INVESTIGATION OF THE VOLUME OF NECK MOVEMENT IN PATIENTS WITH NECK PAIN

Abstract

Nonspecific neck pain is pain localized in the side and back of the neck that shows no pathognomonic signs and symptoms. When the duration of symptoms is greater than 12 weeks of evolution, it acquires the value of chronicity, called nonspecific chronic neck pain. It is a common disorder that generates high impact and socio-economic costs. The number of predominant cases of neck pain worldwide is estimated at 288.7 million, and the number of years spent with neck pain injuries in 2017 worldwide is estimated at approximately 28.6 million. (Bernal-Utrera, C., et al. 2020) .. The prevalence of pain increased among adults in the United States by 25% from 1998 to 2014, according to a 2019 report, with 41% reporting pain in 2013-2014. At least 70 million adults in the United States have chronic pain. Opioid use has increased along with the increased prevalence of pain. Visits to healthcare providers decreased slightly over the same period of time, which may suggest that people tend to manage pain with drugs rather than provider-based non-pharmacological approaches. (Hawk, DC. C., et al. 2020).

Aim: The aim of this study was to monitor the volume of neck movement and the degree of pain in patients with neck pain with a specified diagnosis of disc herniation and an unspecified diagnosis in the neck.

Methods: The contingent in the current study are 80 male and female patients aged 45-70 years selected by indicators of neck pain with clinically proven or not diagnosed disc herniation. Divided into two groups: 40 with a diagnosis of disc herniation (mean age 54.75) and 40 with unspecified one (mean age 50.25). The following types of measurements of the volume of movement in the cervical spine were made: goniometry and centimetry. In the group with a diagnosis of disc herniation, in addition to the kinesitherapy method (therapeutic massage), general developmental exercises and ultrasound were also applied. Only kinesitherapy methods (therapeutic massage, postisometric relaxation and suction cups) were applied to the group without diagnosis.

Results and discussion: When analyzing the results, it was found that in both groups there were significant changes in the outcome of therapy. There was a statistically significant difference in the data (Kruskal-Wallis test, P <0.001) obtained in the two measurements. This is due to the fact that all measured persons have reached the maximum degree of improvement at the first measurement. Comparing the groups, however, some differences were observed in the results of the tests performed. There was a statistically significant difference (Mann Whitney test, P <0.0001) in extension in the two groups. The persons with unspecified diagnosis (second group) have on average by 5.8 degrees with an increased volume of movement of extension in the neck than the persons with a diagnosis. The range of motion in these patients examined by goniometry was also reduced at a lateral slope to the right of an average of 38.13 ± 6.890, which is a result of the diagnosis of disc herniation. This is the reason for the reduced mobility and reduced range of motion in the neck area. The pain examined on the visual-analog scale for pain averaged 9-8, in the second study it reached 3-2 degrees for the first group (diagnosed with a herniated disc). In patients with an unspecified diagnosis, we found increased muscle tone in the following muscles: m. Trapezius on the right mean 3.5 ± 1.2; m. Levator scapulae on the right mean 3.7 ± 1.7. The volume of movement examined by goniometry and muscle tone examined by pre-stretching of m. trapezius pars descendens is reduced in most planes as follows: in flexion mean 43.15 ± 11.200; lateral slope to the right 38.13 ± 6.890; lateral slope to the left 29.50 ± 7.210; when rotating to the right 58.88 ± 10.260; when rotating to the left 50.40 ± 10.370. There was a statistically significant difference in flexion and extension in the sagittal plane (P <0.0001), in degrees in the frontal plane on the right (P <0.0001) and left (P = 0.003), rotation on the right and left (P <0.0001) in degrees , as well as the rotation to

The studied groups are dominated by people in whom the pain is very strong when performing daily activities (DA). The persons in the first group with a left dominant hand are 6 (or 15%), and in the second are 5 (12.5%). Which arm is dominant affects the load on the shoulder girdle and neck and causes problems in its respective part (left or right). The differences (Wilcoxon signed rank test) in the degrees in the frontal plane on the left and right in the two groups were statistically significant (P = 0.02 in the first group and P <0.0001 in the second group), the degrees of rotation (P = 0.005 in the first group and P <0.0001 in the second group), the lateral slope (P = 0.006 in the first group and P = 0.04 in the second group) and rotation in cm have a difference only in the first group (P = 0.006). The probable reason for the appearance of these differences is the fact that in persons with a disc herniation both sides are affected to a large extent, in contrast to persons without a diagnosis, in which the load on the upper limb is decisive.