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Article

Post-Isometric Relaxation versus Self-Stretching for Non-Specific Neck Pain in Working-Age Individuals

by
Vilma Dudonienė
1,*,
Kornelija Mikalajūnė
1,
Aistė Pažėrienė
1 and
Laura Žlibinaitė
2
1
Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania
2
Department of Rehabilitation, Kauno Kolegija Higher Education Institution, Muitines 15, LT-44280 Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(16), 7000; https://doi.org/10.3390/app14167000
Submission received: 25 June 2024 / Revised: 30 July 2024 / Accepted: 8 August 2024 / Published: 9 August 2024
(This article belongs to the Special Issue Exercise, Fitness, Human Performance and Health)
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Versions Notes

Abstract

:
The study aimed to investigate the effectiveness of post-isometric relaxation (PIR) compared to self-stretching (SS) in working-age individuals with chronic non-specific neck pain. A parallel-group study was conducted with 50 patients who were randomized to either the self-stretching (SS, n = 25) or post-isometric relaxation (PIR, n = 25) group and received interventions three times a week for four weeks. In addition to these interventions, all patients were prescribed transcutaneous electrical nerve stimulation (TENS). Outcome measures were neck pain, the neck disability index (NDI), hand grip strength (HGS), and cervical spine range of motion (ROM). Data were collected at baseline and after four weeks of outpatient rehabilitation. Repeated measures ANOVA was used to determine within-group differences, and an independent t-test compared between-group differences. There were no significant differences between the groups at baseline in neck pain intensity. Following both interventions, pain intensity and functional disability decreased, cervical spine ROM increased, and HGS improved (p < 0.05). Between-group analysis showed that participants in the PIR group achieved lower pain intensity (p = 0.032, Cohen’s d = 0.81), greater neck extension ROM (p = 0.001, Cohen’s d = 0.96), and lower neck disability index (p = 0.004, Cohen’s d = 0.85) compared to the SS group. In conclusion, both PIR and SS interventions effectively reduced neck pain, increased range of motion, and decreased the neck disability index in working-age individuals. Neither technique showed superiority in increasing neck ROM and HGS. However, PIR was superior to SS in reducing neck pain and NDI, indicating potential benefits from integrating these interventions during treatment sessions.

1. Introduction

Non-specific neck pain is an increasing health concern among the working-age population [1]. Almost two-thirds of the global population experience neck pain at least once in their lifetime [2], making it the third most burdensome condition among musculoskeletal disorders [3]. Neck pain imposes a significant social and economic burden [4], increasing societal costs and reducing work productivity [5,6]. In most cases, the cause of the pain cannot be pinpointed, thus defining the condition as non-specific neck pain [7]. The pain localization is in the posterior neck region, between the superior nuchal line and the spinous process of the first thoracic vertebra [8].
Many modern professions and occupations require workers to maintain constant sitting or standing positions, affecting their health [9], especially when occupational activities involve a forward-tilted neck [10]. Sitting at work for more than 95% of the working time is considered a risk factor for developing neck pain [11]. Moreover, long working hours with few breaks limit workers’ physical activity [6].
Various treatment protocols are utilized for work-related neck pain [12]. Evidence-based physiotherapy recommends combining manual therapy, exercise, and education [13]. Although a systematic review analyzing 40 articles concluded that there is no single superior type of physical exercise for people with chronic non-specific neck pain [14], different interventions such as manual therapy techniques [15], TENS [16], massage or laser treatments [17], cervical traction [18], as well as stretching, strengthening, endurance training, aerobic conditioning, and cognitive-affective elements [19] may be included in treatment protocols. Additionally, there is strong evidence that for chronic neck pain, mobilization does not need to be applied at the symptomatic level for improvement [8]. Although home-based programs are low-cost and feasible, training adherence is often low [20]. A statistically significant decrease in pain was shown after the self-stretching interventions [21]. Furthermore, it is seen that a stretching exercise program performed regularly for four weeks may decrease neck and shoulder pain and improve neck function and quality of life in office workers suffering from chronic neck pain [22]. Performing stretching exercises can help increase muscle flexibility and endurance [23]. Some studies show that patients with non-specific neck pain can benefit from muscle energy techniques, such as post-isometric relaxation [24]. It is suggested to include post-isometric relaxation in the treatment of non-specific chronic neck pain in individuals with a forward head posture [25].
TENS is a therapeutic strategy that can be proposed to alleviate chronic neck pain [26]. The mechanism of pain relief mediated by low-frequency TENS includes promoting endorphin release, leading to vasodilation in the injured tissue [27]. The use of TENS in combination with other therapies allows patients to increase their activity levels and improve function [27]. However, the clinical efficacy of post-isometric relaxation (PIR) and self-stretching (SS) in addition to TENS remains unclear. This study was conducted to explore the effect of post-isometric relaxation combined with TENS compared to self-stretching combined with TENS for working-age patients complaining of chronic non-specific neck pain.

2. Materials and Methods

2.1. Ethical Considerations and Study Design

The study protocol was approved by the Bioethics Committee (No. MI-KIN(M)-2023-636, dated 11 August 2023) of the Lithuanian Sports University and has been registered at ClinicalTrials.gov with the clinical trial registry number NCT06200064. All participants were thoroughly informed about the study’s essence and agreed to participate by signing an informed consent form. The study was conducted in accordance with the Declaration of Helsinki Ethical Principles and Good Clinical Practices.
This study was a 4-week, single-blinded, randomized controlled trial with a pre-post design, comparing two parallel supervised outpatient groups: one combining TENS with post-isometric relaxation (PIR group; n = 25) and the other combining TENS with self-stretching (SS group; n = 25). The study participants were given a number (from 1 to 62) based on the order of their examination and using a random sequence generator (random.org, accessed on 30 July 2024) were allocated into two groups. This trial was conducted at a Physical Medicine and Rehabilitation center.

2.2. Participants

A consecutive sample of patients diagnosed with neck pain by general practitioners was recruited. The inclusion criteria were individuals aged between 30 and 45 years (1), experiencing chronic (>3 months) non-specific idiopathic, non-traumatic neck pain (2) with a numeric pain rating scale (NPRS) score greater than 3 points (3) [28] and those employed in any job (4). The exclusion criteria included neck pain-related neurological disorders, night pain, severe muscle spasms, involuntary weight loss, symptom mismatch, previous neck surgery, low back pain, use of pain medications, neck pain associated with movement coordination impairments, neck pain accompanied by headaches, neck pain with radiating pain [19], congenital deformities, fibromyalgia [29], and contraindications to TENS [26]. Patients who agreed to participate in the study underwent an evaluation by an experienced physiotherapist who conducted the interview and physical examination of all study participants before the interventions in the first part of the day and the same day after the 12th intervention. A second physiotherapist, blinded to the results of the first examination, performed the interventions.
After the initial evaluation, 62 participants with chronic non-specific neck pain were selected. However, 12 participants were excluded for reasons such as not meeting the inclusion criteria, declining to participate, or other unspecified reasons. The flow of participants is presented in the CONSORT flow chart (Figure 1).

2.3. Outcome Measures

2.3.1. Primary

Pain intensity. Neck pain intensity was assessed using an 11-point numeric pain rating scale (NPRS) scored from 0 to 10, where 0 represents no pain and 10 represents the worst pain imaginable. Patients were asked to rate their average pain over the previous week [30]. The NPRS is known to have moderate reliability (intraclass correlation coefficient (ICC) = 0.67 [0.27–0.84]) in neck pain. The minimal detectable change (MDC) is 2.6 [28], and the minimal clinically important difference (MCID) has been identified as 2 points [31].

2.3.2. Secondary

Neck disability index (NDI). The questionnaire consists of 10 items, each scored from 0 to 5. The total score is interpreted as a percentage, where 0 points or 0% indicates no activity limitation, and 50 points or 100% indicates complete activity limitation. The NDI is a reliable and valid tool for assessing patients with neck pain, with intraclass correlation coefficients ranging from 0.50 to 0.98. Patients scoring between 0–4 points (0–8%) are considered to have no disability, 5–14 points (10–28%) mild disability, 15–24 points (30–48%) moderate disability, 25–34 points (50–64%) severe disability, and 35–50 points (70–100%) complete disability [32]. The minimum detectable change (MDC) and the minimal clinically important difference (MCID) on the NDI are 8.4 and 3.5 points, respectively [33].
Cervical spine range of motion (ROM). ROM was measured using a bubble inclinometer. For neck flexion and extension, the inclinometer was placed on the top of the patient’s head along the sagittal plane while the patient was seated. Lateral flexion was assessed from the same starting position. The inclinometer was placed on the frontal plane atop the patient’s head. For neck rotations to the left and right, measurements were taken from the supine body position; the inclinometer was placed on the forehead. The reading of the inclinometer was set to 0 at the starting position. ROM readings were taken at the endpoint of movement. In this study, the average of three measurements [34,35] was considered for each movement and used for analysis.
Hand grip strength. Grip strength was measured using a Saehan SH5001 hand dynamometer (SAEHAN Corporation, Eschborn, Germany). Measurements for both the dominant and non-dominant hands were taken with the individual seated, while the shoulder was in neutral rotation and adduction, and the elbow was bent at 90 90-degree angle. The patient’s wrist and forearm were in a neutral position. The maximum grip strength was recorded in kilograms (kg). Three measurements were taken. There was 60 s break between trials. For analysis, the average result was taken [36].

2.4. Interventions

The participants were randomized into two groups: the TENS with PIR group (n = 25) and the TENS with SS group (n = 25). The duration of the interventions for both groups was 4 weeks, with sessions occurring 3 times per week, totaling 12 sessions. Each session lasted 50 min. Participants were requested not to take any analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) during the study period to avoid the potential analgesic effects of these medications.
TENS. Each treatment session began with TENS, utilizing the Chattanooga Primera stimulator (DJO Consumer LLC, London, UK). The program selected was “Pain Relief” with the “ENDORPHINIC” setting, lasting 20 min, at a frequency of 5 Hz and a pulse width of 250 μs [37,38]. Two-channel electrodes were employed, and placed over the upper part of the trapezius muscle. The electrodes were positioned on both sides of the spine, 2–5 cm away from the spinal column. The distance between the lateral edges of the upper and lower electrodes was maintained at no less than 5 cm (Figure 2) [26].
Static self-stretching. Static neck muscle self-stretching exercises were supervised by experienced physiotherapists at the Physical Medicine and Rehabilitation Center and performed for 30 min following the TENS procedure. Patients in standing position were instructed to perform neck flexion, extension, lateral flexion, and rotation to the right and left, side bending combined with rotation to stretch the muscles in the cervical region until the onset of mild discomfort and holding each position for 30 s with a 15 s rest between stretches. The sequence of neck movements was repeated three times with a 10 s rest between repetitions [39,40]. No additional aids were used, but to enhance the stretching, patients were asked to change the position of their arms during the movements. First, movements to the asymptomatic side were performed.
Post-isometric relaxation. In this study, one of the autogenic inhibition techniques, post-isometric relaxation (PIR), also known as the “contraction-relaxation” technique, was employed. Depending on the targeted muscle group, the patient was seated, standing, or lying down, and instructed to exert resistance by pressing their head in the specified direction (at 50% of their maximum force) against the resistance provided by the therapist. During the pressing phase, resistance was sustained for 10 s, followed by a passive stretch (10 s duration) of the muscle in the opposite direction of movement. A total of five repetitions were conducted for each neck movement, with a 15 s rest interval between each repetition. All movements were executed without eliciting pain exceeding moderate intensity [41].
All applied interventions were well tolerated by the study participants, and there were no dropouts.

2.5. Statistical Analysis

The statistical analysis was performed using IBM-SPSS Statistics 26 software (IBM Corp., Armonk, NY, USA). Data are presented as mean, standard deviation, and percentage. A statistical power analysis (software package G*Power 3.0) before the initiation of the study indicated that a total number of 40 participants (20 participants in each group) would yield adequate power (>0.85) and a level of significance (<0.05). The numbers were increased to 25 participants per group to account for potential dropouts [42]. Normal distribution of data was assessed using the Kolmogorov–Smirnov test, and all data were found to be normally distributed. Group comparisons at baseline were performed using Student’s t-test for continuous variables and the chi-square test for categorical variables. Two-way analyses of variances (2-way ANOVA) (2 groups [SS and PIR] × 2-time points [pre and post-intervention]) with repeated measures were applied to calculate the significantly different means within and between groups. If a significant interaction of time × group was observed, paired t-tests were used to examine within-group changes, and independent t-tests were conducted to compare between-group differences between the SS and PIR groups. The level of significance was set at p < 0.05. The Pearson test was used for correlations. Since the p-value alone is insufficient to determine the effect of the intervention, the size of the change in outcomes was examined using Cohen’s d effect sizes, with the following interpretations: 0.0–0.2 indicating a small effect, 0.5–0.7 a medium effect, and 0.8–2.0 a large effect.

3. Results

Only patients with chronic neck pain lasting more than three months were recruited for this study. The duration of pain among participants varied from 12 to 32 weeks, with an average duration of 18.4 weeks. The final analytical study sample consisted of a total of 50 participants.
Both groups were homogeneous in terms of age, body height, weight, body mass index, and sex. At baseline, there were no significant differences between the groups in pain intensity, pain duration, NDI, and hand grip strength. Baseline characteristics are provided in Table 1. The mean age of patients was 37.42 ± 4.80 years. The frequency and percentage of female patients were higher than male patients; furthermore, 78% of study participants were aged between 30–40 years and only 22%—between 40–45.
Analysis of the nature of participants’ work revealed that 46% had sedentary jobs, 26% worked in standing service positions, 18% were in roles requiring constant cervical spine movements, and 10% performed tasks requiring high concentration and precision with small materials.

3.1. Primary Outcome

In both groups, pain intensity measured by NPRS was severe before the interventions. Repeated measures analysis of variance (ANOVA) revealed a significant effect of time (F [1, 48] = 185.191, p = 0.000, η = 0.794) and a time × group interaction (F [1, 48] = 4.759, p = 0.034, ƞ2p = 0.090). Subsequent analysis showed that while both interventions significantly reduced pain (p = 0.000), pain reduction was higher in the PIR group compared to SS (p = 0.032, Cohen’s d = 0.81 large effect size) (Table 2).

3.2. Secondary Outcomes

Table 2 demonstrates the pre- and post-intervention values of cervical spine ROM, hand grip strength, and neck disability index.
ANOVA of the ROM values revealed significant time effects on neck flexion, extension, lateral flexion, and rotation (p = 0.000), but a significant time × group interaction effect was revealed only on neck extension, F (1, 48) = 4.846, p = 0.033, ƞ2p = 0.092. Subsequent analysis showed that both interventions significantly increased neck extension ROM (p = 0.000), but post-intervention values were significantly higher in the PIR group vs. the SS group (p = 0.001, Cohen’s d = 0.96 large effect size). There was also a group effect on ROM of neck flexion (F [1, 48] = 9.659, p = 0.003, ƞ2p = 0.168), lateral flexion to symptomatic side (F [1, 48] = 4.241, p = 0.045, ƞ2p = 0.081), and rotation to symptomatic side (F [1, 48] = 4.770, p = 0.034, ƞ2p = 0.090).
ANOVA of the hand grip strength revealed a significant effect of time (F [1, 48] = 19.360, p = 0.000, ƞ2p = 0.380 for dominant hand; F [1, 48] = 29.670, p = 0.000, ƞ2p = 0.382 for non-dominant hand), but no significant time × group interaction was observed.
ANOVA of the neck disability index values revealed a significant effect of time (F [1, 48] = 2025.000, p = 0.000, ƞ2p = 0.878) and time × group interaction (F [1, 48] = 158.760, p = 0.000, ƞ2p = 0.360). Subsequent analysis showed that both interventions significantly improved neck disability (p = 0.000), but post-intervention values were significantly lower in the PIR group vs. the SS group (p = 0.004, Cohen’s d = 0.85 large effect size).
As shown in Figure 3, the effect sizes of both interventions on outcome measures were quite similar. A large effect size was determined for almost all variables, except for rotation to the asymptomatic side (moderate effect size in both groups) and hand grip strength.

4. Discussion

This study aimed to compare the effectiveness of PIR and SS and to determine which intervention, in addition to TENS, was most effective in reducing neck pain, disability index, and increasing cervical spine movements in working-age patients with chronic non-specific neck pain. All study participants received 12 treatment sessions within a four-week period at the outpatient rehabilitation center.
A literature review from 2022 [5] revealed that the burden of neck pain is higher in females than in males, with the highest prevalence occurring between the ages of 45 and 54. However, in the current study, the majority of subjects reporting neck pain were between 30 and 40 years of age, and most patients were women. Our data align with the findings of Wollesen et al. [43], who found that women, particularly those aged 30 to 39 years, are more likely to complain of neck pain.
Non-specific neck pain is prevalent among individuals with sedentary jobs, low levels of physical activity, and occupations requiring constant neck movements. Additionally, even in healthy populations, prolonged static postures can lead to neck pain and discomfort over time [44]. Physical inactivity at work was also noted in this study, as the subjects were engaged in prolonged static positions.
In this study hand grip strength (HGS) was expected to be decreased in response to neck pain. As expected, HGS was reduced, and the strength of the non-dominant hand was significantly lower than that of the dominant hand in both groups. A decrease in HGS may be observed as a consequence of manual work. Office workers tend to have weak grips and a great difference between sides [45]. Furthermore, a decrease in hand grip strength (HGS) was observed when measurements were taken with the wrist in flexed or extended positions, as opposed to a neutral position. Additionally, differences in HGS were noted between sitting and standing postures [46,47]. These variations were attributed to changes in muscle length in flexed and extended positions, resulting in reduced muscle strength. The study by Amin et al. [48] showed that not only wrist positions influence HGS. HGS is significantly lower in flexed, extended, side-bent, or rotated head positions compared to that in neutral positions [48]. Furthermore, non-ergonomic neck postures and the subsequently increased neck muscle tension may provoke cervical nerve root compression, as well as neck pain and headaches [49]. Nerve root irritation in the cervical spine between C5 and C6 may be caused by prolonged and repetitive neck flexion, and this may cause neck pain and potential neurological symptoms along the median nerve [50].
In the current study both interventions significantly reduced neck pain and NDI, but between-group analysis revealed that pain and NDI reduction in the PIR group was significantly higher compared to the SS group. The physiological mechanisms underlying the therapeutic effects of PIR may involve a variety of neurological and biomechanical mechanisms, including hypoalgesia, altered proprioception, motor programming and control, and drainage of tissue fluid congestion [51].
The comparison of cervical ROM within both groups showed significant improvement in all six movements measured and was close to the anatomical ROM of a healthy individual. This might be explained by increases in viscoelastic properties in neck muscles [52]. However pairwise comparison between groups did not show significant differences.
In this study, patients were instructed to stretch the muscles of the cervical spine until they felt mild discomfort and to hold that position for 30 s. Stretching for this duration can help minimize negative effects on the neural function of the affected nerve roots. Longer durations of stretching might negatively impact the neurophysiological properties of the involved nerves. These findings can help optimize stretching duration to achieve the desired benefits while avoiding adverse effects on neural function [53].
With respect to Cohen’s effect size (d), this study found that for both primary and secondary outcome measures, PIR was superior to SS, as PIR showed higher improvements in eight out of ten outcome measures.
The study has several limitations. Firstly, the sample size is relatively small, limiting the ability to draw generalized conclusions. Secondly, the results were not analyzed by gender, which could affect the distribution of outcomes due to differences in ROM and muscle strength between men and women. However, notable strengths of the study include the implementation of parallel groups and a four-week intervention period. Based on the findings of this study, a recommendation can be made to consider integrating TENS, PIR, and SS for clinical practice.

5. Conclusions

Both interventions led to a significant reduction in neck pain and the neck disability index (NDI), as well as improvements in neck range of motion (ROM) and hand grip strength (HGS). However, post-isometric relaxation (PIR) combined with TENS was superior to self-stretching (SS) combined with TENS in reducing neck pain and NDI. No significant differences were observed between the groups regarding improvements in HGS and ROM.
In clinical practice, for individuals with chronic non-specific neck pain, a combination of transcutaneous electrical nerve stimulation (TENS), PIR, and SS may be considered as they are safe and effective for pain and disability in short-term. Patients could receive TENS and PIR treatments in a clinical setting, while independently performing SS exercises at home. This approach aims to optimize therapeutic outcomes and provide patients with comprehensive care for managing chronic non-specific neck pain effectively.

Author Contributions

Conceptualization, V.D. and K.M.; methodology, L.Ž.; software, L.Ž.; validation, L.Ž., A.P. and K.M.; formal analysis, L.Ž.; investigation, K.M.; resources, A.P.; data curation, V.D.; writing—original draft preparation, V.D.; writing—review and editing, A.P.; visualization, V.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Bioethics Committee of Lithuanian Sports University (No. MI-KIN(M)-2023-636, dated 11 August 2023). The study is registered at ClinicalTrials.gov with the clinical trial registry number NCT06200064.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author. The data are not publicly available to protect the participants’ confidentiality.

Acknowledgments

The authors wish to thank all the study participants.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 14 07000 g001
Figure 1. CONSORT flow chart.
Figure 1. CONSORT flow chart.
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Figure 2. TENS electrode placement for neck pain.
Figure 2. TENS electrode placement for neck pain.
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Figure 3. Comparison of Cohen’s d effect size values between the groups. Abbreviations: NPRS, numeric pain rating scale; NDI, neck disability index; SS, self-stretching; PIR, post-isometric relaxation.
Figure 3. Comparison of Cohen’s d effect size values between the groups. Abbreviations: NPRS, numeric pain rating scale; NDI, neck disability index; SS, self-stretching; PIR, post-isometric relaxation.
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Table 1. Characteristics of the participants at baseline.
Table 1. Characteristics of the participants at baseline.
CharacteristicsSS Group
(n = 25)		PIR Group
(n = 25)		Between-Group Comparison
p-Value
Age, yrs.37.72 ± 5.2337.12 ± 4.410.663
Height, cm176.08 ± 9.72175.52 ± 10.660.847
Weight, kg69.87 ± 10.2368.59 ± 10.110.658
Body mass index, kg/m222.42 ± 1.6822.15 ± 1.730.580
Women, n (%)15 (60%)18 (72%)0.551
Pain, NPRS score6.12 ± 1.726.00 ± 1.660.803
Pain duration, weeks18.52 ± 5.0918.80 ± 4.390.836
Dominant handgrip strength, kg23.96 ± 6.6023.64 ± 6.770.866
Non-dominant Handgrip strength, kg20.12 ± 5.8019.72 ± 4.910.723
Neck disability index, %30.32 ± 7.1830.88 ± 7.050.782
Abbreviations: NPRS, numeric pain rating scale.
Table 2. Pain intensity, cervical spine range of motion, hand grip strength, and neck disability index values in the groups pre- and post-interventions (mean ± SD).
Table 2. Pain intensity, cervical spine range of motion, hand grip strength, and neck disability index values in the groups pre- and post-interventions (mean ± SD).
VariableSS Group
(n = 25)		PIR Group
(n = 25)
PrePostMean DifferencePrePostMean Difference
NPRS score6.12 ± 1.723.92 ± 1.192.20 ± 1.55 *6.00 ± 1.662.96 ± 1.813.04 ± 1.14 *#
Flexion (°)32.84 ± 2.8738.88 ± 2.576.04 ± 2.09 *34.80 ± 2.8941.52 ± 2.796.72 ± 1.65 *
Extension (°)37.08 ± 4.6544.52 ± 3.897.44 ± 3.75 *37.40 ± 4.8347.64 ± 2.4610.24 ± 5.13 *#
Lateral flexion to symptomatic side (°)26.24 ± 4.1735.04 ± 2.618.80 ± 3.83 *27.04 ± 3.7437.36 ± 2.3310.32 ± 3.87 *
Lateral flexion to asymptomatic side (°)36.20 ± 1.8038.04 ± 2.641.84 ± 3.85 *36.44 ± 1.3638.92 ± 1.412.48 ± 1.53 *
Rotation to symptomatic side (°)56.44 ± 3.7362.96 ± 3.016.52 ± 4.11 *57.28 ± 3.6365.52 ± 2.608.24 ± 2.89 *
Rotation to asymptomatic side (°)64.36 ± 2.6065.84 ± 2.761.48 ± 1.81 *63.04 ± 3.4164.76 ± 2.671.72 ± 2.32 *
Handgrip strength, dominant hand (kg)23.96 ± 6.6024.80 ± 6.670.84 ± 1.25 *23.64 ± 6.7724.48 ± 6.950.84 ± 1.18 *
Handgrip strength, non-dominant hand (kg)20.12 ± 5.8020.76 ± 5.460.64 ± 1.22 *19.72 ± 4.9120.48 ± 5.150.76 ± 1.74 *
Total NDI score30.32 ± 7.1823.84 ± 5.836.48 ± 3.53 *30.88 ± 7.0519.36 ± 4.6511.52 ± 3.33 *#
Note: *—p < 0.05 indicates significance between pre- and post-interventions within groups. #—p < 0.001 indicates significance between groups post-interventions. Abbreviations: NPRS, numeric pain rating scale; NDI, neck disability index; SS, self-stretching; PIR, post-isometric relaxation.
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Dudonienė, V.; Mikalajūnė, K.; Pažėrienė, A.; Žlibinaitė, L. Post-Isometric Relaxation versus Self-Stretching for Non-Specific Neck Pain in Working-Age Individuals. Appl. Sci. 2024, 14, 7000. https://doi.org/10.3390/app14167000

AMA Style

Dudonienė V, Mikalajūnė K, Pažėrienė A, Žlibinaitė L. Post-Isometric Relaxation versus Self-Stretching for Non-Specific Neck Pain in Working-Age Individuals. Applied Sciences. 2024; 14(16):7000. https://doi.org/10.3390/app14167000

Chicago/Turabian Style

Dudonienė, Vilma, Kornelija Mikalajūnė, Aistė Pažėrienė, and Laura Žlibinaitė. 2024. "Post-Isometric Relaxation versus Self-Stretching for Non-Specific Neck Pain in Working-Age Individuals" Applied Sciences 14, no. 16: 7000. https://doi.org/10.3390/app14167000

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