A Randomized Control Trial to Compare the Effects of Endurance Training Versus Strength Training Among Students with Neck Pain

Neck pain is pain perceived as arising in a region bounded superiorly by the superior nuchal line and inferiorly by an imaginary transverse line through the spinous process of the �rst thoracic vertebra. Musculoskeletal disorders are common among general population; the yearly prevalence of neck pain is almost 30% to 50%. Objective: The purpose of this study was to compare the effects of endurance training versus strengthening exercises among students with chronic neck pain . Methods: It was Randomized Control Trial. A total of 30 patients were recruited into the study and were randomly allocated into two groups, the treatment group and control group. Treatment group received endurance therapy while control group was treated with strengthening exercises. Pre-test and post-test assessments were performed among both groups to compare the effect of these interventions. Results: Independent t-Test interpretation of PNS. Pre-treatment PNS for control group Mean=4.93, SD=1.53, p-value=.614, for experimental group Mean=5.20, SD=1.32, P-value=.614. According to results of Post-treatment PNS, there was signi�cant reduction in pain intensity and p-value<0. 01i.e for experimental group Mean=0.40, SD=0.507, P-Value=0.000. Independent t-Test interpretation of duration of symptoms (DOS). Pre-treatment duration of symptoms for control group Mean=2.60, SD=.632, p-value=.148, for experimental group Mean=2.93, SD=0.594, P-value=.148 Conclusion: It is concluded that endurance exercises were more effective than strength training in improving chronic neck pain among medical students of RMU.


I N T R O D U C T I O N
Neck pain is pain perceived as arising in a region bounded superiorly by the superior nuchal line and inferiorly by an imaginary transverse line through the spinous process of the rst thoracic vertebra. Musculoskeletal disorders are common among general population; the yearly prevalence of neck pain is almost 30% to 50%. Objective: The purpose of this study was to compare the effects of endurance training versus strengthening exercises among students with chronic neck pain. Methods: It was Randomized Control Trial. A total of 30 patients were recruited into the study and were randomly allocated into two groups, the treatment group and control group. Treatment group received endurance therapy while control group was treated with strengthening exercises. Pre-test and post-test assessments were performed among both groups to compare the effect of these interventions. Results: Independent t-Test interpretation of PNS. Pre-treatment PNS for control group Mean=4.93,SD=1.53,for experimental group Mean=5.20,SD=1.32,. According to results of Posttreatment PNS, there was signi cant reduction in pain intensity and p-value<0. 01i.e for experimental group Mean=0.40, SD=0.507, P-Value=0.000. Independent t-Test interpretation of duration of symptoms (DOS). Pre-treatment duration of symptoms for control group Mean=2.60, SD=.632,for experimental group Mean=2.93,SD=0.594, Conclusion: It is concluded that endurance exercises were more effective than strength training in improving chronic neck pain among medical students of RMU. treatment group and the control group. For two months, interventions were used three to four times each week. Each individual did 10-12 repetitions of a weight that they could lift ten times on the rst training session (ten repetitions maximum) and worked their way up to fteen repetitions in phase one. For four weeks, they remained at this level. In phase two, subjects worked out for three sets of 15-20 repetitions at maximal load after the initial 10 repetitions, with a minute of rest in between sets. The subjects in the Control group underwent a specially created strength training program that included cervical isometrics. This training regimen was divided into two halves. both the rst and second phases last for four weeks. Each participant did 5-10 repetitions of a weight that they could lift 10 times during the rst training session (10 repetitions maximum) in phase one, working their way up to a load that could be accomplished for a maximum of 12 repetitions. For four weeks, they remained at this level. Phase two saw the patients performing three sets of ve to ten repeats of the initial twelve to fteen repetitions at their maximum load, with a minute of rest in between sets. Data was entered and analyzed using SPSS version 21.0. Cross tabulation and multiple bar charts were used to present the data. Independent samples t-test was applied at 5% level of signi cance to compare the means of two study groups for the continuous outcome variables.

M E T H O D S
and causes a creep response in the nearby soft tissues [6]. The main cause of pain is overuse of the muscles in the cervical and shoulder girdle, particularly during repetitive low-load tasks that encourages over activity of low threshold motor units [7]. Due to static incorrect head posture, cervical stabilizer muscles may become painful or tight, resulting in neck pain with or without cervicogenic headaches [8]. The most common early symptom of a chronic musculoskeletal condition linked to neck discomfort is neck stiffness, which may or may not be accompanied by headaches [9]. This occupational group frequently adopts a prolonged forward head posture, which may be linked to musculoskeletal diseases. Numerous studies [10] have demonstrated a link between neck pain and a decline in health-related quality of life (HRQoL). Spasms of the shoulders and back muscles can be caused by a variety of things, including long-term popularization of forward head posture [11]. One of the most prevalent postural changes in people with neck disorders is a forward head posture [12]. In comparison to those who do not have neck-shoulder disorders, patients with these disorders have a more severe forward head posture, and their scapular acromion protrudes [13]. NSAIDs and muscle relaxants are two medications used to treat neck discomfort pharmacologically [14]. Mechanical neck pain is . Low power laser (830 to 904 nm) electrotherapy for mechanical neck discomfor t immediately reduces pain and improves function [16]. Ergonomic changes lead to an improvement in working p o s t u r e a n d a d e c r e a s e i n t h e f r e q u e n c y o f musculoskeletal problems. Stretching and isometric workouts serve to increase muscle strength, exibility, and range of motion [17]. Both the sub occipital release technique and the craniocervical exion exercise have been used to improve forward head position. To assess the effectiveness of endurance training for the treatment of neck pain among medical students.
Sample size was thirty n=30. Sampling method was Simple Random sampling and allocation between groups was done using sealed envelope method. Male and female students having neck pain at least once in the last month. Age group of 18 to 30 years. Patients with chronic neck pain due to faulty head posture. Exclusion Criteria: Fracture of cervical spine, Cervical Spondylolisthesis, Tumors of spine, Systemic disorders, Cervical radiculopathy. Structured Questionnaire and Pain Numeric Scale NDI (The NDI contains 10 item with 7 related to daily activities, 2 related to pain, and 1 related to concentration [21]. Thirty patients in total were chosen and randomly divided into the

R E S U L T S
Comparison of pre-and post-treatment effects of pain on sleeping and reading between groups. The experimental group's sleep and reading quality signi cantly improved because of a signi cant reduction in pain-related disruption.  .000 .001 Comparison of pre-and post-treatment effects of pain on normal all-time and the control group's duration equal to less than an hour. Pain Numeric Scale interpretation and analysis within and within groups using a one-way ANOVA test. Pre-PNS P-value was 0.614, Week 4 P-value was 0.39, and Week 8 P-value was 0.000. The pre-and posttreatment means and level of signi cance (p-values) above support the conclusion that endurance training is superior to strength training in reducing chronic neck discomfort in students. The signi cance level estimated in the tables shows that progressive endurance therapy, as opposed to progressive strength training, is more effective in helping students with their bad neck posture and chronic cervical pain. A study by Sadarat Borisu [7] compared the impact of endurance training against strength training on persistent neck discomfort. His research's ndings indicated that combining physical activity regimens could lessen neck pain and disability. Another study found that among females with persistent neck pain, twelve months of neck strength or endurance training signi cantly improved HRQoL compared to the control group. One year of either endurance or strength training seems to slightly improve the HRQoL. In order to alleviate non-speci c chronic neck pain, Saeed Akhter and his colleagues [18] compared the effectiveness of manual therapy combined with an exercise program to an exercise program alone. According to the results, both groups' levels of pain intensity signi cantly decreased after three and twelve weeks, respectively. When compared to an exercise regimen on its own, manual therapy (manipulation) with a treatment plan seems to be preferable. L.L. Andersen used a study to examine the e cacy of short daily doses of progressive resistance training for chronic neck/shoulder discomfort. Limited to moderate evidence has been found in systematic reviews to support the usefulness of physical activity in treating neck and shoulder pain [19]. In this study by R.M. Ruivo, the forward head posture and extended shoulder posture of Portuguese teenagers were examined as a result of a 32-week resistance and stretching exercise program used in physical education classes. The effects of detraining after 16 weeks were also evaluated. Adolescents' forward head and prolonged shoulders were successfully reduced by the exercise intervention [20]. All of these research' ndings, as interpreted, con rm my own ndings that gradual endurance training is helpful for neck pain. The combination of several manual physical training routines also alleviated neck discomfort and stiffness, according to the data. Independent t-Test for comparisons of groups' pre-and post-treatment data The results of the paired ttest within group demonstrate that my null hypothesis was disproved and the study hypothesis-according to which Endurance Training was more effective than Strength Training in reducing student neck pain-was accepted. My

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re a d i n g a n d watc h i n g T V b et we e n g ro u p s . T h e experimental group's sleep and reading quality signi cantly improved because of a signi cant reduction in pain-related disruption.
The comparison of strength training with endurance training for students with chronic neck discomfort to reduce pain and stiffness was the focus of my study. While the control group engaged in strength training for the purpose of reducing neck discomfort and symptoms, the experimental group was told to engage in endurance training with appropriate rest periods. Thirty students with chronic neck pain in total were chosen for this study from Rawalpindi Medical University and Allied Hospitals using purposive sampling. Following simple random sampling, equal patients were divided into the Control and Treatment groups. Ages of the subjects ranged from 18 to 30 years old. Data were gathered using a questionnaire based on the Neck Disability Index and the Pain Numeric Rating Scale. The assessment factors were pre-and post-training questionnaire scores based on NDI and PNS. Evaluations were given to the control and intervention groups. Cross tabulation between the two groups for pre-and posttreatment PNS revealed that most patients in both groups had pre-treatment PNS with pain levels between 3 and 8, while post-treatment PNS data revealed that pain levels had decreased to levels between 0 and 4 under control conditions and 0 to 1 under experimental conditions. Pretreatment symptom duration for both groups ranged from less than one hour to more than four hours. Post-treatment symptom duration showed a signi cant reduction in duration, with the experimental group's duration equal to  .000 .000 .000

D I S C U S S I O N
C O N C L U S I O N S study hypothesis is supported by one-way ANOVA-based statistical analysis of data between and within groups for pre-and post-treatment data, and the null hypothesis was rejected since the p-value was less than 0.05, indicating that the test results were signi cant.
It is concluded that endurance exercises are more effective than strength training in improving chronic neck pain among students.