Pressure Biofeedback on Deep Cervical Flexor Muscles

Mechanical neck pain is the most frequent musculoskeletal disorder. It is characterized by feeling of pain, stiffness and loss of function in the cervical region. It is often related to poor posture, repetitive strain, or local soft tissue dysfunction. Evidence suggests that this disorder significantly influences daily life activities and quality of life. Mechanical neck pain is one of the leading causes of global disability. It shows the importance of physiotherapeutic interventions for the associated pain and functional limitations. The prevalence of this condition has been increasing. Particularly among individuals who engage in prolonged periods of desk work or activities requiring sustained postural maintenance .School teachers are particularly impacted due to the demanding nature of their work.

Studies report a prevalence of 35% to 65% among teachers. primarily caused by prolonged static postures, repetitive overhead activities like writing on boards, and poor ergonomic practices. The shift toward virtual teaching has further worsen the issue by increasing screen time, leading to cervical strain=. Additionally, psychological stress and heavy workloads associated with teaching contribute significantly to musculoskeletal pain.This negatively affects teachers' physical health, productivity, and overall quality of life. Targeting school teachers, a population with unique occupational demands, the study emphasizes early muscle-specific interventions to prevent chronic neck pain and promote functional recovery. School teachers build the future of the nation, for this reason our study is highlighting the importance of preventing any injuries that may cause absenteeism. It also highlights the importance of integrating workplace health promotion and ergonomic solutions into physiotherapy strategies for long-term benefits. Previous studies on cervical impairments indicated that lower endurance in deep cervical flexors is responsible for neck pain. This leads to muscular insufficiency as well as impaired activation. In such cases, poor endurance of deep cervical flexor muscles has been observed and weakness of the anterior cervical flexor muscles can lead to head and neck postural imbalances .A restoration of deep cervical flexor muscle function has been suggested clinically for managing neck pain, but still limited evidence on its efficacy in work-related neck pain has been noted . Mechanical neck pain is associated with disfunction in proprioception. The body's ability to sense joint movement and joint position. These disfunctions can disrupt sensorimotor control causing potential exacerbating pain and functional limitations .

Previous studies has also showed that individuals with neck pain experience increased joint position limitations that indicate compromised cervical proprioception. The imbalance between superficial and deep flexor muscles during neck pain causes DCF to weaken. Mainly leading to hyperactivity of the superficial neck muscles and loss of correct alignment. This leads many cervical deficits like muscular insufficiency and poor muscle activation . General musculoskeletal treatment such as stretching and strengthening of the neck muscles were used as an intervention to reduce neck pain. Severe cases of mechanical neck pain may cause functional disability by limiting the teacher from performing his tasks on daily bases due to the severe pain and discomfort.

Pressure biofeedback is a device that is designed to provide feedback for ensuring the quality and precision in exercise performance and testing. It is used to monitor and provide feedback on the body movement during exercise. Promoting effective exercise to improve neck and back pain by targeting deep muscles. The original value of our study lies in comparing the effectiveness of a combined pressure biofeedback training targeting deep cervical flexor muscles with general musculoskeletal training. consisting non specific neck muscle strengthening and stretching to improve endurance, reduce mechanical neck pain, increase proprioception and improve posture and functional disability.

The investigator expects the results and findings of this study will attribute in filling the gap in musculoskeletal and ergonomic rehabilitation. By highlighting the impact of combined training for deep cervical flexor muscles for school teachers using pressure biofeedback increases deep cervical flexor endurance, reduces pain and increases proprioception and functional disability. The uniqueness of this study is that it investigates the effect of adding pressure biofeedback training to usual care for mechanical neck pain. Specially considering the deep cervical flexor (DCF) muscles.

Previous studies have ignored DCF dysfunction in favor of superficial muscle assessment, despite its contribution to chronic neck pain .Previous study limitations, such as insufficient sample sizes, have further limited the generalizability of the findings. Targeting schoolteachers, who are especially prone to neck pain due to their working conditions .This study clearly combines pressure biofeedback assessment of deep cervical flexor (DCF) endurance with cervical joint position error testing to examine proprioception. Primarily to address the sensory-motor control often impaired in cervical disorders .Impairments in proprioception have been related to poor DCF performance .The intervention design combines ergonomic principles with health promotion strategies in occupational settings, aiming to address the physiological and functional aspects of neck pain .