Publications

Objective: This study aimed to investigate the effects of combined lower trapezius strengthening and deep cervical flexor exercises on pain and forward head posture (FHP) accommodative forces in patients with chronic neck pain.

Design: Single-blind randomized controlled trial

Methods: Forty-two young adults (age: 23.12±3.01 years) with chronic neck pain and FHP (craniovertebral angle <48°) were enrolled in this trial. The participants were randomized to either an experimental group (n=21: modified prone cobra + deep cervical flexor training) or a control group (n=21: deep cervical flexor training only). Both groups received interventions twice a week for 4 weeks (eight sessions). The primary outcomes were Neck Disability Index (NDI) and craniovertebral angle (CVA). The secondary outcomes included lower trapezius strength and sternocleidomastoid muscle mechanical properties (MyotonPRO).

Results: Both groups demonstrated significant time effects for the NDI (experimental: -5.19±2.77 points, control: -4.19±2.82 points; F=118.28, p<0.001, ηp2=0.747) and CVA (p<0.001), surpassing minimal clinically important differences. The experimental group showed significant advantages in regard to left lower trapezius strength gain (+1.63 vs +0.62 kg, F=4.09, p=0.050, ηp2=0.093) and sternocleidomastoid muscle tone/stiffness reduction.

Conclusions: Adding lower trapezius strengthening exercises to cervical stabilization exercises produced superior improvements in the scapular muscle strength and cervical muscle mechanical properties, with comparable effects on pain and posture. Lower trapezius training is a valuable adjunct to conventional neck rehabilitation programs.

Keywords: neck pain, posture, muscle strength, cervical vertebrae

Adding modified prone cobra exercises to deep cervical flexor training produced superior improvements in lower trapezius muscle strength and sternocleidomastoid muscle mechanical properties compared to cervical stabilization alone. The 163% greater left lower trapezius strength gain in the experimental group (1.63 kg vs 0.62 kg) translates to enhanced scapular stabilization capacity, which may reduce chronic compensatory cervical muscle tension patterns. The concurrent 15.2% reduction in SCM stiffness (28.49 N/m) suggests restoration of optimaal cervical muscle mechanics through improved scapulothoracic stability. These biomechanical improvements indicate that lower trapezius strengthening not only addresses local muscle weakness but also produces favorable adaptations in the entire cervicoscapular complex, potentially contributing to sustained pain relief and functional recovery beyond the 4-week intervention period.Both interventions achieved clinically meaningful reductions in neck disability and forward head posture. Neck stabilization exercises demonstrated effectiveness in improving CVA, reducing neck pain. Modified prone cobra exercises significantly strengthened lower trapezius muscles and modified sternocleidomastoid tone and stiffness. However, limited effects were observed for ohter variables, and relationships between MPC exercises and neck pain or oculomotor function remained inconclusive. Lower trapezius strengthening represents a beneficial complement to conventional neck rehabilitation programs, warranting integration into multimodal treatment approaches for chronic neck pain management. Extended intervention periods with progressive intensity may yield more substantial clinical benefits.