Original article
The effects of combined sternocleidomastoid muscle stretching and massage on pain, disability, endurance, kinesiophobia, and range of motion in individuals with chronic neck pain: A randomized, single-blind study

https://doi.org/10.1016/j.msksp.2021.102417Get rights and content

Highlights

  • Stretching and massage applied to the SCM can reduce pain and disability in CNP.

  • Stretching and massage applied to the SCM can increase endurance in CNP.

  • Stretching and massage applied to the SCM can increase some cervical ROM in CNP.

  • These treatments can be an alternative method in individuals with CNP.

Abstract

Background

The effect of interventions to the Sternocleidomastoid (SCM)-muscle, as an important element of neck movement which is overactive in individuals with chronic neck pain (CNP), are unknown.

Objective

The aim of the current study is to investigate the effects of SCM stretching and massage on pain, range of motion (ROM), endurance, disability, and kinesiophobia in individuals with CNP.

Methods

In this study, individuals with CNP were randomized 1:1 to parallel SCM-Group (n = 30) or control group (CG) (n = 30). Conventional physiotherapy was applied to CG. In addition to the same interventions applied to the CG, classical massage and stretching exercises were applied to the SCM-muscle in the SCM-Group. Treatment sessions were administered three times each week for a total of 5 weeks. Pain, endurance, ROM, disability, and kinesiophobia were evaluated. Both prior to and immediately following the treatments. Mixed-model repeated measured ANOVAs were then employed to determine if a group*time interaction existed on the effects of the treatment on each outcome variable for each group as the between-subjects variable and time as the within-subjects variables.

Results

Improvements in pain, disability, ROM(extension, left-lateral flexion, and right/left-rotation), and endurance were found to be greater in the SCM-Group compared to the CG (p < 0.05). Changes in flexion and right-lateral flexion ROM and kinesiophobia did not significantly differ between the groups (p > 0.05).

Conclusion

Stretching exercises and massage applied to the SCM-muscle, together with conventional physiotherapy, can reduce pain and disability, and increase ROM and endurance in individuals with CNP. This treatment may therefore be considered for use as an alternative method in treating CNP.

The study was registered in ClinicalTrials.gov (NCT04345042).

Introduction

Neck pain is considered one of the major musculoskeletal disorders worldwide, with a prevalence varying from 16.7% to 75.1% (Ahmed et al., 2020). The etiology of neck pain is multifactorial. Research evidence supports sedentary lifestyle, poor posture, anxiety, depression, increased computer use, physical or mental stress, working positions, and neuromuscular stress as factors affecting neck muscles that can potentially cause muscle spasm and pain (Haldeman et al., 2010; Kääriä et al., 2012; Paksaichol et al., 2015).

Pain, which leads to functional limitations especially in the cervical region, is associated with a decrease in the activation of the deep cervical flexors such as the longus colli and longus capitis muscles, and an increase in the activation of the superficial cervical flexors, such as SCM and anterior scalene muscles (Nikander et al., 2006). It is reported that in individuals with CNP, there is an increase in the activation of SCM and anterior scalene muscles, especially during isometric cervical flexion and dynamic upper limb movements (Falla et al., 2004a, 2004b). In their study, Falla et al. (2002) concluded that individuals with unilateral CNP had muscle fatigue in their ipsilateral SCM and anterior scalene muscles. Wang et al. (2003) reported postural imbalance in individuals with CNP due to an increased activation and tightening of the suboccipital, SCM, upper trapezius, pectoralis, and rotator cuff muscles. Barton and Hayes (1996) stated that in individuals with neck pain, SCM-muscle relaxation was not possible via biofeedback relaxation training, and that ongoing muscle pain could instead be as a result of continuous muscle contraction. According to Dareh-deh et al. (2020), CNP and forward head posture were found to be present in individuals who excessively used screen-based technological devices (e.g., smartphones). They indicated that individuals with forward head posture and CNP often suffered from weakness of the deep neck flexor muscles, resulting in over-activation of other muscles such as the SCM and anterior scalene muscles.

In previous studies, massage and stretching exercises were frequently used to provide neck muscle inhibition (Herman and Smith 2008; Karlson et al., 2014; Mahajan et al., 2012; Meyer et al., 2006). Massage is the application of hand movements to the skin surface for healing and therapeutic purposes. There are several theories regarding the therapeutic effects of massage. It is thought that touching stimulates pressure receptors and changes blood flow, resulting in psychological relief and a reduction in pain symptoms (Field, 2002; Karlson et al., 2014; Mouraux and Plaghki, 2007). Stretching involves the application of manual or mechanical force to lengthen structures that are adaptively shortened and hypomobile (Mahajan et al., 2012). Stretching has an effect in restoring ROM as well as in restoring original muscle length. It also increases muscle torque and has an analgesic effect by raising the pain threshold (Herman and Smith, 2008).

However, in most studies, stretching and massage performed on individuals with CNP were mainly localized, and did not target any specific muscle group (Ahmed et al., 2020; Kompal et al., 2019). The spinal accessory nerve innervates and passes beneath the SCM or directly through the muscle belly. Excessive contraction and spasm in the SCM can compress this nerve, resulting in pain (Kim and Lee, 2018). Hence, the current study aimed to reduce the load on the accessory nerve and to minimize neck symptoms by applying stretching and massage to the SCM-muscle. In addition, for individuals with CNP, the effect is unknown when massage and stretching applications target only one muscle, rather than an entire area. Thus, the current study aimed to investigate the effects of combined stretching and massage applied to the sternocleidomastoid muscle on pain, disability, endurance, kinesiophobia, and range of motion in individuals with CNP.

Section snippets

Study design

The study was conducted as a single-blind randomized 1:1 parallel study. Individuals with CNP were selected according to the inclusion-exclusion criteria and having agreed to participate in the study. Both the evaluator physiotherapist and the participants were blind to the group allocations and to the content of the treatment program to be applied. This study was approved by the university's local ethics committee (2019–01/04), and written informed consent was obtained from each participant.

Results

The sociodemographic and baseline characteristics of the participants are presented in Table 2. There was no statistically significant difference established between the groups in terms of the participants’ age, BMI, gender, or disease duration. In addition, no significant differences between the groups were noted in the baseline characteristics (Table 2).

The two-way, mixed-model ANOVA of resting pain (F = 4.5, p = 0.03, ηp2 = 0.07) and activity pain (F = 5.3, p = 0.02, ηp2 = 0.08) indicated a

Discussion

The most important finding of this randomized controlled single-blind study examining the effects of stretching and massage applied to the SCM-muscle in individuals with CNP is that rest and activity pain, cervical flexor and extensor muscle endurance, ROM(excluding flexion and right-lateral flexion), and disability improved significantly in the SCM-Group compared to the CG. Comparing pre- and post-intervention results revealed that the groups had similar post-intervention results in terms of

Funding sources

None.

Declaration of competing interest

None declared.

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