EFFECT OF MCKENZIE EXERCISES ON
FUNCTIONAL NECK DISABILITY IN FEMALES
WITH DOWAGER’S HUMP
Nadia A. Abd Elmeged *; Amaal H.M. Ibrahim** ;
Awatef M. Labib *** ; Adel R. Ahmed **** ;
Ghada I. Mohamed ***** and Heba A. Kamal ******
* Researcher of physical therapy for Basic Science Department,Faculty of physical
Therapy,ElKasr ElAiny, Cairo University.
**Professor of physical therapy ,Basic Science Department, Faculty of physical
Therapy ,Cairo University
*** Professor of physical therapy ,Basic Science Department, Faculty of physical
Therapy ,Cairo University
**** Professor of physical therapy ,Basic Science Department, Faculty of physical
Therapy ,Cairo University
*****Assistant professor of physical therapy ,Basic Science Department, Faculty of
physical Therapy ,Cairo University.
******Professor of Radiodiagnosis ,Faculty of Medicine Elkasr Elainy ,Cairo
University .
*E-mail - Dr.nadiasalem91@yahoo.com
ABSTRACT
Background : : Dowager`s hump is a faulty habitual posture alignment
of the cervical spine, where in the head is positioned anterior to the
shoulder. Prolonged forward head posture (FHP) leads to the
development of hump, predominantly seen in menopaused
females.Objective : This study was conducted to investigate the effect of
Mckenzie exercises on females with Dowager’s hump in cervical region
. Methods : Thirty female patients with Dowager’s hump aged from 38-
59 years randomly distributed to 2 equal groups. The treatment was
applied 3 times per week for 8 weeks .Pain intensity level and neck
functional ability were measured pre-treatment and post 8 weeks of
tratment. Group A (control ) : 15 female patient received conventional
physiotherapy and Group B (study ) include 15 female patient received
conventional therapy in addition to Mckenzie exercises. The treatment
was applied 3 times per week for 8 weeks .Pain intensity level and neck
functional ability were measured pre-treatment and post-tratment.
Results: the study group showed statistical significance reduction in pain
intensity level and neck disability index more than control group .
Conclusion : Mckenzie exercises improves neck functional ability and
pain level intensity in females patients with Dowager’s hump in cervical .
Key words :Mckenzie exercises ,Dowager’s hump , NDI ,VAS .
Egypt. J. of Appl. Sci., 36 (7-8) 2021 163-182
INTRODUCTION
Dowager's hump is an abnormal outward curvature of the thoracic
vertebrae of the upper back. Compression of the front portion of the
involved vertebrae due to osteoporosis leads to forward bending of the
spine (kyphosis) and creates a hump at the upper back. Like most
osteoporotic changes, it is often preventable (Duangkaew et al .,
2020).The prevalence of dowager’s hump in older persons is 20 to 40
percent and increases with age (Kado et al., 2013).
Forward head posture(FHP ) can also create dowager’s hump, FHP
occurs when the head moves forward, the torso moves backward and the
hips tip forward to compensate. The natural curve of cervical and lumbar
spine becomes less lordotic . Degenerative changes of the cervical spine
are commonly accompanied by a reduction or loss of the lordosis and are
often considered to be a cause of neck pain ( Grob et al., 2007).
Change in the curvature of the neck bone causes upper crossed
syndrome, which leads to rounded shoulder posture and shoulder pain . FHP
that causes round shoulder and neck pain due to an imbalance between the
curvature of the spine and muscles that are attached to the neck bone, is
correlated with problems in the neck bone all these will lead to fusion of
neck joint which lead to arthritis (Kim and Kim 2016) .
The discs and vertebral bodies become wedged, it progresses to
greater sagittal malalignment. This hump can lead to cervical myelopathy
due to the curve of the spine (Scheer et al ., 2013 ).
Normal movement patterns were altered by persistent pain, joint
fixations, nerve entrapment and protective muscle guarding, new
neuronal pathways were burned into her central nervous system
(Miranda & Kage 2020).
Patients with straight and kyphotic cervical curves were 18 times
more likely to present with cervicogenic symptoms. The studies found a
statistically significant association between cervical pain and lordosis
angle of less than 20 degree. (McAviney et al., 2005).
The Neck Disability Index (NDI) is the most widely used and most
strongly valid instrument for assessing self -rated disability in patients
with neck pain . It has been used effectively in both clinical and research
settings in the treatment of the very common problem (Vernon , 2008 ).
A Visual Analogue Scale (VAS) is a measurement instrument that
measure a characteristic or attitude that is believed to range across a
continuum of values and cannot easily measured. The patient marks on
the line the point that they feel represents their perception of their current
state (Crichton, 2001).
Neck retraction was first recommended by Stevens and McKenzie
to treat cervical pain.It involves pulling the head and neck posteriorly
directly over the thorax, while the head and eyes remain at same level.
164 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Retraction may increase cervical range of motion, improve neck posture
,relieve neck or referred pain, and move the nucleus pulposus to a more
anterior position and prevent recurrences of pain ( Abdulwahab and
Sabbahi., 2000 ).
So there is a gap of knowledge in variety of methods that can
correct or treat dowager’s hump , Also there is no studies that tried
mckenzie exercises as a treatment method for dowager’s hump only few
studied use postural correction . The aim of this study was to investigate
the effect of mckenzie exercises on functional neck ability at female
patients with Dowager’s hump.
MATERIALS AND METHODS :
Design , setting ,methods, population
The study randomized control trial pre-post test design .It performed
at out patient clinic in physical therapy department at El KASR ELAINY
hospital Cairo Egypt from september 2018 to march 2019 . This study
was conducted with the approval &under supervision of the ethical
committee of the faculty of physical therapy , cairo university
(P.T.REC/012/001757) in accordance with standards of the Helsinki
Declaration . All patients participated in the study signing the approved
consent form.
The power of the study was measured post hoc by G*Power 3.1
software. F-test MANOVA within and between interaction effects was
selected. With total sample size 30 subjects, type I error (2 tailed) was
0.05 and effect size of 1.13.
Thirty female patients with age 39 -58 years who met the inclusion
criteria and diagnosed by orthopedist as dowager’s hump with cervical
disc & neck pain were taken as a sample in the study .
Inclusion criteria :
1. 30 Female patients at age ( 39 to 58 years mean age of
menopause) (Li et al ., 2010) (Mahfouz et al., 2015 ).
2. Female patients referred from physician diagnosis as dowager’s
hump with neck pain and referred pain at upper limb .
3. Female patients with limited cervical range of motion flexion,
extension and side bending .
4. Absolute rotatory angle (cervical lordotic angle ) less than 20
degree who have cervicogenic symptoms ( McAviney et al .,
2005).
5. visual analogue scale used to assess pain level ( Hawker et al .,
2011 ).
6. Neck disability index score as neck pain affect the function of
neck at daily living activity ( Sterling & Rebbeck, 2005).
Egypt. J. of Appl. Sci., 36 (7-8) 2021 165
7. BMI is within 25- 30 kg \m2( Sheng et al ., 2017) .
Exclusion criteria :
1. Patients with any neck surgery (chung et al ., 2012 ).
2. Neurological infection and systemic diseases including
cerebrovascular disease ,spinal cord injury ,cancer ,ankylosing
spondylitis (chung et al ., 2012 ).
3. Patients with congenital musculoskeletal deformity (Gupta et al
.,2013 ).
4. Patients with cervical trauma or car accident ( Wani et al ., 2013
).
5. patients with severe osteoporosis by referral of orthopedist (Ali et
al ., 2015 ) .
6. obese patients with BMI more than 30 kg/m2 .
Procedures :
A) Assessment Procedures :
1)Visual analogue scale (VAS)
Pain was measured by Visual Analogue Scale for both groups.
2) Neck disability index (NDI ) :
NDI is a 10-item questionnaire that measures a patient’s selfreported
neck pain related disability. Questions include activities of
daily living, such as: personal care, lifting, reading, work, driving,
sleeping, recreational activities, pain intensity, concentration and
headache. Each question is measured on a scale from 0 (no disability) to
5, and an overall score out of 100 is calculated by adding each item score
together and multiplying it by two. A higher NDI score means the greater
a patient’s perceived disability due to neck pain. (Howell, 2011).
It consists of 10 items each of 10 items each of them is scored
from 0- 5 . The total maximum score is therefore 50 . The original report
provided intervals for interpretation, as (1-4) = no disability, (5-14)
=mild,(15-24) =moderate, (25-34) = severe, (above 34) = complete
disability (Haneline, 2006).
B) Treatment procedures :
1) Group A (control ) : Included 15 female patients were
received conventional physical therapy treatment as ( upper back
extension exercise from prone and sitting position ,abdominal isomertric
166 Egypt. J. of Appl. Sci., 36 (7-8) 2021
exercise ,pectoral stretching (Hallal , 1991) ,3 session per week for 8
week.
1) upper back extension exercise from prone. : patient postioned in prone
,both hands grasp behind the lower back then ask patient to raise her
head and her shoulder up ward .
Fig 1 : Upper back extension from prone .
2) upper back extension exercise from sitting : Patient in sitting
position, both hands behind the patient supported on bed and ask
patient to bring her head ,shoulder and upper back backward as much
as possible.
Fig 2 : Upper back extension ex. From sitting .
Egypt. J. of Appl. Sci., 36 (7-8) 2021 167
3) abdominal isometric exercise :Patient in crock lying position, ask the
patient to contract her abdomen and push her lower back (lumber ) to
bed downward and relax.
4) ) Pectoral stretch exercise :The patient in sitting position ,ask patient
to hold her hands behind the head then therapist pulling both arms
backward as much as possible to stretch pectoralis major with the
limit of pain
2) Group B (study ) : ): 15 female patients had assigned randomly who
received conventional treatment ( upper back extension exercise
from prone and sitting ,abdominal isomertric ex,pectoral stretching
ex.) in addition to McKenzie exercises 3 sessions per week for 8
weeks as
1)Retraction in supine position :
This involved the patient lying supine with the head off the treatment
table with clinician-applied traction and extension maintained
throughout the range of motion to end range .
Fig 3: Retraction in supine position
2)Retraction in sitting position : The patients were in a relaxed
comfortable sitting position with good back support, the patients then
instructed to draw their head as far back as possible, with the head
remaining horizontal, facing forward, and not inclining up or down .
This was repeated 10 to 15 times and also at home .
168 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Fig 4 : Chin in ex . in sitting position .
3) Retraction with patient overpressure : The patients returned to the
neutral sitting position and instructed to apply overpressure by
pressing the chin with their fingers at the end of rang of the
movement. This was repeated 10 to 15 times.
Fig 5 : Chin in with patient overpressure
4 ) Retraction with therapist overpressure : The patients were in a
relaxed comfortable sitting position with good back support and the
therapist was standing at the side of the patients with the thumb;
forefinger of one hand was applied against the patient’s mandible
and the heel of the other hand at the level of the first or second
thoracic vertebrae. The therapist hand on the mandible stabilizes the
head at end range of retraction and repeated 5 or 6 times .
Egypt. J. of Appl. Sci., 36 (7-8) 2021 169
Fig 6 : Chin in with therapist overpressure
5) Retraction with extension : The patients were in a relaxed comfortable
sitting position , The patients instructed to draw their heads as far back
as possible, with the head remaining horizontal, facing forward, and
then instructed to ‘bend his head backwards as far as he can to look at
the ceiling .then returned to the neutral sitting position. The patients
were instructed to repeat the movements 10 to 15 times.
Fig 7 : Chin in with extension
6) Retraction with rotation : The patients were in a relaxed comfortable
sitting position . The patients instructed to retract their heads, but not
fully, and then rotate the head towards the side of pain: ‘Turn as far
as you can as if looking over your right- left shoulder’. After a
second in that position they were instructed to return to the neutral
posture. The same movements were repeated rhythmically 10 to 15
times .
170 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Fig 8 :Chin in with rotation
7) Rotation with patient overpressure : The patients were instructed to repeat
the same movements of some retraction followed by active rotation. Then
instructed and shown the following against your chin; apply extra pressure
so your head is pushed further into rotation.’ After a second in that position
they were instructed to return to the neutral posture.
Fig 9: Rotation with patient over pressure
8)Rotation with therapist overpressure : The patients were in a relaxed
comfortable sitting with the head in a slightly retracted. The therapist
stands behind the patients with his right hand resting lightly on the
patient’s right trapezius. The therapist carried the patient’s head with his
left hand. The patient asked to rotate their heads to end of rang at which
point the therapist produce a further rotation force using the left arm to
rotate the head and the right hand applies a counter - pressure against the
spinous process .The movement was repeated five or six times .
Egypt. J. of Appl. Sci., 36 (7-8) 2021 171
Fig 10 : Rotation with therapist over pressure
9) Lateral flexion:The patients were in a relaxed comfortable sitting
position , The patients instructed to retract the head and then lateral
flex towards the side of pain: ‘Take your right /left ear towards your
shoulders, repeated rhythmically 10 to 15 times, returning to the
neutral position eatch time.
Fig 11 :Chin in with lateral flexion
10) Lateral flexion with patient overpressure: The patients were in a
relaxed comfortable sitting position .The patients instructed to
retraction followed by active lateral flexion with patient pressure at
chin , then they were instructed to return to the upright posture. The
same movements were repeated rhythmically 10 to 15 times .
172 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Fig 12 :Lateral flexion with patient over pressure
10)Lateral flexion therapist overpressure:
The patients were in a relaxed comfortable sitting with the head in a
slightly retracted position. The tip of the therapist’s thumb rests on the left side
of the spinous process of the upper thoracic level and the metatarsophalangeal
junction of the index finger of the left hand rests against the lateral aspect of the
cervical column at the appropriated level. the forearms of the therapist was
positioned parallel to each other .the patients were asked to retract slightly and
then to lateral flex his head to end range. At the end of the movement the
therapist applied downward pressure on the side of the patients head with the
right hand and a counter pressure with the thumb on the spinous process. The
position held for one or two seconds then the patient returns the head to the
upright position the movement is then repeated five to six time .
Fig 13 : Lateral flexion with therapist over pressure
Egypt. J. of Appl. Sci., 36 (7-8) 2021 173
RESULTS
Statistical analysis was conducted using SPSS for windows, version 18
(SPSS, Inc., Chicago, IL). The current test involved two independent variables.
The first one was the (tested group); between subject factor which had two
levels (group A receiving traditional treatment, group B receiving conventional
treatment &Mckenzie exercises ). The second one was the (treatment periods as
8 weeks ); within subject factor which had two levels (pre treatment, post
treatment). In addition, this test involved two tested dependent variables (NDI
and VAS).
Preliminary assumption checking revealed that data was normally
distributed for NDI, ARA, VAS, as assessed by Shapiro-Wilk test (p > 0.05);
there were no univariate or multivariate outliers, as assessed by boxplot and
Mahalanobis distance (p > 0.05), respectively; there were linear relationships, as
assessed by scatterplot; no multicollinearity. There was homogeneity of
variances (p > 0.05), as assessed by Levene's test of homogeneity of variances.
Accordingly, 2×2 mixed design MANOVA was used to compare the NDI and
VAS at different measuring periods at both groups. The alpha level was set at
0.05.
Table (1): Physical characteristics of participants in both groups (A&B).
Items Group A Group B Comparison
S
Mean ± SD Mean ± SD t-value P-value
Age (years) 46.46±6.58 46.73±7.65 -0.102 0.919 NS
Body mass (Kg) 79.73±7.01 78.06±5.56 0.721 0.477 NS
Height (cm) 164.13±5.04 165.33±5.77 -0.606 0.549 NS
BMI (kg/m2) 29.02±3.1 28.68±2.56 0.324 0.749 NS
*SD: standard deviation, P: probability, S: significance, NS: non-significant.
Neck disability index (NDI) :
Table ( 2 ): Mean ±SD and p values of NDI pre and post-test at both
groups.
NDI
Pre test Post test
MD
% of
change p- value
Mean± SD Mean± SD
Group A 30.12 ±3.88 30.1±3.8 0.02 0.06 0.99
Group B 30.78±6.95 18.26 ±7.76 12.52 40.67 0.0001*
MD -0.66 11.84
p- value 0.748 0.0001*
*Significant level is set at alpha level MD: Mean difference p-value: probability value
174 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Figure (14 ): Mean values of NDI pre and post study within both
groups.
As presented in figure (14) there was no significant difference of
NDI at post treatment in compare to pre-treatment (P-value =0.99) at
group (A) while there was significant reduction of NDI at post treatment
in compare to pre-treatment (P-value =0.0001*) at group (B) .
Figure (15): Mean values of NDI pre and post study between both
groups.
As well as, multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant difference of the mean values of the
"post" test between both groups with (p=0.0001*) and this significant
reduction in favour to group B than group A.
Mean values of NDI Pre and post-study within both groups
Mean values of NDI pre and post-study between two groups
30.12 30.1 30.78
18.26
0.
10.
20.
30.
40.
Group A Group B
Mean value of (NDI)
Pre study
Post study
Egypt. J. of Appl. Sci., 36 (7-8) 2021 175
Visual analogue scale (VAS):
Table (5 ): Mean ±SD and p values of VAS pre and post-test at both
groups.
VAS
Pre test Post test
MD
% of
change p- value
Mean± SD Mean± SD
Group A 8.56±0.7 3.26 ±1.03 5.3 61.9 0.0001*
Group B 8.03 ±0.85 8±0.8 0.03 0.3 0.99
MD 0.53 -4.74
p- value 0.088 0.0001*
*Significant level is set at alpha level MD: Mean difference p-value: probability value
8.03
8.56
8.
3.3
0.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Group A Group B
Mean value of (VAS)
Pre study
Post study
Figure (16): Mean values of VAS pre and post study within both
groups
As presented in figure (16) that there was no significant
difference of VAS at post treatment in compare to pre-treatment (P-value
=0.99) in group (A) .While that there was significant reduction of VAS
at post treatment in compare to pre-treatment (P-value =0.0001*) in
group (B) .
Mean values of VAS pre and post study within both groups
176 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Figure (17): Mean values of VAS pre and post study between both
groups
As well as, multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant difference of the mean values of the
"post" test between both groups with (p=0.0001*) and this significant
reduction in favour to group B than group A.
DISCUSSION
The current study was conducted to study the effect of Mckenzie
exercises on pain intensity level ,absolute rotatory angle and neck functional
ability in female patients with dowager’s hump in cervical region .
The result of this study revealed that :
That there was no significant difference of NDI at post treatment in
compare to pre-treatment at control group while there was significant
reduction of NDI at post treatment in compare to pre-treatment at study
group .
Also that there was no significant difference of VAS at post treatment
in compare to pre-treatment in control group ,while showed that there was
significant reduction of VAS at post treatment in compare to pre-treatment
in study group so Mckenzie exercises had a good and safe effect at
dowager’s hump by decreasing neck pain and increasing functional neck
ability .
The results of the current study are in agreement with Gupta et al . ,
(2013) who investigated that deep cervical flexor training as chin in
exercise appeared to be effective in reducing pain and disability. The reason
Mean values of VAS pre and post study between two groups
Egypt. J. of Appl. Sci., 36 (7-8) 2021 177
might be that DCF training specifically involved upper cervical flexion
action and that majority of subjects suffered from neck pain. DCF training
might have directly influenced pain sensitive structures of upper cervical
region .Also DCF muscle training is recommended clinically for
management of neck pain .This study was conducted in 6 months including
2 groups : experimental (DCF training ) and control (conventional isometric
training ) performed at 30 patients each group has 15 patients and treatment
period was 4 weeks .This study showed the same results of our study for
pain intensity level and NDI .
Our results were supported by the work of Chung et al ., (2012 ) who
investigated that retraining of DCF can lead to stabilize the neutral posture
of cervical vertebrae , enhance balance and function of cervical vertebrae ,
which improved the quality of every day life and decrease cervical pain .
The results confirmed by work of Moustafa et al ., (2016 ) who
investigate that McKenzie protocol of treatment had significant
improvement in cervical ROM , pain intensity level and neck functional
activity level . Also physical performance improved in McKenzie group as
a result of enhancement of cognitive and sensory perception of pain and
reduce anxiety toward physical activity . There was another reason to reduce
pain that was performing repetitive neck retraction in patients with cervical
radiclupathy advanced cervical root decompression , diminished
radiclupathy pain in lower cervical area . This study had 2 groups each had
15 patients , one group received conventional treatment as (US and
strengthening ex.) and study group received conventional plus McKenzie
protocol 3 times per week and treatment time last for 6 weeks . Their age
ranged from 30 to 50 years old .
These results were in line with Moustafa and Diab ., (2011) who
found that strengthening deep cervical flexors through chin tucks in supine
along with posture correction exercises significantly reduced pain in cases of
lower cervical spondylotic radiculopathy the same for patients of dowager’s
hump .
Abdulwahab & Sabbahi ., ( 2000) agreed with the current study ,
who investigated that neck retraction was first recommended by
McKenzie to treat cervical pain. It involves pulling the head and neck
posteriorly into a position in which the head is aligned more directly over
the thorax, while the head and eyes remain level. .It is believed that neck
retraction may increase cervical range of motion, improve resting neck
radicular pain, and possibly move the nucleus pulposus to a more anterior
position and prevent recurrences of pain.
Similarly Rathore ( 2003) found that Neck retraction, which has
been advocated by McKenzie in the treatment of patients with cervical
problems causes extension of the lower cervical segments and may alleviate
stress on the posterior annulus and thereby relieve pain. In patients with
178 Egypt. J. of Appl. Sci., 36 (7-8) 2021
neck and radicular pain, repeated neck retraction was shown to result in a
significant decrease in peripheral pain and decreased nerve root compression
. A positive response to spinal loading would result in lowered pain
intensity, centralization of symptoms or an increased range of motion.
Our results were supported by the work of Kim et al ., (2018 ) who
study on the effects of McKenzie exercise on functional recovery and FHP
in patients with chronic neck pain, McKenzie exercise led to significant
changes of craniovertebral angle and NDI .This study was divided into 3
groups group A underwent McKenzie exercises and myofacial release group
B underwent McKenzie exercises and Kinesio taping, and group C
underwent McKenzie exercise, MFR, and Kinesio taping. It was including
forward head posture patients with chronic neck pain , treatment period was
4 weeks , 3 sessions per week .The study showed that all three types of
interventions improved FHP with chronic neck pain which lead to enhance
NDI and posture of neck to shoulder .
In contrast ,the study done by Lytras et al ., (2017 ) found that the
VAS, NDI and ROM scores improved equally in both groups,(therapeutic
ex and McKenzie ex ) suggests that the McKenzie method is equally
effective in improving the clinical presentation of chronic neck pain
patients.,but therapeutic exercise seems to be more effective in improving
strength of neck muscles than McKenzie exercises.
CONCLUSION :
Based on the scope and findings of this study, It can be concluded
that Mckenzie exercises are safe and effective modality, and resulted in
great improvements in pain intensity and functional neck ability in
female patients with Dowager”s hump at cervical region .
RECOMMENDATION:
Further study should be concluded with large number of sample
also different age groups , concluded with longer treatment period .
We should try the study at different work related disorder or
special jobs like dentists ,also different groups of sex (males ) and try
different type of exercises .
REFERENCES
Abdulwahab, S. S. and M. Sabbahi (2000). Neck retractions, cervical root
decompression, and radicular pain. Journal of Orthopaedic & Sports
Physical Therapy, 30(1): 4-12.
Ali, M. F. ; S. H. El-Wardany and S. K. Alduraibi (2015). Effect of kinesio
taping in patients with mechanical neck dysfunction. Med J Cairo
Univ, 83: 867-873
Egypt. J. of Appl. Sci., 36 (7-8) 2021 179
Chung, S. H. ; J. G. Her ; T. Ko ; Y. Y. You and J. S. Lee (2012). Effects of
exercise on deep cervical flexors in patients with chronic neck pain.
Journal of Physical Therapy Science, 24(7): 629-632.
Crichton, N. (2001). Visual analogue scale (VAS). J Clin Nurs, 10(5): 706-6.
Duangkaew, R. ; J. Bettany‐Saltikov ; P. Van Schaik ; G. Kandasamy and
J. Hogg (2020). PROTOCOL: Exercise interventions to improve back
shape/posture, balance, falls and fear of falling in older adults with
hyperkyphosis: A systematic review. Campbell Systematic
Reviews, 16(3): e1101.
Grob, D. ; H. Frauenfelder and A. F. Mannion, (2007). The association
between cervical spine curvature and neck pain. European Spine
Journal, 16(5): 669-678.
Gupta, B.D. ; S. Aggarwal ; B. Gupta ; M. Gupta and N. Gupta (2013).
Effect of deep cervical flexor training vs. conventional isometric
training on forward head posture, pain, neck disability index in
dentists suffering from chronic neck pain. Journal of clinical and
diagnostic research: JCDR, 7(10):, 2261.
Haneline, M.T. (2006): Evidence-based chiropractic practice, 1 st ed. Jones
and Bartlett learning, 26(3): 139-51.
Hawker, G. A. ; S. Mian ; T. Kendzerska and M. French (2011). Measures
of adult pain: Visual analog scale for pain (vas pain), numeric rating
scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form
mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs),
short form‐36 bodily pain scale (sf‐36 bps), and measure of
intermittent and constant osteoarthritis pain (icoap). Arthritis care &
research, 63(S11):, S240-S252.
Howell, E. R. (2011). The association between neck pain, the Neck Disability
Index and cervical ranges of motion: a narrative review. The Journal
of the Canadian Chiropractic Association, 55(3): 211
Kado, D.M. ; K.E. Schmader and D.J. Sullivan (2013). Overview of
hyperkyphosis in older persons.
Kim, E. K. and J. S. Kim (2016). Correlation between rounded shoulder
posture, neck disability indices, and degree of forward head posture.
Journal of physical therapy science, 28(10): 2929-2932.
Kim, J. ; S. Kim ; J. Shim ; H. Kim ; S. Moon ; N. Lee and E. Choi (2018).
Effects of McKenzie exercise, Kinesio taping, and myofascial release
on the forward head posture. Journal of physical therapy science,
30(8): 1103-1107
Li, S. ; H. He ; M. Ding and C. He (2010). The correlation of osteoporosis to
clinical features: a study of 4382 female cases of a hospital cohort
with musculoskeletal symptoms in southwest China. BMC
Musculoskeletal Disorders, 11(1): 183.
180 Egypt. J. of Appl. Sci., 36 (7-8) 2021
Lytras, D. ; N. Koulis and E. Sykaras (2017). Comparison of two Exercise
Programs in Patients with Chronic Neck Pain.
Mahfouz, E.M. ; N.N. Kamal and E.S. Mohammed (2015). Quantifying
diabetes risk and identifying contributing factors among middle aged
females in Minia district, Egypt. Intern. J. Healthcare Science, 3(2):
643-652.
McAviney, J. ; D. Schulz ; R. Bock ; D. E. Harrison and B. Holland (2005).
Determining the relationship between cervical lordosis and neck
complaints. Journal of manipulative and physiological therapeutics,
28(3): 187-193.
Miranda, N. S. and V. Kage (2020). Effect of MaRhyThe versus myofascial
mobility tool in female individuals with or without neck pain having
forward head posture and buffalo hump–A randomized clinical trial.
Indian Journal of Physical Therapy and Research, 2(2): 113
Moustafa, I.M. ; A.A. Diab ; S. Taha and D.E. Harrison (2016). Addition of
a sagittal cervical posture corrective orthotic device to a multimodal
rehabilitation program improves short-and long-term outcomes in
patients with discogenic cervical 73 ra di c ul o pa t hy. A rc hive s o f
p hysi cal me di ci ne a n d rehabilitation, 97(12): 2034-2044
Moustafa, I.; A. Diaab ; A. Ahmed ; D. Harrison and T.M. Shousha (2011).
The efHicacy of cervical lordosis rehabilitation for nerve root
function, pain, and segmental motion in cervical spondylotic
radiculopathy. WCPT
Rathore, S. (2003). Use of McKenzie cervical protocol in the treatment of
radicular neck pain in a machine operator. The journal of the
Canadian Chiropractic association, 47(4): 291.
Scheer, J.K. ; J.A. Tang ; J.S. Smith ; F.L. Acosta ; T.S. Protopsaltis ;
B. Blondel and C.P. Ames (2013). Cervical spine alignment,
sagittal deformity, and clinical implications: a review. Journal of
Neurosurgery: Spine, 19(2): 141-159.
Sheng, B. ; K. Truong ; H. Spitler ; L. Zhang ; X. Tong and L. Chen
(2017). The long-term effects of bariatric surgery on type 2
diabetes remission, microvascular and macrovascular
complications, and mortality: a systematic review and metaanalysis.
Obesity surgery, 27(10): 2724-2732.
Sterling, M. and T. Rebbeck, (2005). The neck disability index
(NDI). Australian Journal of Physiotherapy, 51(4): 271.
Vernon, H. (2008). The Neck Disability Index: state-of-the-art, 1991-
2008. Journal of manipulative and physiological
therapeutics, 31(7): 491-502.
Egypt. J. of Appl. Sci., 36 (7-8) 2021 181
Wani, S. ; N. Raka ; J. Jethwa and R. Mohammed (2013). Comparative
efficacy of cervical retraction exercises (McKenzie) with and without
using pressure biofeedback in cervical spondylosis. International
Journal of Therapy and Rehabilitation, 20(10): 501- 508
تأثير تمارين تقنية ماکنزي عمى تحدب دواجر للإناث في منطقة الرقبة
نادية عبد المنعم عبد المجيد ، أ.د/ أمال حسن محمد اب ا رهيم ، أ.د/ عواطف محمد لبيب
، أ.د / عادل رشاد احمد ، أ.م.د/ غادة اسماعيل محمد ، أ.د/ هبة کمال أحمد ،
*باحث بقسم عموم اساسية لمعلاج الطبيعي – کمية العلاج الطبيعي -القصر العيني – جامعة القاىرة ,
**استاذ بقسم العموم الاساسية لمعلاج الطبيعى – کمية العلاج الطبيعى – جامعة القاىرة
***استاذ بقسم العموم الاساسية لمعلاج الطبيعى – کمية العلاج الطبيعى – جامعة القاىرة ,
****استاذ بقسم العموم الاساسية لمعلاج الطبيعى – کمية العلاج الطبيعى – جامعة القاىرة,
*****استاذ مساعد بقسم العموم الاساسية لمعلاج الطبيعى – کمية العلاج الطبيعى – جامعة القاىرة ,
******استاذ الاشعة التشخيصية – کمية الطب – القصر العينى – جامعة القاىرة.
الخمفية : تحدب دواجر ىو خمل في محاذاة الوضعية المعتادة لمعمود الفقرى العنقى حيث أن
ال أ رس في وضع امامى لمکتف. ان وضع ال أ رس للامام لفت ا رت طويمة ينتج عنو تحدب دواجر
وغالب اً يظير عند الاناث في سن اليأس .
الهدف من البحث : د ا رسة تأثير تمارين ماکنزى عمى تحدب دواجر للاناث في منطقة الرقبة .
85 عام وتم تقسيميم - الطريقة : تم اختيار 03 مريضة بتحدب دواجر يت ا روح سنيم من 03
عشوائي اً الى مجموعتين متساويتين : وقد تم العلاج 0 م ا رت اسبوعي اً لمدة ثمانية اسابيع . وقد
تم قياس معدل شدة الالم ومؤشر العجز الوظيفي قبل اج ا رء العلاج وبعده بثمانية اسابيع .
مجموعة )أ( التحکم : تضمن 58 مريضة قد تمقت برنامج العلاج الطبيعى التقميدى : تمرين
تمديد الظير العموى في وضع الجموس اولانبطاح وتمرين البطن متساوى القياس وتمرين اطالة
الصدر.
مجموعة )ب( الد ا رسة : تضمن 58 مريضة تمقت العلاج التقميدى بالاضافة الى تمارين
ماکنزى.تم قياس معدل شدة الالم ومؤشر العجز الوظيفي قبل وبعد العلاج .
النتائج :
اظيرت مجموعة الد ا رسة انخفاض احصائي ممحوظ في معدل شدة الالم ومؤشر العجز الوظيفي
اکثر من مجموعة التحکم .
الاستنتاج : .
أداء تمارين تقنية ماکنزي يؤدي الي تحسن معدل الالم و القدرة الوظيفية لمرقبة في
مرضي تحدب داوج رللاناث في الرقبة .
الکممات الدالة : تمارين ماکنزى- تحدب دواجر– مؤشر العجز الوظيفيى --المقياس التناظرى
المرئى .
