Effect of lower trapezius and serratus anterior muscle strengthening on pain and function in patients with chronic mechanical neck pain Abichandani, Deepa; Vora, Kanchi License: Creative Commons: Attribution (CC BY) Document Version Publisher's PDF, also known as Version of record Citation for published version (Harvard): Abichandani, D & Vora, K 2017, 'Effect of lower trapezius and serratus anterior muscle strengthening on pain and function in patients with chronic mechanical neck pain' International Journal of Science and Research, vol. 6, no. 9, ART20176627, pp. 528-534. Link to publication on Research at Birmingham portal Publisher Rights Statement: Checked for eligibility: 12/03/2019 General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. 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Apr. 2019 International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Effect of Lower Trapezius and Serratus Anterior Muscle Strengthening on Pain and Function in Patients with Chronic Mechanical Neck Pain Dr Deepa Abichandani1, Kanchi Vora2 1Assistant Professor, School of Physiotherapy, D.Y.Patil University, Navi Mumbai 2 Physiotherapy Intern, D.Y.Patil Hospital and Research Center Abstract: Background: Neck pain is considered to be a very frequent and disabling complaint among the general population. Purpose: To study the effect of strength training of Lower Trapezius and Serratus Anterior muscles on pain and function in patients with chronic mechanical neck pain. Method: 24 chronic mechanical neck pain samples (12 experimental and 12 control groups)participated.The pre and post-assessment was done with Numerical Rating Scale (NRS), Algometer, Push-Pull Dynamometer and Neck Disability Index Scale (NDI)for Pain, Pain Pressure Threshold (PPT), Muscle Strength and Function respectively. The experimental group was given strength training along with conventional physiotherapy whereas the control group underwent only conventional physiotherapy. Results: The results showed a statistically significant difference in PPT (p value: 0.04), Lower Trapezius strength (p value: 0.02), Serratus Anterior strength(p value: 0.003) and NDI (p value: 0.04). Conclusion: Strength training for Lower Trapezius and Serratus Anterior muscles along with conventional physiotherapy should be incorporated in treatment of Chronic Mechanical Neck pain patients. Keywords: Chronic mechanical neck pain, Lower Trapezius, Serratus Anterior, Strength Training 1. Introduction the side and in all upper limb movements.[11]In accordance with this, altered orientation of the scapula is usually caused Neck pain has become a common complaint in office by altered activity or poor neuromuscular control of the workers especially those engaged in sedentary occupations muscle segments mainly the trapezius and serratus anterior [11] characterized by intensive computer use. [1]It affects 30% to muscles. Biomechanical reasoning indicates that altered 50% of the general population in any given year[2]having a axioscapular muscle activation associated with altered point prevalence of nearly 13% and a lifetime prevalence of scapular orientation may induce increased load on the [12,13,14] 50%. [3]Prevalence of neck pain is highest in the age group cervical spine. of 25-45 years as well as among women, manual workers and other ethnic groups[4]. It affects occupational and Also, recent studies have shown that neck and shoulder pain avocational activities of daily living as well as quality of life are likely to be caused by excess activation of Upper which ultimately leads to a high level of morbidity. [5] Trapezius combined with decreased control of Lower [1] Trapezius and Serratus Anterior muscles. According to Chronic pain is pain which lasts for more than 3 to 6 another study performed by Sally Wegner et al, there is [15] months. Chronic neck pain is characterized by a widespread altered trapezius muscle activity in neck pain patients. sensation of hyperalgesia in the muscles and ligaments Supporting this, mechanical neck pain patients are likely to during active as well as passive movements.[1]It is usually have a good Upper Trapezius muscle activity and decreased known to be caused due to mechanical dysfunction of the activity of Lower Trapezius and Serratus Anterior Muscles. cervical spine.[6]According to International Association for the Study of Pain (IASP), clinical features of neck pain To the author’s best knowledge most of the studies have include pain and stiffness in the neck, headache, dizziness concentrated on studying the scapular muscles as a whole and radiating pain to the shoulders and upper limbs. Clinical and not the Lower Trapezius and Serratus Anterior muscles findings include decreased range of cervical movement, exclusively. Therefore, the purpose of our study is to find increased fatigability and decreased pain pressure thresholds the effect of strengthening of Lower Trapezius and Serratus of cervical muscles.[7] Anterior muscles along with conventional therapy protocol in chronic mechanical neck pain patients. The activity of the trapezius and serratus anterior muscles which are the main stabilizers of the scapula depends upon 2. Review of Literature force production, neuromuscular control and recruitment which in turn require coordinated activities occurring at the 1) Scapular muscle activity from selected strengthening right moment, creating the right amount of force and exercises performed at low and high intensities. maintained for the right length of time. This precise firing Study was performed by Christoffer H. Andersen, Mette K pattern and recruitment requires the serratus anterior Zebis et al at Copenhagen, Denmark. It determined scapular muscles to couple with upper, middle and lower trapezius muscle activity during strengthening exercises for scapular resulting in ‘force couples’. These force couples are muscles at low and high intensities (Borg CR10 levels 3 and necessary for normal scapular orientation [8,9,10]with arms by 8). Surface EMG from selected scapular muscles was Volume 6 Issue 9, September 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Paper ID: ART20176627 528 International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 recorded during 7 strengthening exercises and expressed as in normal subjects using a handheld dynamometer. 172 percentage of the maximal EMG. Seventeen women aged subjects with varying levels of overhead activity were 24-55 years without serious disorders participated. Press-up, chosen. A handheld dynamometer was used to test the prone flexion, one-arm row, and prone abduction at Borg upper, middle and lower trapezius, rhomboids and serratus 3and press up, push-up plus, and one-arm row at Borg 8- anterior muscles. A 2 factor ANOVA was performed for predominantly activated the serratus anterior over the lower each of the muscles. The results showed that activity levels trapezius. The middle trapezius was activated over the upper did not significantly affect the unilateral ratios. trapezius by one-arm row and prone abduction. Only the press-up and push-up plus activated both the lower trapezius 5) Physical exercises and functional rehabilitation for and serratus anterior muscles over the upper trapezius. In the management of chronic neck pain conclusion, several of the investigated exercises both at low This study was performed by J. Ylinen to reassess the and high intensities activated the serratus anterior and lower effectiveness of different exercise methods in relieving pain and middle trapezius muscles, respectively over the upper and improving disability in patients with chronic nonspecific trapezius muscle. neck pain. Ten randomized controlled or comparative high- quality trials were included using the following outcome 2) Lower trapezius and serratus anterior activation: measures- patient’s rated pain and disability as well as pain which exercise to use for scapular neuromuscular pressure threshold and neck strength and range of motion. reeducation? Results revealed moderate evidence supporting the Gonçalves Barreto, Rodrigo Py et al did a study on Low