Chronic neck pain affects 30-50% of individuals annually and is a leading cause of disability, often linked to muscle imbalances and compensatory over activation of superficial muscles. While craniocervical flexion trainning (CCFT) improves neuromuscular control and reduces pain, limited researches has examined the additional benefits of semispinalis cervicis strengthening. This randomized controlled trial, conducted at Fauji Foundation Hospital and Foundation University College of Physical Therapy will assess the effects of combining semispinalis cervicis strengthening with CCFT on pain, cervical erange of motion, muscle strength and functional disability. Participants will be randomly assigned to either CCFT alone or CCFT with semispinalis cervicis strengthening, performed three times per week for four weeks. Data will be collected at baseline, mid study (week 2) and end of study (week 4) using the Numeric pain rating scale, Goniometer, Sphygmomanometer and Nexk disability index. This study addresses a research gap by exploring deep cervical extensors strengthening alongside CCFT, potentially improving rehabilitation strategies for pain relief, cervical stability and functional recovery.
Adults aged 18 to 35.
Chronic nonspecific Neck Pain persisting for more than 3 months.
Willingness to participate and and signed an informed consent form.
Self reported neck pain intensity greater than and equal to 3 on 11 point numerical pain scale.
Recent neck injuries and surgeries.
Several medical conditions like Hypertension, RA and Cardiovascular Diseases.
Significant psychiatric disorders.
Parallel
Craniocervical Flexion Training alone
Procedure/Surgery10-minute hot pack treatment before starting the protocol. Week 1: Muscle Activation, • Hold for 5-10 seconds. * Perform in supine with a sphygmomanometer device. * Nod head gently as if saying "yes," aiming for 20-22 mmHg. Week 2: Endurance Training Goal: • Hold for 10-15 seconds. Increase holding time and precision. Exercise: • Maintain the contraction at 24-26 mmHg on the device. Week 3: Strength and Postural Training •Hold for 15 seconds. Exercise: * Perform CCFT in sitting or standing. Week 4: Functional Integration * Maintain contraction during functional tasks (e.g., desk work). * Hold for 15-20 seconds. * Sets/Reps: 3 sets of 8-12 repetitions.
Semispinalis Cervicis strengthening with Craniocervical Flexion Training:
Procedure/SurgeryCraniocervical flexion training will be same as given to group A. Week 1: Semispinalis Cervicis Activation: * Patient sits upright with neutral spine. * Therapist applies gentle manual resistance at C2 vertebra while the patient resists backward motion. * Hold for 3-5 seconds, then relax. Week 2: Progressive Activation with Increased Resistance: * Apply moderate manual resistance at C2. * Hold for 5 seconds, focusing on controlled movement. Week 3: Strength and Functional Coordination with Dynamic Resistance: * Introduce light movement (e.g., slight backward head tilt) under resistance. * Therapist adjusts resistance dynamically. Week 4: Advanced Endurance and Functional Integration with Functional Movements: * Combine resistance training with controlled head rotations or slight lateral flexion. * Maintain resistance and stability. * Reps/Sets: 3-4 sets of 12 reps.
Chronic Neck Pain
Chronic Neck Pain will be measured using Numeric Pain Rating Scale, minimum value is 0 and maximum value is 10.
Neck Range of Motion
Neck Range of Motion will be measured using Goniometer, minimum and maximum value depends on movement.
Neck Muscle Strength
Neck Muscle Strength will be measured with Sphygmomanometer, minimum and maximm value depends on hold time of 20mmHg.
Neck Functional Disability
Neck Disability Index will be used to measure Neck Functional Disability, 0 to 50 is range.
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