Section: Physical Medicine

and Rehabilitation

Original Research Article EFFECT OF MUSCLE ENERGY TECHNIQUE AND

MCKENZIE EXERCISE IN IMPROVING DISABILITY
AND REDUCING PAIN IN COLLEGE STUDENTS
WITH MECHANICAL NECK PAIN

Received : 10/01/2024
Periyaswamy Jayaseeli1, G.K. Scindia2, Jeyaraj Jeyakhar3, S. Ramya
Received in revised form : 24/02/2024 Malini4
Accepted : 12/03/2024
1
Assistant Professor, Department of Physical Medicine and Rehabilitation Government Vellore
Medical College Hospital, Tamilnadu, India.
Keywords: 2
Assistant Professor, Department of Physical Medicine and Rehabilitation, Madurai Medical
Mechanical neck pain, Muscle Energy
Technique, McKenzie exercise, Visual College, Tamilnadu, India.
3
Analogue Scale, Neck Disability Index. Assistant Professor, Department of Physical Medicine and Rehabilitation, Pudukottai Medical
College, Tamilnadu, India.
4
Corresponding Author: Assistant Professor, Department of Physical Medicine and Rehabilitation, Government Karur
Dr. S.Ramya Malini, Medical College and Hospital, Tamilnadu, India.
Email: [email protected]

DOI: 10.47009/jamp.2024.6.3.161 Abstract

Background: Neck pain is a common problem, with an annual incidence of
Source of Support: Nil,
Conflict of Interest: None declared
approximately 15%. Cervicalgia is another name for neck pain. that students
subject themselves to hours of prolonged reading, writing, and computer work,
Int J Acad Med Pharm making them a high-risk group for neck pain. This study aimed to investigate
2024; 6 (3); 716-720
the effect of the Muscle Energy Technique and McKenzie Exercise on
Students with Mechanical Neck Pain. Material and Methods: This quasi-
experimental research design included 30 patients at the Government Vellore
Medical College and Hospital for one year. Group A received the Muscle
Energy Technique, Group B received the McKenzie exercise, and Group C
received static stretching. Post-test measures were taken after six weeks of
training. The treatment duration was 15-20 minutes per session, with 3
sessions per week for 6 weeks. Results: There was a significant difference in
VAS and NDI scores among the three groups (p<0.05). The post-test mean
value showed improvement in all three groups, with greater improvements
observed in the Muscle Energy Technique group. The VAS and NDI values
were lower in group A than in the other two groups. Conclusion: Our study
shows that these three treatments are effective at reducing pain and disability.
However, Muscle Energy Technique has shown better results in reducing pain
and disability in patients with mechanical neck pain.

INTRODUCTION palpation of the cervical muscles. The source of

symptoms in mechanical neck pain is not
Neck pain is one of the most common completely understood but has been purported to be
musculoskeletal disorders among the general related to various anatomical structures, particularly
population. The point prevalence ranges from 10 to the zygapophyseal or uncovertebral joints of the
22% and up to 38% in the elderly population, while cervical spine. Students subject themselves to hours
the lifetime prevalence ranges from 14.2% to 71%. of prolonged reading, writing, and computer work
Cervicalgia is another name for neck pain. The which puts them at a high risk for neck pain.
International Association for the Study of Pain Aim
defines neck pain as: “Pain perceived as arising This study aimed to investigate the effect of the
from anywhere within the region bounded Muscle Energy Technique and McKenzie Exercise
superiorly by superior nuchal line, inferior by an on Students with Mechanical Neck Pain.
unoriginally transverse line through the tip of the
first thoracic spinous process, and laterally by MATERIALS AND METHODS
sagittal plane tangential to the lateral border of the
neck”. Mechanical neck pain is a generalised neck This quasi-experimental study was conducted on 30
and/or shoulder pain with mechanical students with mechanical neck pain at the
characteristics, including symptoms provoked by Government Vellore Medical College and Hospital,
maintained neck postures, neck movement, or Vellore, for one year. The study was approved by

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ISSN (O): 2687-5365; ISSN (P): 2753-6556
the Institutional Ethics Committee before initiation, Upper Trapezius stretching: Instruct the patient to
and informed consent was obtained from all slowly tilt your head sideways bringing the left ear
patients. towards the left shoulder. They felt a gentle stretch
Inclusion Criteria along the right side of the neck and shoulders. Hold
Students age group 18-23 years (both male and for 10 to 15 seconds, repeat 5 to 10 times, and repeat
female), VAS score (4-8) moderate pain, neck on to the opposite side.
disability index > 10, and neck pain of minimum Muscle Energy Technique: Muscle Energy
duration of the past 3 weeks were included. Technique (MET) was first described by Fred
Exclusion Criteria Mitchell.[1] MET is a soft tissue osteopathic
Students with signs of serious pathology in the neck, manipulation method that incorporates precisely
history of recent surgeries in the previous 12 directed, isometric and isotonic contraction to
months, history of trauma or fractures in the cervical improve musculoskeletal function and reduce pain. 2-
5
spine, signs of cervical radiculopathy, myelopathy, MET can be used to stretch or lengthen muscles
IVDP or thoracic outlet syndrome, signs of and fascia that lack flexibility. MET requires the
cervicogenic headache, signs of myofascial pain patient to create a force by activating the targeted
syndrome, facet joint syndrome, ligament musculotendinous unit against a precisely directed
instability, or malignancies were excluded from the counterforce applied by the therapist, followed by
study. relaxation and passive stretch.
Methods McKenzie exercises: The McKenzie method also
The method of randomisation was that students who called as MDT- Mechanical Diagnosis and Therapy.
reported first, second, and third at our outpatient Intervention component of the McKenzie method. 6-
10
clinic were assigned to Groups A, B, and C, represent the corresponding repeated and/or
respectively, with 10 in each group. sustained flexion and extension movements. The
Group A: Muscle Energy Technique: It involves a McKenzie method uses an approach that includes
post-isometric relaxation technique for the upper postural awareness and repetitive movement with
trapezius and levator scapulae muscles (Figure 1: A the fundamental idea that a converse power can
and B). The therapist takes the agonist muscle to a diminish pain and return functions.
comfortable location before the tension barrier and Stretching Exercises: Stretching involves the
holds the position. The therapist provided equal application of manual or mechanical force to
resistance to the participant contracting the agonist elongate (lengthen) adaptively shortened and
muscle with approximately 30% of their strength, hypomobile structures. Stretching is believed to
for 7-10 seconds. The participant relaxed for provide many physical benefits, including improved
approximately 5 seconds. Upon exhalation, the flexibility, injury prevention, and improved muscle
therapist moved the muscle to a new restriction performance.[11] Promotion of healing, and possibly
barrier with an additional gentle stretch passing it decreased onset of muscle soreness. Static stretching
(without pain), to a new starting point for safety, and involves stretching a muscle to a point of discomfort
to reduce contraction. Furthermore, the participant and holding the stretch for a length of time,
could assist in assuming this position. This position followed by a return to the normal resting muscle
can also be held for 10-60 seconds before the next length.
isometric contraction occurs. This process was Statistical Analysis
repeated three to five times. All data analyses were performed using the
Group B: McKenzie exercise: This included neck computer software SPSS for Windows. All data
retraction, neck flexion, neck retraction and collected were compared using paired ‘t’ test and
extension, retraction and rotation, retraction, and one-way ANOVA technique and ‘F’ test and a p-
lateral flexion (Figure 1: C, D, E, F, G). Each value of 0.05 was considered statistically
exercise was repeated 5-10 times per session and significant.
held for 5–10 s.
Group C: Control group: levator scapula stretching
(Figure 1: H, I). Patient position: sitting upright on a
chair. Rotate your head by 45° to the left. Place your
left hand behind your head and gently pull it at an
angle to the knee. Hold for 10 to 15 seconds, repeat
5 to 10 times, and repeat on to the opposite side.
Stop the movement when you feel a slight sting on
the right side of your neck.
The pre-test scores of the Neck Disability Index
(NDI) and Visual Analogue Scale (VAS) were
recorded. Post-test scores were obtained at the end
of treatment on the Neck Disability Index (NDI) and
Visual Analogue Scale (VAS). The treatment
duration was six weeks.
A

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 B F

G
C

H
D

I
Figure 1: (A) Post-isometric relaxation for upper
trapezius (B) Post-isometric relaxation for levator
E scapulae (C) Neck retraction (D) Neck flexion (E) Neck

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International Journal of Academic Medicine and Pharmacy (www.academicmed.org)
ISSN (O): 2687-5365; ISSN (P): 2753-6556
retraction and extension (F) Retraction and rotation Using the Visual Analogue Scale for Groups A, B,
(G) Retraction and lateral flexion (H) Levator scapula and C, the calculated ‘F’ ratio was 14.643 (Table 2).
stretching (I) Upper trapezius stretching. For 2 and 27 degrees of freedom at a 5% level of
significance, the table ‘F’ ratio was 3.35. The pain
RESULTS was significantly affected by VAS.
Neck Disability Index for Groups A, B, and C, the
This study included 30 patients who were divided calculated ‘F’ ratio was 6.528. For 2 and 27 degrees
into three groups of each 10 patients. of freedom at a 5% level of significance, the table
There was a significant difference in the VAS and ‘F’ ratio was 3.35. There was a significant effect of
NDI scores among the three groups. [Table 1] disability on the NDI. [Table 2]

Table 1: Comparison of VAS and NDI scale between the three groups
Group A Group B Group C P value
Pre-test 77 63 47
VAS scale Post-test 57 51 43 <0.05
Mean difference 20 12 4
Pre-test 200 168 145
NDI scale Post-test 158 154 141 <0.05
Mean difference 42 14 4

Table 2: Tabular presentation of one-way ANOVA for VAS and NDI scale
Source of Variation
One way ANOVA Calculated ‘F’ ratio Table ‘F’ ratio P- value
Between samples Within samples
Sum of Squares 9.87 9.1
VAS scale Degree of freedom 2 27 14.643 3.35 <0.05
Mean square 4.935 0.337
Sum of Squares 9.87 9.1
NDI scale Degree of freedom 2 27 14.643 3.35 <0.05
Mean square 4.935 0.337

DISCUSSION ratio null hypothesis is rejected. Hence, disability

has a significant effect on NDI.
Paired ‘T’ test results show that the pretest and post- The results of this study demonstrated the
test values of the Visual Analogue Scale for Group effectiveness of the Muscle Energy Technique in
A, B and C, for 9 degrees of freedom and at a 5% reducing neck pain and disability compared with
level of significance, the table ‘t’ value is 2.262 McKenzie exercise and conventional treatment.
(Table 1), and the calculated ‘t’ value for a group Recorded values were analysed using a paired t-test
are 13.45, 7.292 and 2.430 respectively. Since the and one-way ANOVA, and the results revealed that
calculated ‘t’ value is greater than the table ‘t’ value the three programs relieved neck pain and disability.
null hypothesis is rejected. Hence, there was a One-way analysis of variance was used to determine
significant effect on VAS in all groups. The pretest group differences ANOVA was used and the results
and post-test values of the Neck Disability Index for showed that there was a significant difference
Group A, B and C are using paired ‘T‘ test, For 9 between the groups. Students who received the
degrees of freedom and at a 5% level of Muscle Energy Technique showed greater
significance, the table ‘t’ value is 2.262 (Table 1), improvement when compared to the students who
and the calculated ‘t’ value for a group are 16.797, received the McKenzie exercise and the students
8.674 and 2.478 respectively. Since the calculated who received levator scapulae stretching and upper
‘t’ value is greater than the table ‘t’ value null trapezius stretching.
hypothesis is rejected. Hence, there was a significant
effect of all groups on the NDI. CONCLUSION
The results of one-way ANOVA showed that the
Visual Analogue scores for Groups A, B, and F’ In conclusion, these three treatments are effective in
were 14.643 (Table 2). For 2 and 27 degrees of reducing pain and disability. However, the muscle
freedom at the 5% level of significance, the table ‘F’ energy technique has shown better results in
ratio was 3.35. Since the calculated ‘F’ ratio is more reducing pain and disability in patients with
than the table value ‘F’ ratio null hypothesis is mechanical neck pain.
rejected. Hence, there was a significant effect of Limitations
pain on the VAS. This study focused only on the upper trapezius and
Neck Disability Index for Groups A, B, and C, the levator scapula to decrease pain and disability.
calculated ‘F’ ratio was 6.528 (Table 2). For 2 and Other accessory muscles around the neck could not
27 degrees of freedom at the 5% level of be considered due to lack of time. Students who
significance, the table ‘F’ ratio was 3.35. Since the participated in this study were between the age
calculated ‘F’ ratio is more than the table value ‘F’

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