This clinical trial study aims to compare the effects of DNS (Dynamic Neuromuscular Stabilization) exercises and deep cervical muscle exercises on fat infiltration, disability, and posture in individuals with chronic non-specific neck pain. The clinical questions of this study are as follows:
* Can DNS and deep cervical muscle exercises decrease muscle fat infiltration? * Can DNS and deep cervical muscle exercises improve neck disability? * Can DNS and deep cervical muscle exercises improve neck posture?
Researchers will compare DNS and deep cervical muscle exercises to people with non-specific neck pain. DNS exercises are hypothesized to significantly reduce fat infiltration and improve neck disability and neck posture compared to deep cervical muscle exercises.
The participants will undergo an MRI scan and clinical assessment, such as NDI (Neck Disability Index) and posture checking, before being randomly divided into two groups. The first group will perform DNS exercises, and the second group will engage in deep cervical muscle exercises. Both sets of exercises will be performed for 16 weeks as part of a daily routine. After the 16-week exercises, the participants will undergo a follow-up MRI, NDI, and posture checking.
Non-specific neck pain condition for three months or more
Mild to moderate disability ( more than 10% of NDI)
Mild to moderate pain level(2-8/10 of NRS)
A history of spine surgery or cervical injury
Participated in a neck exercise program in the past three months
Upper extremity problems
Radiating pain, numbness, and weakness of the upper extremities
Parallel
Dynamic Neuromuscular Stabilization exercises
Other interventionDNS is a method used to enhance muscle stability. It is a manual and rehabilitative approach based on developmental kinesiology to optimize the movement system. These exercises optimize internal muscle forces on each spinal segment.
Deep Cervical Muscle exercises
Other interventionDeep cervical muscle exercises are isometric exercises that strengthen weak muscles without causing discomfort to pain-sensitive structures like ligaments, tendons, or neck joints. This involves contracting specific muscles without changing muscle length or impeding joint movement.
Change of muscle fat infiltration in the flexor and extensor muscles
All participants will be conducted a standard MRI of the cervical spine. They will be asked to lie on their backs and maintain a neutral cervical spine position without rotation, lateral flexion, or exaggerated lordosis. A neck coil will be used during the examination to enhance imaging accuracy. MRI will be performed using the SIGNA Premier 3.OT (GE Healthcare Japan) (Repetition time, 8000 ms; Excitation time, 102 ms; Voxel size, 0.4 x 0.4 mm; Field of view, 200 x 200 mm; Thickness, 3.5 mm). Specific neck muscles (Longus Colli + capitis, Multifidus, Semispinalis cervicis, Semispinalis capitis, and Splenius capitis + cervicis) will be mapped and analyzed for fatty infiltration using Miele-lxiv image processing software. The total fatty infiltration for bilateral muscles at different levels in the neck will be calculated.
Change of disability level
The Neck Disability Index (NDI) is a 10-question survey that measures how neck pain affects daily life. The patient rates their pain intensity, headaches, and difficulty with personal care, lifting, reading, concentration, work, driving, sleeping, and recreation. A change of 5%-10% is considered meaningful.
Change of posture
Shisei-Karte is a Japanese AI-based website that analyzes posture using images. It assesses head posture, including forward and backward tilts and misalignment. The goal is to detect issues like forward head posture. The process has three steps: (1) participants register with basic details, (2) a side-view photo is taken, and (3) the AI analyzes and displays results in about 30 seconds.
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