study Focusing on Physical Health

Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists' performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.

The effectiveness of Kinesio taping on playing-related pain, function and muscle strength in violin players: A randomized controlled clinical trial

OBJECTIVES

This study aimed to investigate the effectiveness of Kinesio taping (KT) on playing-related pain, upper extremity and hand function, grip and pinch strength in violin players.

DESIGN

Randomized controlled trial.

SETTING

Faculty of health sciences.

PARTICIPANTS

One hundred seventeen participants who were professional violinists for at least two years (82 women; mean age, 22.76 ± 3.87 years) were randomized to receive either therapeutic tape application (KT group), a sham tape application (placebo group), or no application (control group) for one week.

OUTCOME MEASURES

The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) in one week. The secondary outcomes were the Visual Analogue Scale (VAS), the Purdue Pegboard Test, grip and pinch strength. Outcome measures were performed at baseline, immediately after the intervention, and one week later (follow-up). Participants were asked to play the "Violin Concerto No.2, Op.35 (Rieding, Oskar)"; pre-and post-performance pain and grip and pinch strength were assessed.

RESULTS

The overall group-by-time interaction was not significant for DASH, but the improvement in the mean VAS-playing was slightly better in the KT group than in others (p < 0.05). The mean post-performance VAS-playing remained similar in the KT group while slightly increasing in the other groups (p < 0.05). In addition, a decrease in the mean post-performance grip strength of the left hand was significantly lower in the KT group than in the other groups (p < 0.05).

CONCLUSIONS

Violin players receiving an application of KT represented minor improvements in playing-related pain, and post-performance pain intensity and grip strength of the left hand slightly remained after 1 week kT application. The possible post-performance effect of the tape on the pain intensity and grip strength must also be considered because KT can be used during the performance.

Prevalence and associated factors of playing-related musculoskeletal disorders among music students in Europe. Baseline findings from the Risk of Music Students (RISMUS) longitudinal multicentre study

Musculoskeletal (MSK) conditions among professional musicians and music students are frequent and may have significant physical and psychosocial consequences on their lives and/or on their playing abilities. The Risk of Music Students (RISMUS) research project was set up in 2018 to longitudinally identify factors associated with increased risk of playing-related musculoskeletal disorders (PRMDs) in a large sample of music students enrolled in pan-European institutions. The aim of this cross-sectional study was to describe the prevalence of playing-related musculoskeletal disorders (PRMDs) in this novel population at baseline of the RISMUS project. A further goal was to begin to identify variables that might be associated with the self-reported presence of PRMDs among music students. Eight hundred and fifty students from fifty-six conservatories and music universities in Europe completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, health history and PRMDs, psychological distress, perfectionism and fatigue. A total of 560 (65%) out of 850 participants self-reported a positive history of painful MSK conditions in the last 12 months, 408 (48%) of whom self-reported PRMDs. Results showed that coming from West Europe, being a first- or a second-year Masters student, having more years of experience and higher rates of perceived exertion after 45 minutes of practice without breaks were factors significantly associated with self-reported presence of PRMDs. According to the authors’ knowledge, a large-scale multicentre study investigating prevalence and associated factors for PRMDs among music students at different stages of their education (from Pre-college to Masters levels) has not been conducted before. The high prevalence of PRMDs among music students, especially those studying at university-level, has been confirmed in this study and associated factors have been identified, highlighting the need for relevant targeted interventions as well as effective prevention and treatment strategies.

Women with mechanical neck pain exhibit increased activation of their superficial neck extensors when performing the cranio-cervical flexion test

Several studies have analysed the activity of superficial neck flexors, but the activity of neck extensors has been less investigated in patients with neck pain OBJECTIVES: 1, to investigate the differences in the activation of superficial neck flexor and extensor musculature during the cranio-cervical flexion test (CCFT) in women with mechanical chronic neck pain when compared to asymptomatic women; 2, to investigate the correlation between neck muscle activity and the clinical features of neck pain DESIGN: Cross-sectional METHODS: Surface electromyography was recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles of 30 women with mechanical chronic neck pain and 30 asymptomatic women as they performed the CCFT. Comparisons of the normalized root mean square between both groups were conducted with 2x5 ANCOVA with task level as the within-subjects variable, group as the between-subjects variable, and pain related-disability as a co-variate RESULTS: Women with mechanical neck pain exhibited increased activity of superficial neck flexors (sternocleidomastoid: F = 14.448, P < 0.001; anterior scalene: F = 21.693, P < 0.001) and superficial neck extensors (splenius capitis: F = 4.692, P < 0.001; upper trapezius: F = 4.245, P < 0.001) as compared to asymptomatic women. Higher pain related-disability was associated with more electrical activity of the anterior scalene and upper trapezius muscles during the CCFT CONCLUSIONS: Women with mechanical chronic neck pain exhibit an increased activity of their superficial neck flexors and superficial neck extensors during a low-load task such as CCFT when compared to asymptomatic pain-free women. Our results should be considered when designing therapeutic exercise programs for this population.

Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain

Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.

Musculoskeletal disorders and complaints in professional musicians: a systematic review of prevalence, risk factors, and clinical treatment effects

PURPOSE

Musicians' practice and performance routines reportedly lead to musculoskeletal complaints and disorders (MCD) that impact their wellbeing and performance abilities. This systematic review aims to assess the prevalence, risk factors, prevention and effectiveness of treatments for MCD in professional musicians and consider the methodological quality of the included studies.

METHODS

A systematic literature search was performed in December 2017 using electronic databases and supplemented by a hand search. Case-control studies, cohort studies, cross-sectional studies, interventional studies and case reports investigating the prevalence, risk factors, prevention or treatment effects of MCD in professional musicians or music students (age ≥ 16 years) were included. Quality assessments of the included studies were performed using an adapted version of the "Study Quality Assessment Tools" from the National Heart, Lung, and Blood Institute.

RESULTS

One case-control study, 6 cohort studies, 62 cross-sectional studies, 12 interventional studies and 28 case reports were included and assessed for methodological quality. The study designs, terminology, and outcomes were heterogeneous, as the analyses mostly did not control for major confounders, and the definition of exposure was often vague. Therefore, evidence that being a professional musician is a risk factor for MCD as well as the causal relationship between these factors remains low despite the fact that a large number of studies have been performed.

CONCLUSIONS

Studies with high internal and external validity regarding the prevalence, risk factors and effectiveness of the prevention or treatment of MCD in professional musicians are still missing. Further high-quality observational and interventional studies are required.

Reliability of a Method to Measure Neck Surface Electromyography, Kinematics, and Pain Occurrence in Participants With Neck Pain

OBJECTIVE

To investigate the reliability of a novel method to measure neck surface electromyography (SEMG), kinematics, and pain during active movements in participants with neck pain.

METHODS

This test-retest study evaluated 23 participants with chronic neck pain. Each was measured twice within a single session. Three-dimensional kinematics and SEMG were recorded in 10° increments during forward and side flexion, extension, and rotation of the neck. Neck position during pain occurrence was also measured.

RESULTS

Intraclass correlation coefficients were >0.80 for 96% and 100% of SEMG and kinematic data, respectively. The percentage of standard error of the measurement (SEM) values were <25% for 91% of all SEMG measures; most were <15%, and some were <10%. For ranges of motion in the primary plane, percentage of SEM values were all <6% (SEM 1°-3°). Intraclass correlation coefficients for neck position during pain occurrence were all >0.60, except for right rotation (0.48) (SEM values 2°-8°). Pain occurred approximately 59% to 75% into the total range of motion and persisted to its end.

CONCLUSIONS

This methodology showed good reliability. It may be suitable for neck pain subclassification to evaluate the effects of treatment on pain, kinematics, and muscle activity during functional neck movements. The point of pain occurrence suggests increasing mechanical load on tissues may be one of the causative factors for movement-associated neck pain.

How do we assess musicians' musculoskeletal symptoms?: a review of outcomes and tools used

Recent reviews of musicians' musculoskeletal symptoms (MSS) have reported heterogeneity in the outcomes reported and data collection tools used, making it difficult to compare and synthesise findings. The purpose of this present review was to improve the consistency of future research, by documenting the outcomes reported in recent studies of musicians' MSS and the data collection tools used. All English language, peer-reviewed studies, published 2007-2016 that reported musicians' self-reported MSS outcomes were identified. Details of the types of outcomes reported and the tools used were extracted, and synthesised descriptively. A range of MSS outcomes were reported, including MSS with a temporal relationship to activities performed, and the consequences of symptoms. Only 24% of studies used standardised questionnaires, with the Nordic Musculoskeletal Questionnaire (NMQ) being the most commonly used. To improve the homogeneity of outcomes and data collection tools when investigating musicians' MSS, we recommend using the NMQ, where appropriate. Recall periods of 12-months and 7-d are the most appropriate for prevalence, and 7-d recall periods for ratings. Importantly, outcomes and the tools used to collect data should be reported in sufficient detail to ensure that the study can be replicated, critiqued, and accurately interpreted.

Musicians injuries: Upper quarter motor control deficits in musicians with prolonged symptoms - A case-control study

STUDY DESIGN

Case-control study.

BACKGROUND

A large number of student and professional musicians are affected by long term playing related musculoskeletal disorders (PRMSDs) during their career, with prevalence rates above 80%.

OBJECTIVE

To investigate if there were differences between musicians with and without prolonged symptoms of upper quarter PRMSDs in the presence of: (1) scapular dyskinesis; (2) cervical motor control and endurance deficits.

METHODS

Seventy-two musicians (24 males; 48 females) were matched based on sex, type of instrument and average hours played per week and assigned to one of two groups: A symptomatic group (mean age 23.3 ± 8.2 years) with history of prolonged PRMSDs (constant symptoms lasting more than one week) during the past year; and a control group (mean age 25 ± 10.5 years) with no history of PRMSDs lasting more than one week. Musicians completed a questionnaire and underwent clinical testing for the presence of scapular dyskinesis and cervical motor control and endurance deficits using the following tests: (1) cervical flexor endurance test; (2) scapular dyskinesis test; and (3) craniocervical flexion test. Assessor blinding as to group assignment was ensured.

RESULTS

Participants in the symptomatic group presented with a statistically significant higher prevalence of positive scapular dyskinesis (P < .0001; OR = 7.8) and lower scores for the craniocervical flexion test (P < .0001).

CONCLUSION

Musicians with prolonged symptoms of PRMSDs presented with higher prevalence of scapular and cervical motor control deficits detected by standard clinical tests when compared to the control group.

LEVEL OF EVIDENCE

Therapy, level 4. CLINICALTRIALS.

GOV IDENTIFIER

NCT02267395.

Electromyography of neck and shoulder muscles in instrumental musicians with musculoskeletal pain compared to asymptomatic controls: A systematic review and meta-analysis

Musicians report a high prevalence of annual musculoskeletal pain (86-89%), attributed to prolonged playing times consisting of repetitive static and dynamic muscle activity. The aim of this study was to explore, compare and synthesise evidence on electromyographic (EMG) muscle activity in neck, shoulder and spinal musculature between painful and asymptomatic instrumental musicians. Ovid, Wiley, Web of Science and Scopus databases were searched in August 2016 for cross-sectional studies that compared EMG activity of neck, shoulder and spinal musculature between musicians with musculoskeletal pain and asymptomatic comparisons. An updated search was performed in May 2017, adding a further study. Two authors independently assessed papers for inclusion and then quality, determined using a modified Downs and Black Checklist. Means and standard deviations were extracted from each study to calculate effect sizes and compare results. Six studies were found to fulfil inclusion criteria. Five studies were deemed high-quality with one being low-quality. Conflicting evidence was found supporting increases in upper trapezius EMG muscle activity in musicians reporting of pain. Moderate-quality evidence indicates increased SCM activity in musicians reporting pain. There was limited evidence supporting increased activity of deltoids, lower trapezius and the upper cervical extensors in musicians reporting of musculoskeletal pain. Meta-analysis of results of three studies assessing upper trapezius activity were conflicting with these not being statistically significant. Further studies with prospective designs, larger population sizes and on broader instrumental groups are warranted.

Differences in neck surface electromyography, kinematics and pain occurrence during physiological neck movements between neck pain and asymptomatic participants. A cross-sectional study

BACKGROUND

Neck pain has been associated with altered muscle activity and impaired kinematics. Patients frequently report pain during physiological neck movements. Previously, the average muscle activity during these movements has been measured. However, muscle activity is modulated by the position in the range of movement, hence the study of neck muscle activity in discrete sections of the range of movement is warranted. Evidence is conflicting regarding range of movement restriction in neck pain. No study has assessed the point in the range of movement at which pain occurs. This study aimed to investigate neck kinematics, muscle activity and pain during physiological neck movements in participants with and without neck pain.

METHODS

Neck kinematics and surface electromyography were recorded continuously and analysed in 10° increments during forward and side flexion, extension and rotation of the neck in 20 neck pain and 20 asymptomatic participants. Point of pain occurrence in the range of movement was recorded.

FINDINGS

Neck pain participants demonstrated significantly lower activity of scalene during flexion and extension, and a non-significant higher activity in sternocleidomastoids during rotation. No differences in neck kinematics were observed. 65% of neck pain participants reported pain during at least one neck movement. Pain was reported in the last ≈20-40% of the range of movement.

INTERPRETATION

Exercises used in current practice to minimise scalene activity may not be appropriate for all neck pain patients. Restricted range of movement is not a consistent feature of neck pain. Movement associated neck pain is present at the end of range of movement, which has implications for the study of neck pain and rehabilitation.

Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain

OBJECTIVES

To determine feasibility and potential of Alexander technique (AT) group classes for chronic neck pain and to assess changes in self-efficacy, posture, and neck muscle activity as potential mechanisms for pain reduction.

DESIGN

A single-group, multiple-baseline design, with two pre-tests to control for regression toward the mean, a post-test immediately after the intervention, and another post-test five weeks later to examine retention of benefits. Participants were predominately middle-aged; all had experienced neck pain for at least six months.

INTERVENTION

Participants attended ten one-hour group classes in AT, an embodied mindful approach that may reduce habitual overactivation of muscles, including superficial neck muscles, over five weeks.

OUTCOME MEASURES

(1) self-reports: Northwick Park Questionnaire (to assess neck pain and associated disability) and Pain Self-Efficacy Questionnaire; (2) superficial neck flexor activation and fatigue (assessed by electromyography and power spectral analysis) during the cranio-cervical flexion test; (3) posture during a video game task.

RESULTS

There were no significant changes in outcomes between pre-tests. All participants completed the intervention. After the intervention: (1) participants reported significantly reduced neck pain; (2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; (3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another.

CONCLUSIONS

Group AT classes may provide a cost-effective approach to reducing neck pain by teaching participants to decrease excessive habitual muscle contraction during everyday activity.