Effectiveness of Isometric Exercises on Disability and Pain of Cervical Spondylosis

Determining the effectiveness of isometric neck exercises on pain and disability of cervical spondylosis

Single-blind randomized clinical trial with a control group (1:1), parallel design of 24 patients with chronic neck pain, enrolled between January 2017 and March 2017, followed for 4 weeks. Excel software's rand function was used for randomization. Random allocation concealment was performed using sealed opaque envelopes.

The main location of the trial is the rheumatology clinic of Vali-e-Asr hospital, Zanjan, Iran. Intervention group performed neck isometric exercises 6 days a week for 4 weeks as 3 sets/day, each set consists of 6 movements, holding each movement for 10 seconds, and repeating each 5 times with a 5-second rest between them. Data analysts and the outcome assessor are masked.

Patients >18 years with chronic neck pain, clinical findings and signs on cervical magnetic resonance imaging compatible with cervical spondylosis, without acute cervical nerve root compression, without neck surgical indications, not receiving exercise therapy or physiotherapy during the 6 weeks prior to the study are included in the trial. A history of neck surgery over the past year, history of inflammatory diseases involving the neck joints, history of fractures or dislocations of the cervical vertebrae, pregnant women, either patients who did not have a good compliance with the intervention or had difficulty following the study and a history of myelopathy are excluded.

1. Intervention group receiving home-based neck isometric strengthening exercises. 2. Control group receiving no intervention.

1. Cervical disability score on the Neck Disability Index 2. Neck Pain score on the Neck Pain and Disability Scale

Microsoft Excel program was used to allocate participants randomly to each group using Blocked randomization with randomly varying blocks (block size 4 and 8). Concealed opaque envelopes identifying the assignments to each group were randomly chosen by participants.

Initially, the outcome assessor, who is blind to the allocation of the study groups, evaluated all study participants in terms of clinical outcomes. Participants then go to the therapist with an envelope containing their random allocation for intervention. The therapist is an experienced physiotherapist and exercise therapist who is not blind group allocations. The therapist is not involved in other parts of the study. Then, depending on the allocation of the participants, the therapist either teaches them the exercises (intervention group) or does not teach them (control group). After four weeks, the clinical outcomes are re-evaluated by the same clinical outcome assessor and the data are collected and made available to data analysts who are blind to group allocations. It should be noted that, given the nature of the intervention, which is a type of exercise therapy, and the fact that the control group did not receive any intervention, it was naturally not possible to blind the participants and the therapist during the clinical trial.

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