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EFFECTS OF ISOMETRIC NECK EXERCISES IN IMPROVING CERVICAL RANGE

OF MOTION IN LONG TIME HELMET WEARERS

Article · June 2015

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TJPRC: International Journal of Physiotherapy &
Occupational Therapy (TJPRC: IJPOT)
Vol. 1, Issue 1, Jun 2015, 9-16
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EFFECTS OF ISOMETRIC NECK EXERCISES IN IMPROVING

CERVICAL RANGE OF MOTION IN LONG TIME HELMET WEARERS

C. V. SENTHILNATHAN, A. GURULAKSHMI & G. MOHAN KUMAR

Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute, Chennai, Tamil Nadu, India

ABSTRACT
Objectives
To study the effectiveness of isometric neck exercises in improving cervical range of motion in long time helmet
wearers.

Background of the Study

Helmet wearing is very essential while riding bikes, which acts as a lifesaving equipment. The helmet is a
protective headgear. The primary goal of the helmet is to protect the riders head during impact thus preventing or reducing
head injury and saving the rider life. It may also restrict range of motion. Sometimes it may cause hair falls. So, while
wearing helmet the postural neck muscles works against gravity where the muscles undergoes fatigue which leads to the
chances of occurring neck injuries. In this study we are going to discuss about the effects of isometric neck exercise in
improving cervical range of motion.

Methodology

Experimental, Pre-post test type of study conducted in 30 individuals of Dr. M.G.R. Educational and research
institute staffs by Random sampling. Samples are selected based on the inclusion and exclusion criteria. Informed consent
obtained from all participants. Participants will be randomized into 2 groups; Group A-Experimental group, Group B-
Control group. Total duration is 7 weeks and the subject will be treated for a period of 6 days a week & results measured
with (ROM) Goniometer.

Results

On comparing mean values of GROUP-A and GROUP-B on cervical ROM flexion, extension, Rt& Lt lateral
flexion shows the significant difference in post test of GROUP-A. In GROUP-A isometric neck exercises is given.
GROUP-A shows more effective than GROUP-B.

KEYWORDS: Isometric Neck Exercise, Cervical Range of Motion

INTRODUCTION

Helmet wearing is very essential while riding bikes, which acts as an lifesaving equipment. The helmet is a
protective headgear. The primary goal of the helmet is to protect the riders head during impact thus preventing or reducing
head injury and saving the riders life. Increasing helmet use promoted as an effective method of reducing road injuries and
death [1, 2].

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10 C. V. Senthilnathan, A. Gurulakshmi & G. Mohan Kumar

Head injuries are the main cause of death and disability among motor cycle users. Wearing helmet is the single
most effective way reducing head injuries and also decreases the risk and severity of injuries among motor cyclist. But
surveys cite many reasons for not wearing helmets are uncomfortable, fear of hair loss, sometimes it will lead to head ache,
[1-3]
neck pain and some other reasons also there . A helmet reduces the impact of sudden jerks caused due to pot holes
normally; a long drive of bikes causes fatigue of paraspinal muscles that support the spine and hence leads to the
spondylosis. So wearing helmet in long time it may also restrict in range of motion. While wearing helmet, the postural
neck muscles works against the gravity where the muscles undergoes fatigue which leads to neck injuries. So isometric
exercises is given to the cervical muscles[4]. The isometric exercise is claimed to be an effective method for acute tension in
soft tissue problem that reduces muscle spasm. It is responsible for spinal fixation reduces pain and lengthened the
tightened neck muscle to normalize cervical range of motion[5-10].

The aim of this study is to determine the effectiveness of isometric neck exercises in improving cervical range of
motion in long time helmet wearers.

METHODOLOGY
Study Design
An experimental study was conducted to determine the effectiveness of isometric neck exercises increases in
improving cervical range motion in long time helmet wearers. Pre-post test type of study conducted in 30 individuals of Dr.
M.G.R. Educational and research institute staffs by Random sampling, samples are selected based on the inclusion and
exclusion criteria.

Sample Selection Criteria

• Inclusion Criteria
Above 20 years of age, Both male and female are included, helmet wearers for more than 5 years, Frequent long
distance riders.

• Exclusion Criteria

Any history of trauma of cervical region. History of spine pathology. History of dizziness and vertigo.
Rheumatoid arthritis. Ankylosing spondylitis. Congenital malformation of spine. Cervical pain. Torticollis. Recent teeth
excision. Tuberculosis of spine bones or joints.

• Procedure

The study was done on DR. M.G.R. Educational and Research Institute staffs. 30 individuals were selected based
on inclusion and exclusion criteria. Informed consent was obtained from all the participants. Participants were randomized
into two groups.

Group A–Experimental group, Group B–Control group. All the subjects were assessed initially with universal
goniometer measuring the cervical range of motion followed by a pre-test.

Group–A

Participants in Group–A were undergone the isometric exercise for 7 weeks.

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Effects of Isometric Neck Exercises in Improving Cervical 11
Range of Motion in Long Time Helmet Wearers

Exercises

Isometric neck flexion, Isometric neck extension, Isometric lateral flexion

Exercise Protocol

Each exercise should be done for a period of 10 seconds repeated for 10 times with an interval of 3 seconds.
seconds

Isometric Neck Flexion

Position of patient – sitting or standing

Procedure

Ask the patient to bend his/her neck forward with their hand on forehead. Tell the patient to try to bend his neck
forward while pushing back with his hand.

Figure 1

Isometric Neck Extension

Positioning of patient – Sitting or standing

Procedure: Ask the patient to keep neck straight and place their hand at back of their head. Try to push the head
backward while pushing forward with their hand.

Figure 2

Isometric Lateral Flexion

Positioning of patient – Sitting or standing

Procedure: Ask the patient to keep head straight and chin at level put his/her right hand on the right side of their
head. Try to bring their head down to your right shoulder while pushing up with their right hand. Repeat the side bending,
but to the left side with their left hand.

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12 C. V. Senthilnathan, A. Gurulakshmi & G. Mohan Kumar

Figure 3 Figure 4

GROUP–B

Participants in group B were not be treated with any form of exercises.

RESULTS

Group A-experimental group (isometric neck exercises) & Group B-control group

Table 1: Comparison of Pre Test in Cervical ROM between

Group-A (Experimental) and Group-B (Control)
Cervical Group–A Group – B
T-Test Significance
Rom Mean Sd Mean Sd
Flexion 28.60 4.27 31.80 3.34 2.285 0.030
Extension 31.73 3.32 32.06 3.01 0.288 0.776
Rt LF 33.53 2.44 34.00 3.07 0.460 0.649
Lt LF 33.46 3.50 35.06 3.10 5.806 0.000

The Table 1 reveals the Mean, standard deviation (S.D), t-value and p-value of the cervical ROM in flexion,
extension, Rt & Lt lateral flexion between GROUP A & GROUP B in pre-test.

Table 1 shows that there is no significant difference in the pre-test values of cervical ROM between GROUP A &
GROUP B ***<0.005)

Both the group shows no significant difference in the pre-test values of cervical ROM between GROUP A &
GROUP B.

Graph 1: Comparison of Pretest in Cervical Rom between

Group-A (Experimental) and Group-B (Control)

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Effects of Isometric Neck Exercises in Improving Cervical 13
Range of Motion in Long Time Helmet Wearers

Table 2: Comparison of Post Test in Cervical Rom between

Group-A (Experimental) and Group-B (Control)

Cervical Group-A Group-B

T-Test Significance
Rom
Mean Sd Mean Sd
Flexion 36.80 3.53 32.60 2.82 0.484 0.001
Extension 38.26 2.43 33.06 3.04 0.400 0.000
Rt LF 39.40 1.84 35.13 3.20 4.470 0.000
Lt LF 39.06 3.19 36.33 3.28 2.309 0.029

The Table 2 reveals the Mean, standard deviation (S.D), t-value and p-value of the cervical ROM in flexion,
extension, Rt & Lt lateral flexion between GROUP A & GROUP B in post-test.

Table 2 shows that there is significant difference in the post-test values of cervical ROM between GROUP A &
GROUP B (***<0.001)

Graph 2: Comparison of Post Test in Cervical Rom between

Group-A (Experimental) and Group-B (Control)

On comparing mean values of GROUP-A and GROUP-B on cervical ROM flexion, extension, Rt & Lt lateral
flexion shows the significant difference in post test of GROUP-A. In GROUP-A isometric neck exercises is given.
GROUP-A shows more effective than GROUP-B.

DISCUSSIONS

The numbers of persons involved in the study were the age group of above 20 years. A sample of 30 subjects were
selected and assessed. The samples were advised to perform the protocol for 7 weeks and the subject will be treated for a
period of 6 days a week. Pre-test data about goniometer measurement between cervical ROM in flexion, extension and Rt
and Lt lateral flexion were recorded. After giving treatment for 7 weeks the above mentioned procedure was followed to
study the differences. In a study, Berhardt et al extended the experimental methodology reported by Wilke et al to the
cervical spine, and demonstrated the feasibility of producing axial rotation of the cervical by co-ordinated actions of eight
simulated muscle forces[6,7]. Petrofsky JS, Phillips CA states that these experiments were to quantify the maximum strength
of the neck muscles in these directions and to examine the relationship between isometric strength and endurance for
various submaximal isometric tensions. Isometric contractions were sustained to fatigue by these subjects at tensions of

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14 C. V. Senthilnathan, A. Gurulakshmi & G. Mohan Kumar

25,40,55,70 and 90% of the maximum isometric strength in each of the directions of movement. Generally, the endurance
of the muscles involved in ventral flexion was less than that found in dorsal and lateral flexion of the head [8-9]. However
the strength of the muscles involved was progressively greater for lateral, dorsal and ventral flexion respectively[10]. The
purpose of this present study is to focus the effects of isometric neck exercises in improving cervical range of motion in
long time helmet wearers. The cervical range of motion was measured before and after the study period of 7 weeks[11,12].
The result of this study showed the benefits of isometric neck exercise for improving cervical range of motion in long time
helmet wearers[13-20]. There is improvement in the cervical range of motion after the completion of program.

The pre and post test of cervical range of motion in experimental group is statistically significant at p<0.01 i.e.,
there is significant improvements in cervical range of motion after the training programme.

CONCLUSIONS

The present study concluded that the isometric neck exercise is beneficial to improve the cervical range of motion
in long time helmet wearers. There is significant difference between pre and post test after the 7 weeks treatment
programme. The isometric neck exercises for long time helmet wearers show a significant improvement when compared to
the control group.

REFERENCES

1. Ayman Ali Gallom et al Evaluation of cervical range of motion and isometric neck muscle strength: reliability and
validity. Clinical Rehabilitation 2005; 16; 851–858.

2. Burnett AF et al Hayes KC. Neck flexor muscle strength, efficiency, and relaxation times in normal subjects and
subjects with unilateral neck pain and headache. Arch Physical therapy Rehabilitation 2005: 77: 680–687.

3. Folland JP et al., Lopes, A. and Yong-Hing, K.: The immediate effect of manipulation versus mobilization on pain
and range of motion in the cervical spine: A randomized controlled trial. J Manipulative Physiotherapy; 15: 570-
575, 2005.

4. Thomas T et al., Muscle energy concepts - a need for change. Journal of Osteopathic Medicine; 3(2): 54-59, 2004

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Manipulative therapy; 2(4): 149-155, 2003.

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Effects of Isometric Neck Exercises in Improving Cervical 15
Range of Motion in Long Time Helmet Wearers

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