To study the combination of upper extremity PNF patterns and SS exercises on improving neck pain, function, scapular position, and scapular muscles strength in patients with NSCNP and SD.
1- Have referred from orthopedic surgeon diagnosed with non specific chronic neck pain (NSCNP) that has been localized to the cervical and periscapular areas for at least three months.
History of previous neck surgery.
Recent or old fractures.
Cognitive impairment and inability to understand the scale.
Systematic inflammatory disease e.g., rheumatoid arthritis and ankylosing spondylitis, neck pain with radiculopathy or neuropathy.
Parallel
PNF
Other interventionUpper extremity PNF exercise is an exercise method that dynamically stabilizes the scapula and affect scapular muscles activity (Witt et al., 2011). Upper extremity PNF patterns consisted of four diagonal patterns (D1 flexion, D2 flexion, D1 extension, and D2 extension) and six key components manual contact, body position, verbal cues pattern of movement, timing of movement and resistance. Patient will be at sitting position with involved side up, head, spine, and scapula in neutral
Traditional neck pain treatment
Other interventionCervical muscles stretch + Craniocervical retraction ex + Manual therapy
Traditional neck pain treatment + Blackburn scapular stabilization exercises
Other interventionThe patients will receive Traditional treatment of neck pain and Scapular stabilization exercises (Blackburn exercises). Blackburn exercises are one of the ways to treat scapular dyskinesia. Perform 2 sets of 20 repetitions of each exercise each session (3 sessions per week) for four weeks (panse et al .,2018). The exercise load will be 60% of the one-repetition maximum (1-RM) during the first week due to their first exposure to the exercises. The evaluation of one-repetition maximum (1-RM) will be every week for all exercises. From the second evaluation, more weight will be added (compare to the previous evaluation) to maintain the overload.
scapular muscle strength
Hand-held dynamometer (HHD) (Model 01165, Lafayette Instrument Company, Indiana) is an easy and reliable device to assess isometric muscle strength for shoulder and scapular muscles in both clinical and research settings The patient will be instructed to maintain the midrange position during each muscle test as resistance was gradually applied via the HHD until the examiner matches the subject's effort Assess upper trapezius, middle trapezius, lower trapezius, and serratus anterior
Assessment of scapular posture
Assessment of scapular posture by lateral scapular slide test, It used to determine scapula involves measuring the distance from the inferior angle of the scapula to the nearest vertebral spinous process using a tape measure or goniometer in three positions: shoulder in neutral, shoulder at 45 degrees of coronal plane abduction with hands resting on hips, and the shoulder at 90 degrees abduction with the arms in full internal rotation.
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