|Year : 2021 | Volume
| Issue : 2 | Page : 81-84
Relationship between shoulder range of motion and neck pain and neck function among college students with mechanical neck pain
S Priya, S Haripriya, Anamika Arjun
Department of Physiotherapy, Laxmi Memorial College of Physiotherapy, Mangaluru, Karnataka, India
|Date of Submission||12-Nov-2021|
|Date of Decision||11-Dec-2021|
|Date of Acceptance||13-Dec-2021|
|Date of Web Publication||15-Feb-2022|
Dr. Anamika Arjun
Department of Physiotherapy, Laxmi Memorial College of Physiotherapy, AJ Towers, Balmatta, Mangaluru, Karnataka
Source of Support: None, Conflict of Interest: None
CONTEXT: Mechanical neck pain is the leading cause of disability. The pain can be felt locally in the neck and also in the arms or shoulders. Several studies have found that there is a substantial link between neck pain and upper limb impairment.
AIMS: The present study aims to find the correlation between neck pain and neck function and shoulder joint range of motion (ROM) among college students with mechanical neck pain.
SETTINGS AND DESIGN: An observational cross-sectional study was conducted among 35 college students both male and female in a tertiary hospital, India.
SUBJECTS AND METHODS: ROM, neck pain, and neck function were assessed using a universal goniometer, Visual Analog Scale, and Neck Disability Index, respectively.
STATISTICAL ANALYSIS USED: Karl Pearson's correlation coefficient was used to analyze the correlation between shoulder ROM and neck pain and neck function.
RESULTS: Correlation between shoulder ROM with neck pain and neck function showed a negative correlation, with r = −0.665, r = −0.537, r = −0.282, and r = −0.650, r = −0.639, r = −0.550 (P < 0.05) which is statistically significant.
CONCLUSIONS: The present study concludes that there is a significant relation between shoulder ROM (abduction, internal rotation, and external rotation) with neck pain and neck function.
Keywords: Mechanical neck pain, neck function, shoulder range of motion
|How to cite this article:|
Priya S, Haripriya S, Arjun A. Relationship between shoulder range of motion and neck pain and neck function among college students with mechanical neck pain. Physiother - J Indian Assoc Physiother 2021;15:81-4
|How to cite this URL:|
Priya S, Haripriya S, Arjun A. Relationship between shoulder range of motion and neck pain and neck function among college students with mechanical neck pain. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2022 May 21];15:81-4. Available from: https://www.pjiap.org/text.asp?2021/15/2/81/337723
| Introduction|| |
Mechanical neck pain is defined as pain in the anatomical region of the neck, and to date, the specific pathological cause of pain is not determined. The pain can be felt locally in the neck and also in the arms or shoulders. Reported 1-year prevalence of neck pain among nursing and physiotherapy students ranged from 34.6% to 54.8%, which may be related to their manual handling of patients during their clinical placements, long training hours, or even discipline-related stress as observed in graduate students., Students put themselves through hours of intense study, reading, writing, and computer, and as a result, they are a high-risk group for neck pain. Hence, this study aims to find out the relationship between shoulder range of motion (ROM) and neck pain and function among college students.
There is a substantial link between neck pain and upper limb impairment. Neck pain that is not particular has been demonstrated to have a significant influence on upper limb function. A survey of the UK patients with mechanical neck pain found that 67% presented with associated upper limb symptoms without neurological deficit. The anatomical relationship between the cervical region and the shoulder has been the focus of previous studies. Among the published literature, Ishikawa et al. highlighted the trapezius muscle as an important common structure in the shoulder and cervical dysfunctions. Kim et al. identified a moderate correlation between scapular asymmetry and pain intensity in patients with mild neck pain was identified. In a clinical trial conducted by Lee found that shoulder stabilization exercises reduce pain and increase function in patients with neck pain, supporting the relationship between the cervical region and the scapular and shoulder muscles. The anatomical and physiological hypotheses to explain the influence of the neck region on the shoulder are mainly related to the muscular and myofascial connections between these two regions. Hence, the present study aims to investigate if there is any correlation between neck pain and neck function and shoulder joint ROM among college students with mechanical neck pain.
| Subjects and Methods|| |
Study design and recruitment of patients
An observational cross-sectional study was conducted in a tertiary hospital, southern India. The study was approved by the Institutional Ethical Committee. Thirty-five participants with mechanical neck pain (sample size calculated using 80% study power and 95% confidence interval [CI]) fulfilling inclusion and exclusion criteria were recruited using the convenience sampling technique. Young adults (18–25 years) with subacute and chronic mechanical neck pain were included in this study. Patients having acute onset neck pain, symptomatic herniated disc or radiculopathy, under analgesic medication, recent fractures, and history of any surgery on the head, face, neck, or medically unstable were excluded from the study. All participants were verbally explained about the study in brief and then were recruited in the study after written consent.
Baseline data and outcome measures
Age, weight, height, and duration of neck pain were noted. Subjectively, perceived neck pain was measured using the Visual Analog Scale (VAS), neck function was assessed using Neck Disability Index (NDI), and ROM was measured using a universal goniometer. All the outcome measures have good reliability and validity.
Participants were selected according to the inclusion and exclusion criteria. Participants were asked to fill the scales: NDI and VAS, before the assessment begins. Participants who have score 5 or more in NDI and a score of 5 or more in VAS, respectively, were recruited. Arm squeeze test was performed on each participant to rule out cervical radiculopathy and participants with a positive arm squeeze test were excluded from the study. Thirty-five participants were selected. The experimental procedure was explained to the participants before taking the consent. Shoulder ROM was evaluated in the selected participants. During arm movements, rotator cuff muscles contract and prevent sliding of the head of the humerus and allow full ROM and provide stability. The movements facilitated by the rotator cuff are shoulder abduction, internal rotation, and external rotation. Shoulder joint abduction, internal rotation, and external rotation were measured using a universal goniometer.
Data were analyzed using SPSS v. 20.0 (IBM SPSS statistics ver. 20.0 ( IBM Co., Armonk, NY, USA). Karl Pearson correlation coefficient test was used for correlation analysis between shoulder ROM with neck pain (VAS) and neck function (NDI). Data were analyzed at a 95% CI, 80% power, and a P ≤ 0.05 was considered statistically significant.
| Results|| |
Thirty-five college students, 13 male and 22 female participated in the study.
Correlation analysis between ROM and VAS showed a negative correlation with r = −0.665 (P < 0.05) for the ROM in abduction and r = −0.537 (P < 0.05) for the ROM in external rotation and r = − 0.282 (P < 0.05) for the ROM in internal rotation. In the correlation analysis between ROM and NDI r = −0.650 (P < 0.05) for ROM in abduction, r = −0.0639 (P < 0.05) for the ROM in external rotation, and r = −0.550 for the ROM in internal rotation. Thus, the results show a negative correlation between shoulder ROM and neck pain and neck function [Table 1].
|Table 1: Correlation among shoulder range of motion, neck pain, and neck function|
Click here to view
| Discussion|| |
The present study intended to find out the relationship between shoulder ROM and neck pain and neck function among college students with mechanical neck pain. All the 35 participants in the study were assessed, and shoulder joint ROM of external rotation, internal rotation, and abduction was measured using a goniometer. A significant negative correlation between neck pain and shoulder joint ROM in abduction and external rotation was found in the participants. Several mechanisms reported in previous studies can explain the aforesaid findings. Many previous studies have demonstrated that neck pain can induce restriction in shoulder movements. A cross-sectional study conducted by da Silva et al. showed that chronic neck pain is related to changes in functional performance and flexibility of the shoulder. The greater the neck pain intensity and catastrophizing, the lower the functional performance, and lateral rotation ROM of the shoulder. Shin et al. conducted a study to find out correlations among VAS, NDI, shoulder joint ROM, and muscle strength in young women with forward head posture. There was a strong negative connection between neck pain and external rotation ROM in this study. This study found a significant negative relationship between neck pain and outer rotation ROM.
Thirty-five young adults, both male and female in the age group of 18–25 years were selected for this study. They are a high-risk group for neck pain because students put themselves through hours of intense study, reading, writing, and computer work, smartphone usage, and high level of stress and anxiety. In a cross-sectional survey, Lloyd Long Yu Chan discovered that up to 59.9% of undergraduates have had neck discomfort at some point in their lives, with physiotherapy, general nursing, and arts students having the highest period prevalence estimations of neck pain among all respondents. Smartphone usage induces more neck flexion than visual display terminals prolonged smartphone usage can increase mechanical stress on the cervical spine and altered neck muscle activation patterns, which may lead to neck pain. Neck pain was strongly connected with maintaining the neck in a forward bent posture for an extended period and making repetitive movements in terms of physical job components. Kwon et al. reported that muscle activity in the upper limb is lower with forward head posture compared to normal neck posture. Due to the change in the alignment of the scapula, the muscle activity in the serratus anterior muscle is decreased in people with forward head posture during shoulder flexion or upward movement of the arm over the head.
| Conclusions|| |
The present study concludes that there is a significant relation between shoulder ROM (abduction, internal rotation, and external rotation) with neck pain and function.
Limitations of the study
The limitations of the present study are that it has taken universal goniometer has an instrument to measure shoulder joint ROM were as electronic goniometer would give more specific readings also, we included only college students within the age group of 18–25 years were as mechanical neck pain have a high prevalence in other age groups also, which is not considered in this study.
The authors would like to acknowledge Dr. Manjula Suvarna, Assistant Professor/Statistician for her contribution toward sample size calculation, data analysis, and interpretation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haldeman S, Carroll L, Cassidy D, Schubert J, Nygren A. The bone and joint decade 2000-2010 task force on neck pain and its associated disorders: Executive summary. Spine (Phila Pa 1976) 2008;33:S5-7.
Alshagga MA, Nimer AR, Yan LP, Ibrahim IA, Al-Ghamdi SS, Radman Al-Dubai SA. Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian medical college. BMC Res Notes 2013;6:244.
Gholami T, Pahlavian AH, Akbarzadeh M, Motamedzade M, Moghaddam RH. The role of burnout syndrome as a mediator for the effect of psychosocial risk factors on the intensity of musculoskeletal disorders: A structural equation modeling approach. Int J Occup Saf Ergon 2016;22:283-90.
Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: A systematic review. Pain 1998;77:1-13.
Mc Lean SM, Taylor J. Measuring upper limb disability in non-specific neck pain: A clinical performance measure. Int J Physiother Rehabil 2010;1:44-52.
Ishikawa H, Muraki T, Morise S, Sekiguchi Y, Yamamoto N, Itoi E, et al
. Changes in stiffness of the dorsal scapular muscles before and after computer work: A comparison between individuals with and without neck and shoulder complaints. Eur J Appl Physiol 2017;117:179-87.
Kim SR, Kang MH, Bahng SY, An JK, Lee JY, Park SY, et al
. Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain. J Phys Ther Sci 2016;28:1508-10.
da Silva RM, Bezerra MA, Santos-de-Araújo AD, de Paula Gomes CA, da Silva Souza C, de Souza Matias PH, et al
. Inactive individuals with chronic neck pain have changes in range of motion and functional performance of the shoulder. Physiother Res Int 2018;23:e1739.
Shin YJ, Kim WH, Kim SG. Correlations among visual analogue scale, neck disability index, shoulder joint range of motion, and muscle strength in young women with forward head posture. J Exerc Rehabil 2017;13:413-7.
Chan LL, Wong AY, Wang MH, Cheung K, Samartzis D. The prevalence of neck pain and associated risk factors among undergraduate students: A large-scale cross-sectional study. Int J Ind Ergon 2020;76:169-78.
Kwon JW, Son SM, Lee NK. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci 2015;27:1739-42.