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Table 3 Description of modalities used in the intervention programs

From: Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial



Cervical mobilization [57]

Low-velocity passive mobilization techniques to the symptomatic cervical segments as determined by the physiotherapist’s clinical examination. Physiotherapists are free to select from what are termed passive accessory and physiological movement techniques as deemed relevant to the individual participant based on the initial and progressive reassessments.

Specific therapeutic exercises [26, 58, 59]

Cervical flexors

(i) Train craniocervical flexor (CCF) activation and holding capacity. Participants learn the correct movement and train to hold the contraction with and without feedback in progressively more difficult inner range positions.

(ii) Train the interaction of deep and superficial cervical flexors in movement patterning and functional tasks.

(iii) Train co-contraction of the deep cervical flexors and extensors.

(iv) Train strength and endurance of the cervical flexors.

Cervical extensors

(i) Train craniocervical extensors and rotators (head extension, head rotation < 40°) with the cervical spine in a neutral position.

(ii) Train cervical extension to bias the cervical extensors (extend cervical spine keeping the craniocervical region in a neutral position)

(iii) Train strength and endurance.

Axioscapular muscles

(i) Train scapular muscles in particular the upper/ middle/ lower trapezius and serratus anterior in both open and closed chain positions, with and without load and movement of the upper limb.

(ii) Train correct scapular posture.

Postural correction exercise

(i) Train a neutral spinal posture from first treatment.

(ii) Train scapulothoracic and cervical postures. Participants train to actively correct their posture and maintain for 10s. Practice is in sitting, standing (2-3 times an hour).

Sensorimotor exercises [7, 59]

Cervical JPS. The participants practice moving their head to points in different directions initially with eyes open, using a laser pointer mounted onto a lightweight headband. This practice will involve relocating the head back to a neutral posture or to predetermined points in range. The exercise is progressed by closing the eyes and by changing directions and ranges of movement.

Cervical movement sense. The participants practice tracing horizontal and vertical lines on a chart on the wall focusing on accuracy and secondarily speed using a laser pointer mounted onto a lightweight headband for feedback on performance. Exercises are progressed by increasing speed and tracing more intricate patterns such as a figure of eight, zig-zag or an alphabet pattern.

Oculomotor control exercises

(i) Train eye follow. The participants follow a target moving from side to side and up and down while keeping their head still.

(ii) Train gaze stability exercises. The participants perform active movements, while fixing their gaze on the target. Progressions include increasing the target’s speed, changing the participant’s position and changing visual background and focus point.

(iii) Train eye head co-ordination exercises. The participants move their eyes and head in the same direction to focus on a target. Progressions include moving the eyes first then the head and moving eyes and head in opposite directions.

Balance exercises [7, 59]

The training starts with static balance and progresses to dynamic balance and challenging gait. The exercises will be progressed by closing the eyes, altering the support surface (i.e. a soft surface), concurrent voluntary movements, or increasing speed.