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Effectiveness of McKenzie approach
and segmental spinal stabilization
exercises on neck pain in individuals
with cervical postural syndrome: An
experimental study
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DOI:
10.4103/jehp.jehp_239_23 Rutuja R. Avaghade, Sandeep B. Shinde1, Sayalee B. Dhane1

Abstract:
BACKGROUND: This study “Effectiveness of Mckenzie approach and segmental spinal stabilization
exercises on neck pain in individuals with cervical postural syndrome: an experimental study” was
conducted to study and find the effectiveness of Mckenzie approach and segmental spinal stabilization
exercises on reduction of pain, correction of rounded shoulder, and disability. Pain, disability, and
rounded shoulders are the major limiting factors as it affects the quality of life and reduces efficiency
and social participation.
MATERIALS AND METHODS: The study was conducted among 120 individuals with cervical postural
syndrome, and fulfilling the inclusion and exclusion criteria was included. The outcome measures
were Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Vernier caliper to evaluate pain,
functional disability, and rounded shoulder, respectively. Subjects were randomly divided into two
groups, Group A and Group B, by using SPSS software. Interventional training was given for 6 weeks
to the patients. Group A subjects were given spinal stabilization exercises. Group B subjects were
given Mckenzie approach. The statistical analysis was performed using SPSS; pre‑test and post‑test
were used to calculate the results, followed by data presentation and analysis.
RESULT: The result showed that at the end of the 6 weeks on comparison between pre‑ and
Department of
post‑intervention of Group A and Group B, both the techniques were effective, but group B was
Physiotherapy, Krishna
significantly effective than Group A.
Institute of Medical
Science, Deemed CONCLUSION: It was noted that McKenzie approach and segmental spinal stabilization exercises
to be University, were effective on neck pain in individuals with cervical postural syndrome, but on comparing both
Karad, Maharashtra, techniques, Mckenzie protocol is more beneficial than segmental spinal stabilization exercises. The
India, 1Department of study accepts the alternate hypothesis that there is significant effect of McKenzie approach and
Musculoskeletal Sciences segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome.
Physiotherapy, Krishna Keywords:
Institute of Medical Cervical postural syndrome, Mckenzie approach, neck pain, segmental spinal stabilization exercises
Science, Deemed to
be University, Karad,
Maharashtra, India
Introduction irregularities that predisposes individuals
Address for to pathological diseases like neck pain
correspondence:
Dr. Sandeep B. Shinde,
Department of
N eck pain is a very frequent ailment.
Poor posture can induce muscular
imbalance, resulting in a defective
is forward head posture. “Cervical
postural syndrome” is a very common
uncomfortable and painful postural
Musculoskeletal Sciences
Physiotherapy, Krishna interaction between various body complaint characterized by a protruding
Institute of Medical parts. One of the most common cervical chin and rounded shoulders.[1]
Science, Deemed to
be University, Karad,
This is an open access journal, and articles are
Maharashtra, India. distributed under the terms of the Creative Commons How to cite this article: Avaghade RR, Shinde SB,
E‑mail: drsandeepshinde24 Attribution‑NonCommercial‑ShareAlike 4.0 License, which Dhane SB. Effectiveness of McKenzie approach and
@gmail.com allows others to remix, tweak, and build upon the work segmental spinal stabilization exercises on neck
non‑commercially, as long as appropriate credit is given and pain in individuals with cervical postural syndrome:
Received: 21‑02‑2023 An experimental study. J Edu Health Promot
the new creations are licensed under the identical terms.
Accepted: 07‑04‑2023 2023;12:225.
Published: 29-07-2023 For reprints contact: [email protected]

© 2023 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

Neck pain ranks fourth as a cause of years lived with posture and body mechanics. soft cervical collar which
disability and has a 12‑month prevalence of 30%–50%.[2,3] is an orthopedic device is used to immobilize the neck.
High level prevalence of cervical pain is associated with Spinal manipulation where manual therapy is used to
a high level of neck flexion as well as static and awkward maximize painless movement, reduce muscle tightness,
postures during sitting.[1] The prevalence of neck pain is improve joint mobility, and correct alignment problems
higher in females than in males.[4] Neck muscles have an and hot moist pack.[4]
important role in normal mobility and stability of cervical
spine. The cervical muscles may be the reason of pain Pharmacotherapy treatment includes that systemic
too. Research’s advice that weakness or fatigue of collar nonsteroidal anti‑inflammatory drugs (NSAIDs) have
muscles may be associated to neck pain. Impairment of been found to be beneficial for spinal pain in general.[4]
Deep Cervical Flexors (DCF) as well as superficial and Excessive anterior positioning of the head in relation to
deep extensors of cervical spine in patients with neck pain a vertical reference line is known as front head posture.
Rounded shoulder posture is characterized by acromion
is generally accepted.[5] Postural neck pains can be treated
protraction in front of the line of gravity, shoulder
with long‑term exercises that include stretching exercises,
protraction, and downward rotation, as well as anterior
positional release, isometric and iso‑kinetic strengthening
tilt. Rounded shoulder posture can develop incorrectly
exercises, and postural correction exercises.[1]
owing to a lack of physical activity and poor posture
habits in daily life. Excessive anterior positioning of the
Neck pain can also be considered by mechanisms as
head in relation to a vertical reference line is termed as
mechanical, neuropathic, or secondary to another reason.
forward head posture. The acromion protraction in front
Mechanical pain refers to pain originating in the spine
of the line of gravity, shoulder protraction, downward
or its supporting structures, such as ligaments and
rotation, and anterior tilt are all characteristics of
muscles which further predisposes to poor posture.[4,6] A
rounded shoulder posture.[8]
hyperirritable spot in skeletal muscle that is accompanied
by a hypersensitive palpable nodule in a taut band is The McKenzie technique was announced in Sweden in
known as a myofascial trigger point (MTrP), which 1985 and came to be often used in the 1990 as a treatment
also may play a significant role in the development of modality for patients with mechanical problems of the
mechanical neck pain.[7] Physiotherapy includes, exercise spine. McKenzie exercises, devised by Robin McKenzie,[9]
therapy, traction which is used to relieve pressure on also known as diagnostic and mechanical therapy.[10]
the spine, electrotherapy etc. Active or passive physical Improvement in symptoms is successively measured in
exercises are designed to strengthen or stabilize the spine terms of “centralization,” a phenomenon that has been
that may reduce pain, prevent injuries, and improve commonly used.[11] It combines recurrent end range
actions by examination; the classification of direction
Table 1: Age Distribution for exercise is contingent upon the patient’s response
Age Number of subjects Number of subjects Total to those recurring actions. Posture correction ensuring
Group (Group A) (Group B) the maintaining of the correction is a vital characteristic
30‑35 24 13 37 of the McKenzie exercise.[12] The McKenzie protocol has
36‑40 21 22 43 been commonly used in low back conditions, which
41‑45 15 25 40 may be employed in the treatment of mechanical neck
Interpretation: Table 1 represents three age groups, group 1 complies of
subjects between 30 and 35 years, which consist of total 37 subjects; group 2 pain in three syndromes as postural, dysfunction,
complies of subjects between 36 and 40 years, which consist of total 43 and derangement. Postural syndrome is caused by
subjects; group 3 complies of subjects between 41 and 45 years, which
consist of total 40 subjects
mechanical deformation of soft tissue, as a results of
certain postural stresses. The treatment is correction
Table 2: Gender Distribution
of postural. The dysfunction syndrome is caused by
adaptive shortening of certain structure due to poor
Group A B
Gender Male‑36 Male‑35
postural habits. The derangement syndrome defined as
Female‑24 Female‑ 25
change in the position of intervertebral discs and alters
Interpretation: Table 2 represents that a total of 120 subjects were taken for the position of two adjacent vertebrae. It is treated by
the study. Out of 120 subjects, 71 were males and 49 were females neck retraction exercise.[13]

Table 3: Comparison between pre‑ and post‑test mean scores of VAS (at rest and on activity) between the
group A and group B
Pre (group A) Post (group A) Pre (group B) Post (group B) P
At rest 4.44±0.893 2.18±0.688 5.05 0.714 2.36±0.742 <0.001
On activity 6.18±0.625 2.64±0.882 6.34±0.448 2.72±0.945 <0.001
Interpretation: Above table shows comparison of pre‑ and post‑mean values of VAS score between group A and group B. Both the groups were found to be
statistically extremely significant (P<0.0001)

2 Journal of Education and Health Promotion | Volume 12 | July 2023

 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

Table 4: Comparison between pre‑ and post‑test mean scores of Vernier caliper (right and left) between the
group A and group B
Pre (group A) Post (group A) Pre (group B) Post (group B) P
Right 8.31±0.469 6.11±0.670 8.01±0.436 5.75±0.866 0.0010
Left 8.31±0.474 6.05±0.701 8.02±0.478 5.69±0.816 0.0010
Interpretation: Above table shows a comparison of pre‑ and post‑mean values of Vernier caliper score between group A and group B. Both the groups were found
to be statistically extremely significant (P<0.0001)

Table 5: Comparison between pre‑ and post‑test pain, make the most of function, and progress physical
mean scores of NDI between the group A and impairments for individuals with general neck pain.[24]
group B The concept of postural stabilization was characterized
Pre Post Pre Post P by body oscillations and reflected by center of mass
(group A) (group A) (group B) (group B)
horizontal acceleration which continuously changing.
49±7.876 24±4.643 52±13.021 21±2.046 <0.001
Interpretation: Above table shows comparison of post‑mean values of NDI
It was proved that posture was not a stationary
score between group A and group B. Both the groups were found to be phenomenon, but it could alternate phases by changing
statistically extremely significant (P<0.0001) postural performance indexes. [25] Postural stability
was affected by many different conditions such as
McKenzie method is one of the popular approaches to low back pain,[26] chronic neck pain,[27] scoliosis,[28] and
evaluating and treating patients with neck pain. This osteoporosis‑related kyphosis.[29] Furthermore, postural
method is best known as a classification‑based treatment stability was an essential requirement for activities of
approach, which categorizes patients with neck pain into daily living.[30] Muscular and skeletal structures can
biomechanical subgroups. In this approach, patients are change into an incorrect shape due to a reduction in
evaluated using repeated end range cervical movements physical activity and inappropriate posture habits in
and postural assessments to identify a specific mechanical daily living.[8] Excessive anterior positioning of the head
classification.[14] A key aspect of the McKenzie approach in relation to a vertical reference line is referred to as
is that the patients receive individualized treatment forward head posture.[31] Rounded shoulder posture
based upon their clinical presentation. The McKenzie refers to a posture characterized by acromion protraction
method customs an assessment method, which purposes in front of the line of gravity, shoulder protraction, and
to identify subgroups of patients among the nonspecific downward rotation as well as anterior tilt.[8,32,33] Core
spinal pain population whose complains behave in stabilization training with the stable behavior of spine
a parallel way when subjected to mechanical forces could have positive effects on postural control systems,
within the physical examination.[10] The derangement and it could change the overall postural stability.[34‑36]
syndrome is the most prevalent treatment classification. Cervical spine stabilization training was mentioned here.
This syndrome is characterized by the centralization and
peripheralization of symptoms, in response to repeated For people with neck pain, getting the right treatment
movements or sustained postures of the lumbar spine is must to a quick recovery. Several studies have
within the physical examination.[15‑17] been conducted with the goal of treating the disorder
using various interventional techniques, with positive
Spinal stabilization training has become a popular outcomes, despite the fact that treating cervical postural
approach. It has been used for treating patients with syndrome patients has received little attention. As a
musculoskeletal spinal disorders, for preventing injuries, result, this research aimed to see how effective segmental
and performance enhancement in athletic and sedentary spinal stabilization exercises and the McKenzie technique
populations.[18,19] The term of spinal stability was first are for treating neck discomfort in people who have
described by Panjabi.[20] The physiologic basis of this cervical postural syndrome.
approach was the activation or reorganization of three
anatomical systems that include passive, active, and Materials and Methods
neural.[19,21] The main point of the training was to create
awareness and to reform posture, strength, endurance, Study design and setting
coordination, and proprioception.[19,21] The present study was an experimental study (pre‑ to
post‑test) that was started after being approved by the
Cervical stabilization exercises aims to train deep Institutional ethical clearance committee of Krishna
stabilizer muscles of the cervical spine and improve institute of medical sciences deemed to be university,
coordination between superficial and deep cervical Karad.
muscles: axial elongation exercise, craniocervical
flexion exercise, cervical extension exercise, and Study participants and sampling
cervico‑scapulothoracic strengthening exercises.[22,23] Intervention was performed for a period of 6 weeks.
Cervical stabilization exercises are often used to decrease Patients of all genders ranging in age from 30 to 45 years
Journal of Education and Health Promotion | Volume 12 | July 2023 3
 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

experiencing neck pain for more than 90 days, diagnosed • GROUP A (Segmental spinal stabilization exercises):
with cervical postural syndrome as per Mckenzie’s
assessment and falling under 4‑7 score of Visual analog The participants were given segmental spinal stabilization
scale were included. Patients were excluded if they had exercises for strengthening deep (rectus capitis anterior,
history of neck/back surgery, recent history of trauma rectus capitis lateralis, longus capitis, and longus colli)
or fracture, congenital disorder of cervical spine, and and superficial cervical muscles (splenius capitis,
psychiatric disease or drug abuse. The present research sternocleidomastoid, anterior scalene, and upper
comprised of 120 individuals was randomly divided and trapezius) as this muscles tend to get weaken in neck
assigned into group A and group B with 60 individuals pain. [24,42] Segmental spinal stabilization exercises
in each by using SPSS software. The study duration was consisted of axial elongation, cervical extension exercises,
period of one year at Krishna hospital in Physiotherapy cervico‑scapulothoracic strengthening, and cranio‑cervical
outpatient department, Karad. flexion exercises. The participants were asked to perform
these exercises for 10 repetitions for 5 sets.
Data collection tool and technique
Data collection tools Axial elongation exercises
Visual Analog Scale (VAS) They are performed to correct posture. The participants
It is a measurement tool that seeks to measure a gently performed chin‑in and shoulder retraction while
characteristic that believed to range across a continuum seated, and then elongate the entire spine by imaging a
of values and cannot easily be directly measured. VAS is string pulling from the top of the head.
a uni‑dimensional measure of pain intensity, which has
been extensively used in various adult people.[8] Validity Craniocervical flexion and cervical extension
of VAS measured by intraclass co‑relation co score was exercises
0.97 [95% CI = 0.96 to 0.98] They are performed to retrain the deep cervical flexors
and improve postural awareness. The participants were
Neck Disability Index (NDI)[37]
requested to learn the correct craniocervical flexion in
NDI is a disorder‑specific functional status survey with
10 items inclusive of pain, personal care, lifting, reading, a supine position by using a pressure biofeedback unit
headaches, concentration, work, driving, sleeping, and under supervision before they performed the exercise at
recreation. A higher score indicates more patient‑rated home without pressure biofeedback.
disability.[21] Validity of NDI measured by intra‑class
co‑relation co‑score was 0.88 [0.63 to 0.95]. For the cervical extension exercise
The participants firstly were asked to maintain
Vernier caliper craniocervical flexion and then lift and hold the head
Instrument for making very accurate linear and neck in a prone position.
measurements,[21] Vernier calipers were used to measure
the distance between the acromion of the shoulder joint A rowing exercise
and the table surface three times, and the numbers were The participants were using elastic band to strengthen
averaged and used for analysis.[38] shoulder extensors and scapular retractors.

Procedure Y exercise
They are performed with an elastic band, in a standing
The study protocol was presented for approval in position to strengthen the lower trapezius muscles.
front of the Protocol Committee and the Institutional
Ethics Committee of KIMSDU, Karad. After finding The participants were asked to maintain chin‑in posture
the suitability of the subjects as per the inclusion and and spinal alignment throughout performing these
exclusion criteria, the participants were briefed about the exercises.
nature of the study and the intervention. The informed
consent was obtained from the participants who are • Group B: (McKenzie Approach)
willing to participate and were recruited for the study.
All the subjects were assessed for neck pain using Visual The participants received McKenzie cervical exercises
Analog Scale and Neck Disability Index. The subjects including,
were divided into two groups based on inclusion and 1) Head retraction: Hold for 10 secs for 10 repetitions
exclusion criteria. Both the groups were treated with hot 2) Neck extension in supine position: 10 repetitions
moist pack before the treatment. 3) Neck extension in sitting: 10 repetitions
4) Left and right lateral bending: 10 repetitions
Group A: Segmental spinal stabilization exercises[5,13,24,39,40] 5) Head turning: 10 repetitions
Group B: McKenzie approach[13,41] 6) Neck flexion in sitting: 10 repetitions
4 Journal of Education and Health Promotion | Volume 12 | July 2023
 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

Ethical consideration posture, can result from the cervical spine being held in a
This study is the part of the research project and is protracted position for an extended period of time.[6,47,49,50]
approved by institutional ethical committee of Krishna
Institute of Medical Sciences Deemed to be University, To our knowledge, randomized clinical trials involving
Karad, Maharashtra. The authors maintained all the patients with neck pain and comparing the McKenzie
protocols before performing all the procedures engaged method with other treatment modalities have not been
in this study involving human participants in accordance reported in the literature, with the exception of one study
with the ethical standards of the institutional research on patients with whiplash‑associated disorders.[51]
committee.
Failure of the head to line up with the vertical axis of the
Results body[52,53] can result in additional body misalignments,
such as rounded shoulders and increased thoracic
Age‑wise distribution of participants kyphosis, [47,54] which can worsen impairments [55]
caused by the altered location of the LOG. The result of
Gender‑wise distribution of participants
combining all these postural errors is frequently referred
Outcome measures to as “slouched posture”[56,57] or “slumped posture.”[52,58]
Visual Analogue Scale (VAS)
Vernier caliper
This study, “Effectiveness of McKenzie approach and
Neck Disability Index (NDI)
segmental spinal stabilization exercises on neck pain
Discussion
in individuals with Cervical Postural Syndrome,” was
Cervical postural syndrome is a chronic condition conducted with an objective to find and compare the
that does not autocorrect because the dysfunction of effectiveness of McKenzie approach and segmental
spinal stabilization exercises on neck pain in individuals
the proprioceptive system leads to the occurrence of a
with cervical postural syndrome.
new body pattern considered by the postural system as
ideal and maintaining it in time.[1] When the posture or
Pre‑ and post‑assessment were taken using Visual
integrity of the cervical spine is compromised, it is easily Analog Scale, Neck Disability Index, and Vernier caliper.
susceptible to tension, strain, and fatigue.[43] Group A was given segmental spinal stabilization
exercises, whereas group B was given McKenzie
The cervical spine provides musculoskeletal stability and
approach.
support for the cranium, as well as a flexible, protective
column for movement, balance adaptation, and housing The results showed that there was significant reduction
of the spinal cord and vertebral artery.[44] in pain intensity, post 6 weeks of intervention, in both
the groups. According to Gorel. Kjellman et al., they had
Reviews of randomized clinical trials focused on patients performed a study on neck pain by providing treatment
with neck pain have shown positive effects of active with McKenzie exercise, conventional exercises, and
physiotherapy, electromagnetic therapy, manipulation, ultrasound.[46] They found that the McKenzie treatment
and mobilization. However, the information presented was more favorable than general exercise and control
in those reviews was based on a very small number of group and had rapid improvement in pain intensity
investigations for each treatment modality; thus, it is during the first three weeks.[38]
difficult to utilize the results in a clinical setting.[41,45,46]
According to Yi‑Liang Kuo, Tsung‑Han Lee, and Yi‑Ju
Normally, the cervical spine is lordotic. Other than Tsai, they had performed study on neck pain by giving
flexion and extension movements of the neck that take spinal stabilization exercises where the pain intensity
place in the sagittal plane, protraction, and retraction reduced. The study mentioned about training the deep
movements also come into play in this plane. Protraction stabilizer muscles of the cervical spine and improving
movement is an outcome of extension of the upper coordination between superficial and deep cervical
cervical spine and flexion of the lower cervical spine; muscles.[24]
however, retraction movement results from flexion of
the upper cervical spine and extension of the lower The results showed that there was significant reduction
cervical spine.[47] in pain, disability, and correction of rounded shoulders,
after 6 weeks of intervention, in both the groups.
The line of gravity (LOG), which defines normal posture, According to Ilinca I and Rosulescu E, neck rehabilitation
passes through the external auditory meatus, the cervical is to help the patient to return to the highest level of
spine’s bodies, the acromion, and is anterior to the function, with relieving pain, restoring normal joint
thoracic spine.[48] The forward head posture (FHP), which mobility, strengthening of specific postural muscle
is considered to be a deviation from neutral or normal groups, and postural retraining.[1]
Journal of Education and Health Promotion | Volume 12 | July 2023 5
 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

Segmental spinal exercises were proven effective on showed extremely significant effects on both the groups
neck pain, where Ghaderi F and Jafarabadi carried out for reduction of pain, improving functional ability, and
a study and found increased deep flexor endurance and correction of rounded shoulders. Thus, incorporating
decreased EMG activity of sternocleidomastoid muscles, patient education and a home exercise program will
which suggest an important role for stabilizing exercises improve outcomes and hasten recovery.
on reducing the activity of superficial muscles in chronic
neck pain.[5] Limitation and recommendation
Some limitations did exist in the current research. This
Mean age of the Group A participants was 37.9 ± 6.127, research focuses on the patients with chronic neck pain;
whereas for Group B was 38.8 ± 4.274 [Tables 1 and 2]. thus, patients with acute neck pain or mild pain with VAS
Mean VAS value within the group A before the treatment of 0‑2 were excluded. Also, the age limit was narrowed.
was 4.44 ± 0.893 (at rest) and 6.18 ± 0.625 (on activity), Further studies should be performed on large sample
which was reduced to 2.18 ± 0.688 (at rest) and size. Multicentric trials should be executed by using more
2.64 ± 0.882 (on activity), whereas for group B, before reliable and valid outcome measures such as advanced
treatment the mean VAS value was 5.05 ± 0.714 (at rest) imaging modalities.
and 6.34 ± 0.448 (on activity), which was reduced to
2.36 ± 0.742 (at rest) and 2.72 ± 0.945 (on activity). Conclusion
On comparing both the groups, the post values for The present study concluded that both McKenzie
group A were 2.18 ± 0.688 (at rest) 2.64 ± 0.882 (on activity) approach and segmental spinal stabilization exercises
and for group B 2.36 ± 0.742 (at rest) and 2.72 ± 0.945 (on were effective on neck pain in individuals with cervical
activity). Both the groups showed significant difference postural syndrome.
with respect to VAS [Table 3]. Mean value of Vernier
caliper within the group A, before the treatment was The findings of the present study showed that both the
8.31 ± 0.469 (right) and 8.31 ± 0.474 (left), which was techniques bring significant reduction in pain, disability,
reduced to 6.11 ± 0.670 (right) and 6.05 ± 0.701 (left), and correction of rounded shoulders, after 4 weeks of
whereas for group B, before treatment the mean intervention.
Vernier caliper value was 8.01 ± 0.436 (right) and
8.02 ± 0.478 (left), which was reduced to 5.75 ± 0.866 (right) This study also concluded that on comparing both the
and 5.69 ± 0.816 (left). techniques group B (McKenzie approach) showed more
significant results in reduction in pain, disability, and
On comparing both the groups, the post values for
correction of rounded shoulders than group A (segmental
group A were 6.11 ± 0.670 (right) and 6.05 ± 0.701 (left)
spinal stabilization exercises). Hence, McKenzie protocol
and for group B, 5.75 ± 0.866 (right) and 5.69 ± 0.816 (left).
is more beneficial than segmental spinal stabilization
Both the groups showed significant difference with
exercises.
respect to Vernier caliper measurements [Table 4]. Mean
value of NDI within the group A before the treatment
Acknowledgment
was 49 ± 7.876, which was reduced to 24 ± 4.643, whereas
We acknowledge the guidance of Dr. G. Varadharajulu,
for group B, before treatment the mean NDI value was
Dean, Krishna College of Physiotherapy, KIMSDU,
52 ± 13.021, which was reduced to 21 ± 2.046.
Karad and Dr. Kakade SV, for statistical help.
On comparing both the groups, the post values for group A
were 24 ± 4.643, and for group B, 21 ± 2. 046. Both the Ethical approval
groups showed significant difference with respect to NDI. The study was approved by institutional ethical
committee of Krishna Institute of Medical Sciences
[Table 5] Neck pain is a common problem, and it has Deemed to be University, Karad, Maharashtra.
been increased in these recent years. Several reasons are
responsible for this including changes in lifestyle, work Financial support and sponsorship
habits, and technology usage. Cervical postural syndrome Krishna Institute of Medical Sciences Deemed to be
may have long‑term complications, which may result in University, Karad.
pain, reduced quality of life, and sometimes, this chronic
neck pain may also result into mental health issues such Conflicts of interest
anxiety and depression. Therefore, it is very necessary to There are no conflicts of interest.
treat this condition as early as possible. Application of
McKenzie approach and segmental spinal stabilization Author contribution
exercises in physiotherapy will benefit the patients with Rutuja Avaghade conducted literature review for this
cervical postural syndrome. Result of the present study manuscript, developed the introduction section of the
6 Journal of Education and Health Promotion | Volume 12 | July 2023
 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

manuscript, conducted the discussion of the study and with chronic non‑specific low back pain: a randomised placebo
finding; collected data; and analyzed the data. Dr. Sandeep controlled trial with short and longer term follow‑up. British
journal of sports medicine. 2018 May 1;52(9):594‑600.
Shinde provided a description of the background 16. Magee DJ. Orthopedic Physical Assessment‑E‑Book. Elsevier
information, collected data and analyzed the data, and Saunders: St. Louis, Missouri; 2014.
participated in the prescription of the manuscript. All the 17. Owen PJ, Miller CT, Mundell NL, Verswijveren SJ, Tagliaferri SD,
authors read and approved the final manuscript. Brisby H, et al. Which specific modes of exercise training are most
effective for treating low back pain? Network meta‑analysis. Br J
Sports Med 2020;54:1279‑87.
References 18. Wertli MM, Rasmussen‑Barr E, Held U, Weiser S, Bachmann LM,
Brunner F. Fear‑avoidance beliefs—A moderator of treatment
1. Kasumovic M, Gorcevic E, Gorcevic S, Osmanovic J. Cervical efficacy in patients with low back pain: A systematic review.
syndrome–The effectiveness of physical therapy interventions. Spine J 2014;14:2658‑78.
Med Arch 2013;67:414‑7.
19. Van Dieën JH, Reeves NP, Kawchuk G, Van Dillen LR,
2. Falla D, Hodges PW. Individualized exercise interventions for Hodges PW. Motor control changes in low back pain: Divergence
spinal pain. Exerc Sport Sci Rev 2017;45:105‑15. in presentations and mechanisms. J Orthop Sports Phys Ther
3. Cross KM, Kuenze C, Grindstaff T, Hertel J. Thoracic spine thrust 2019;49:370‑9.
manipulation improves pain, range of motion, and self‑reported 20. Sahasrabuddhe S, B Shinde S, Ghadage PP. Effect of stretching
function in patients with mechanical neck pain: A systematic and strengthening protocol on forward flexed posture in
review. J Orthop Sports Phys Ther 2011;41:633‑42. post‑menopausal women. J Pharm Res Int 2021;33:306‑14.
4. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. 21. Hodges PW, Tucker K. Moving differently in pain: A new theory
Mayo Clin Proc 2015;90:284‑99. to explain the adaptation to pain. Pain 2011;152:S90‑8.
5. Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG 22. Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T,
assessment of the effects of stabilization exercise on nonspecific et al. Exercises for mechanical neck disorders. Cochrane Database
chronic neck pain: A randomized controlled trial. J Back Syst Rev 2015.
Musculoskelet Rehabil 2017;30:211‑9. 23. Ganesh GS, Mohanty P, Pattnaik M, Mishra C. Effectiveness of
6. Mylonas K, Angelopoulos P, Billis E, Tsepis E, Fousekis K. mobilization therapy and exercises in mechanical neck pain.
Combining targeted instrument‑assisted soft tissue mobilization Physiother Theory Pract 2015;31:99‑106.
applications and neuromuscular exercises can correct forward 24. Kuo YL, Lee TH, Tsai YJ. Evaluation of a cervical stabilization
head posture and improve the functionality of patients with exercise program for pain, disability, and physical impairments
mechanical neck pain: A randomized control study. BMC in university violinists with nonspecific neck pain. Int J Environ
Musculoskelet Disord 2021;22:1‑9. Res Public Health 2020;17:5430.
7. Al‑Najjar HM, Mohammed AH, Mosaad DM. Effect of ice 25. Rabuffetti M, Bovi G, Quadri PL, Cattaneo D, Benvenuti F,
massage with integrated neuromuscular inhibition technique Ferrarin M. An experimental paradigm to assess postural
on pain and function in subjects with mechanical neck pain: stabilization: No more movement and not yet posture. IEEE Trans
Randomized controlled trial. Bulletin of Faculty of Physical Neural Syst Rehabil Eng 2011;19:420‑6.
Therapy 2020;25:1‑7. 26. Cramer H, Mehling WE, Saha FJ, Dobos G, Lauche R. Postural
8. Do YL, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded awareness and its relation to pain: Validation of an innovative
shoulder posture and forward head posture according to exercise instrument measuring awareness of body posture in patients with
methods. J Phys Ther Sci 2017;29:1824‑7. chronic pain. BMC Musculoskelet Disord 2018;19:109.
9. Lam OT, Strenger DM, Chan‑Fee M, Pham PT, Preuss RA, 27. Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical proprioception
Robbins SM. Effectiveness of the McKenzie Method of Mechanical impairment in neck pain‑pathophysiology, clinical evaluation,
Diagnosis and Therapy for treating low back pain: Literature review and management: A narrative review. Pain Ther 2021;10:143‑64.
with meta‑analysis. J Orthop Sports Phys Ther 2018;48:476‑90. 28. Park J, So WY. The effect of the Schroth rehabilitation exercise
10. Sahrmann S, Azevedo DC, Van Dillen L. Diagnosis and treatment program on spinal and feet alignment in adolescent patients with
of movement system impairment syndromes. Braz J Phys Ther idiopathic scoliosis: A pilot study. Healthcare 2022;10:398.
2017;21:391‑9. 29. Granacher U, Gollhofer A, Hortobágyi T, Kressig RW,
11. Will JS, Bury DC, Miller JA. Mechanical low back pain. Am Fam Muehlbauer T. The importance of trunk muscle strength for
Physician 2018;98:421‑8. balance, functional performance, and fall prevention in seniors:
12. Kuppusamy S, Narayanasamy R, Christopher J. Effectiveness of A systematic review. Sports medicine 2013;43:627‑41.
Mckenzie exercises and mat based pilates exercises in subjects 30. Kaya DO, Ergun N, Hayran M. Effects of different segmental
with chronic non‑specific low back pain: A comparative study. spinal stabilization exercise protocols on postural stability in
Int J Prev Treat 2013;2:47‑54. asymptomatic subjects: Randomized controlled trial. J Back
13. Kumar S, Kumar N, PraveShen S, Kumar R, Sharma N. Musculoskelet Rehabil 2012;25:109‑16.
Compare the effectiveness of McKenzie Techniques and 31. Xie Y, Szeto GP, Dai J, Madeleine P. A comparison of muscle
Isometric Strengthening Exercise In Patients with Cervical activity in using touchscreen smartphone among young people
Radiculopathy. European Journal of Molecular & Clinical with and without chronic neck–shoulder pain. Ergonomics
Medicine. 2021 Jan 16;7(11):4679‑91. 2016;59:61‑72.
14. Edmond SL, Werneke MW, Young M, Grigsby D, McClenahan B, 32. Yang H, Bae S. Effects of shortening of pectoralis minor muscle
Harris G, et al. Cognitive behavioural interventions, and function on muscle activity of trapezius and pectoralis major muscles.
and pain outcomes among patients with chronic neck pain J Korean Soc Integr Med 2013;1:85‑92.
managed with the McKenzie approach. Musculoskeletal Care 33. Seitz AL, McClure PW, Finucane S, Boardman ND 3 rd ,
2020;18:46‑52. Michener LA. Mechanisms of rotator cuff tendinopathy: Intrinsic,
15. Garcia AN, Costa LD, Hancock MJ, De Souza FS, extrinsic, or both? Clin Biomech (Bristol, Avon) 2011;26:1‑12.
de Oliveira Gomes GV, De Almeida MO, Costa LO. McKenzie 34. Muthukrishnan R, Shenoy SD, Jaspal SS, Nellikunja S, Fernandes S.
Method of Mechanical Diagnosis and Therapy was slightly more The differential effects of core stabilization exercise regime
effective than placebo for pain, but not for disability, in patients and conventional physiotherapy regime on postural control

Journal of Education and Health Promotion | Volume 12 | July 2023 7

 Avaghade, et al.: Effect of McKenzie approach and segmental spinal stabilization on cervical postural syndrome

parameters during perturbation in patients with movement and et al. Exercises for mechanical neck disorders. Cochrane Database
control impairment chronic low back pain. BMC Sports Sci Med Syst Rev 2012.
Rehabil 2010;2:1‑2. 46. Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N,
35. Wirth K, Hartmann H, Mickel C, Szilvas E, Keiner M, Sander A. et al. Manual therapy and exercise for neck pain: A systematic
Core stability in athletes: A critical analysis of current guidelines. review. Man Ther 2010;15:334‑54.
Sports Med 2017;47:401‑14. 47. Singla D, Veqar Z. Association between forward head, rounded
36. Borghuis J, Hof AL, Lemmink KA. The importance of shoulders, and increased thoracic kyphosis: A review of the
sensory‑motor control in providing core stability. Sports Med literature. J Chiropr Med 2017;16:220‑9.
2008;38:893‑916. 48. Kendall FP, McCreary EK, Provance PG, Rodgers MM,
37. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Romani WA. Muscles: Testing and Function with Posture and
Clewley D, Walton DM, et al.; American Physical Therapy Pain. Baltimore, MD: Lippincott Williams & Wilkins; 2005.
Association. Neck pain: Revision 2017: Clinical practice 49. Neumann DA. Kinesiology of the Musculoskeletal System‑E‑Book:
guidelines linked to the international classification of functioning, Foundations for Rehabilitation. Elsevier Saunders, St. Louis,
disability and health from the orthopaedic section of the Missouri; 2016.
American Physical Therapy Association. J Orthop Sports Phys
50. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C,
Ther 2017;47:A1‑83.
Keener JD, et al. Head and shoulder posture affect scapular
38. Kim EK, Kim JS. Correlation between rounded shoulder posture,
mechanics and muscle activity in overhead tasks. J Electromyogr
neck disability indices, and degree of forward head posture. J Phys
Kinesiol 2010;20:701‑9.
Ther Sci 2016;28:2929‑32.
51. Sterling M. Physiotherapy management of whiplash‑associated
39. George BA, Shinde SB. Effect of activity specific spinal stabilization
disorders (WAD). J Physiother 2014;60:5‑12.
exercises on pain and spinal mobility in lumbar spondylosis. Int
J Health Sci Res 2019;9:174‑82. 52. Szczygieł E, Węglarz K, Piotrowski K, Mazur T, Miętel S, Golec J.
Biomechanical influences on head posture and the respiratory
40. Shinde SB, Bhende RP. Evidence‑based treatment strategies
movements of the chest. Acta Bioeng Biomech 2015;17:143‑8.
for “text neck syndrome”: A review. Int J Occup Saf Health
2023;13:245‑57. 53. Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of
forward head posture on muscle activity during neck protraction
41. Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T,
et al. Exercises for mechanical neck disorders: A cochrane review and retraction. J Phys Ther Sci 2015;27:977‑9.
update. Man Ther 2016;24:25‑45. 54. Kim DH, Kim CJ, Son SM. Neck pain in adults with forward
42. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect head posture: Effects of craniovertebral angle and cervical range
of manual therapy and stabilizing exercises on forward head of motion. Osong Public Health Res Perspect 2018;9:309‑13.
and rounded shoulder postures: A six‑week intervention with 55. Lee JH. Effects of forward head posture on static and dynamic
a one‑month follow‑up study. BMC Musculoskelet Disord balance control. J Phys Ther Sci 2016;28:274‑7.
2019;20:1‑8. 56. Ravi Kiran HG, Siddique PA, Adarsh T, Vijay C. Functional
43. Aroeira RM, Furlan RM, Pertence AE, Casas EB, Greco M. outcome of arthroscopic subacromial decompression in primary
Relationship between head posture and lumbar curve in shoulder impingement syndrome due to extrinsic mechanical
a sitting position: A biomechanical study. Fisioter Mov causes. Int J Orthop 2017;3:110‑6.
2017;30:453‑61. 57. Jung SI, Lee NK, Kang KW, Kim K, Do YL. The effect of
44. Wani S, Raka N, Jethwa J, Mohammed R. Comparative efficacy of smartphone usage time on posture and respiratory function.
cervical retraction exercises (McKenzie) with and without using J Phys Ther Sci 2016;28:186‑9.
pressure biofeedback in cervical spondylosis. Int J Ther Rehabil 58. Szikszay T, Hall T, von Piekartz H. In vivo effects of limb
2013;20:501‑8. movement on nerve stretch, strain, and tension: A systematic
45. Kay TM, Gross A, Goldsmith CH, Rutherford S, Voth S, Hoving JL, review. J Back Musculoskelet Rehabil 2017;30:1171‑86.

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