|Year : 2022 | Volume
| Issue : 3 | Page : 331-338
Efficiency of matrix rhythm therapy on pain, strength, and quality of life in forward neck posture: A randomized controlled trial
Varun C Naik, Mayuri Kerkar, Sazney Mascarenhas
Department of Cardiovascular and Pulmonary Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
|Date of Submission||27-May-2022|
|Date of Acceptance||09-Aug-2022|
|Date of Web Publication||27-Dec-2022|
Dr. Varun C Naik
KAHER Institute of Physiotherapy, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
Objective: To determine and compare the effects of the Dynamic Exercise Program (DEP) and matrix rhythm therapy (MaRhyThe©) along with conventional physiotherapy in asymptomatic subjects with forward head posture (FHP) on a craniovertebral angle (CVA), strength, pain, and quality of life (QoL) using CVA, pressure biofeedback unit, pain algometer, and short form (SF-36), respectively. Methodology: Sixty-five people were screened for the study, of which 30 were included (18 females and 12 males) who participated in the study. The study participants were randomly allocated to Group A (DEP) or Group B (MaRhyThe©). Preintervention outcome measures used were CVA for the neck position, a craniocervical flexion endurance test for strength, a pain algometer for pain pressure threshold, and SF-36 for QoL. Postintervention outcome measures were recorded on the 6th day after intervention. Results: Data were analyzed descriptively with a priori establishment of success criteria of P < 0.05. Within-group analysis of both groups demonstrated statistically significant parameters of CVA, strength, and pain as P < 0.05. Between groups analysis demonstrated Group B to be statistically significant in all the outcome measures CVA (P < 0.0001), strength (P < 0.0001), and pain (P < 0.0001). SF-36 showed a positive effect on some subdomains as to emotional well-being (0.0320) and pain (0.0047*). Conclusion: It was determined that both deep exercise programs and MaRhyThe© when combined with conventional physiotherapy are effective in treating FHP. However, MaRhyThe© with conventional physiotherapy was found to be superior in reducing pain and improving range of motion, strength, and QoL.
Keywords: Algometer, craniovertebral angle, forward neck posture, MaRhyThe©, matrix rhythm therapy, therabands®
|How to cite this article:|
Naik VC, Kerkar M, Mascarenhas S. Efficiency of matrix rhythm therapy on pain, strength, and quality of life in forward neck posture: A randomized controlled trial. J Sci Soc 2022;49:331-8
|How to cite this URL:|
Naik VC, Kerkar M, Mascarenhas S. Efficiency of matrix rhythm therapy on pain, strength, and quality of life in forward neck posture: A randomized controlled trial. J Sci Soc [serial online] 2022 [cited 2023 Jan 31];49:331-8. Available from: https://www.jscisociety.com/text.asp?2022/49/3/331/365162
| Introduction|| |
One of the most common types of postural disorders described as an anterior position of the head about the vertical line of the body's center of gravity is forward head posture (FHP). When combined with improper sitting posture, carrying heavy school bags, sitting in front of a computer screen for extended periods without adequate workplace ergonomics, and a lack of exercise, FHP has been linked to a reduced cervical range of motion (ROM). The anterior cervical muscles lengthen and weaken, and the posterior cervical muscles shorten, as a result of FHP. If postural misalignment generates cervical muscular imbalances, the joint and muscle are overworked, making FHP issues persistent. It also decreases craniocervical flexion ROM and activation of deep cervical flexors. Reduced activation of these flexors during craniocervical flexion exercises is connected to greater activation of superficial muscles including the sternocleidomastoid muscle and the anterior scalene muscle in those who have neck pain. The reduction in the craniovertebral angle (CVA), which is a reliable diagnostic of FHP, has been linked to this misalignment in FHP.
FHP can be diagnosed both subjectively and objectively through CVA measurement, which can be done using electronic head posture equipment, X-rays, or a photographic technique. Traditional physiotherapy treatment for symptomatic FHP is required, which includes pain-relieving modalities, muscle spasm reduction, and muscle imbalance correction. When asymptomatic FHP is detected, simple home exercise programs that programs self-care activities may be prescribed, greatly assisting in preventing future difficulties. In addition, when joint play therapy was used on the neck, the participants had a better ROM and reduced pain. Strengthening and stretching activities of the neck and shoulder flexor muscles and stretching exercises for the neck extensor and pectorals muscles enhance neck alignment. The dynamic exercise program (DEP) comprises gradually increasing ROM through successive motions while moving across the available ROM in a controlled manner. By repeating and rehearsing movement, DEP aids in the restoration of dynamic function and neuromuscular control, hence enhancing motor control. DEP activities help to raise the core temperature by increasing nerve conduction velocity, muscle compliance, and enzymatic cycling while also increasing energy output.
Matrix rhythm therapy (MaRhyThe©) was created by Dr. Ulrich G. Randoll at Erlangen University in Germany. It' is a relatively recent therapeutic method for a wide range of musculoskeletal issues. The concept behind MaRhyThe© is that the body's cells vibrate or oscillate between the frequencies of 8–12 Hertz (Hz). MaRhyThe© is applied using the Matrixmobil®, a Class IIA medical device. It synchronizes the body's intrinsic vibrations through the neuromuscular system in the alpha rhythm (8–12 Hz). In all warm-blooded creatures, it' is a fundamental frequency range and it' is one of the signs of proper cellular logistics, which ensures life processes. MaRhyThe© to regularize the extracellular environment to normal so that hindered extracellular and cellular functions can resume. The treatment is systemic, depending on physiological cycles and concentrating extracellular matrix (ECM) to optimize cellular logistics and so restore metabolism. As a result, there will be no negative consequences.
There has been no study to evaluate and compare the effect of MaRhyThe© and dynamic exercise program in subjects with FHP; hence, this study aims to determine the effectiveness and complete the two recent treatment methods. The objective of the study is to compare the effects of DEP in subjects with FHP on ROM, strength functions, and using CVA, pressure biofeedback unit (PBU), neck disability index, and pain algometer, respectively.
| Methodology|| |
Ethical clearance was obtained from the Institutional Ethical Committee of from KAHER Institute of Physiotherapy, Belagavi, Karnataka, India (KIPT/SI No. 556/May 25 2021). The study was with Clinical Trial Registry – India with reference no: CTRI/2021/03/031728. Recruitment and data collection was conducted between March and August of 2021. A total of 65 people (n = 65) were screened for eligibility. The study enlisted the participation of thirty people (n = 30). The participants were randomly assigned to one of two study groups: Group A: DEP and conventional physiotherapy (n = 15) or Group B: MaRhyThe© and conventional physiotherapy (n = 15) using a closed envelope technique. Written consent was then taken from all participants, and details about the study were briefed in their vernacular languages. Individuals were selected based on the inclusion criteria which were: (1) Subjects of all gender, aged between 25 and 40 years with or without neck pain, (2) subjects with CVA <44°, and (3) subjects willing to participate in the study. The purpose and procedure of the study were explained and written informed consent was obtained. A brief demographic data were taken from the participants before the assessment.
The primary outcome measures were eCVA, strength, pain, and quality of life (QoL).
All outcome measures were recorded at baseline and after intervention (day 6).
The angle was calculated using a smartphone app with a protractor. The participants were seated on a stool and directed to concentrate on a specific spot at eye level. A photograph of the participant's left side was taken from a lateral perspective. A line was drawn from the spinous process of C7 to the tragus of the ear and a horizontal line passing through C7 was used to calculate the angle.
The strength was assessed using the craniocervical flexion endurance test (CCFE). In a supine position, the subject's cervical spine was in a neutral position. The PBU was placed between the plinth and the posterior neck just behind the occiput. The cuff was then inflated to a 20 mmHg baseline pressure. To assist them to understand the exam process, each participant received a single practice session. Following that, the subject was told to avoid raising his head during the CCFE test, which reduced superficial flexor activation. The neck flexion movement was then repeated five times at five different pressure levels (22, 24, 26, 28, and 30 mmHg), with a 10-s hold at each level and a 30-s rest in between. If the person could not maintain a specified neck posture for 10 s at a certain pressure level, or if the maximum pressure level of 30 mmHg was achieved, the test was over.
Pain pressure threshold
The pain pressure threshold was assessed using analog altogether. The pain level was determined using an analog algometer (Baseline FDK). The instrument is a force gauge with a disc-shaped rubber tip with a 1 cm2 surface area. Kilograms per square centimeter are used to measure pressure. The algometer was positioned at a predetermined trigger point, with the metal rod perpendicular to the skin's surface and the patient sitting. The pressure was increased at a rate of 1 kg/s. The patient was told to point to the spot where he or she felt discomfort. The technique was performed three times with a 1-min break between each subject after the dial had been set to 0. For the analysis, the average of three measurements was utilized.
Quality of life
SA short form 36 (SF-36) questionnaire was SF to determine QoL. This questionnaire was used to measure subjects' QoL at the baseline and 1 week after the intervention.
Group A: Dynamic exercise program using theraband
The intervention and the study's nature were explained to the participants. DEP was given to 15 people. It contained the following items: In the prone position, placing a hydro collator pack for 15 min over the neck area. Neck flexion against Theraband resistance (10 s hold × 10 repitions × 3 sets), neck extension against Theraband resistance (10 s hold × 10 repitions × 3 sets), bilateral trapezius muscle fiber stretching (30 s hold × 3 repitions), and chin tucks exercises with manual resistance (10 s hold × 10 repitions × 3 sets) were given in a sitting position with back supported on a chair.
Group B: Matrix rhythm therapy
The subject was made to sit comfortably and the area to be treated (neck and upper trapezius) was exposed and talcum powder was applied over the treatment area to avoid the friction caused by the Matrixmobil® probe. An electrically powered oscillator (resonator) with an asymmetric head whose mechanical oscillations are complemented by a magnetic sinusoidal phase-synchronized field applies it. These mechanical oscillations cause a longitudinal motion in the musculature that can be seen, as analogous to muscle strain. The treatment with Matrix Mobil® included longitudinal strokes given with the probe of the device. The session was delivered for 60 min. The treatment was concentrated more on tender points to release the tightness and reduce pain. Only one session of 45–60 min was given per subject.
Subject characteristics were compared for both testing t-test and normality of posttested posttest scores various parameters in Group A were Group B was analyzed by Kolmogorov–Smirnov test. The pretest and posttest scores of all parameters in Group A and Group B follow a normal distribution. Therefore, the parametric tests were applied. Within-group analysis and between-group analyses used dependent t-tests and independent t-tests, respectively, to determine the statistical significance of the variables. The level of significance for all statistical tests was set at P < 0.05. All statistical analyses were carried out using Microsoft Excel and IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corporation.
| Results|| |
[Table 1] and [Table 2] show the mean ± standard deviation for age, height, weight, body index mass BMI, CVA angle, CCFE, Pain Pressure Algometer scores (PPA), and SF-36 for Group A and Group B. There was no significant difference between the groups in age, height, weight, and pre-and post-test scores (P > 0.05) except for BMI (P < 0.0196). Demographic data were explained using the mean gender and age of the participants in Group A as 33.33% men, 66.67% females, and 32.60 ± 6.85 years, while the mean gender and age of the participants in Group B were 46.67% males, 53.33% females, and 32.87 ± 7.19 years, indicating homogeneity. The individuals in Group A had a mean BMI of 24.37 ± 2.84 kg/m2, whereas Group B had a mean BMI of 21.57 ± 3.34 kg/m2, indicating that they were heterogeneous showing statistical significance.
|Table 1: Comparison of Group A and Group B with gender, age, and body mass index|
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|Table 2: Normality of pretest and posttest sores of various parameters in Group A and Group B by Kolmogorov-Smirnov test|
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[Table 3] and [Table 4] revealed a significant improvement was noted within the group by the dependent t-test for CVA (in degrees) in Group A (P = 0.0001) with a mean difference of −4.36 and that of Group B (P = 0.0001) with a mean difference of −11.91. Statistical significance was also noted by the dependent t-test in terms of CVA, with Group B being superior to Group A (P = 0.0001) with an effect sizes of 0.9845 to 0.9320, respectively.
|Table 3: Within group comparison of pretest and posttest craniovertebral angle (°) scores in Group A and Group B by dependent t-test|
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|Table 4: Between group comparison of Group A and Group B with pretest and posttest craniovertebral angle (°) scores by independent t-test|
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[Table 5] and [Table 6] exposed the CCFE test (in mmHg), both Group A (P = 0.0192) and Group B (P = 0.0001) showed a significant improvement in the dependent t-test when compared before and after the intervention. Statistical significance was also noted by the independent t-test in terms of CCFE, with Group B being superior to Group A (P = 0.0001) with an effect sizes of 0.8890 to 0.3390, respectively.
|Table 5: Within group comparison of pretest and posttest craniocervical flexion endurance (mmHg) scores in Group A and Group B by dependent t-test|
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|Table 6: Between group comparison of Group A and Group B with pretest and posttest craniocervical flexion endurance (mmHg) scores by independent t-test|
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Similarly, significant improvement was noted within the group by the dependent t-test for pain-pressure (gs) in Group A (P = 0.0001) with a mean difference of −0.28 and that of Group B (P = 0.0001) with a mean difference of −0.94. Statistical significance was also noted by independent t-test in terms of pain pressure, with Group B being superior to Group A (P = 0.0001) with an effect size of 0.9380 to 0.8910, respectively, in [Table 7] and [Table 8].
|Table 7: Within group comparison of pretest and posttest pain-pressure (gs) scores in Group A and Group B by dependent t-test|
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|Table 8: Between group comparison of Group A and Group B with pretest and posttest pain-pressure (gs) scores by independent t-test|
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[Table 9] and [Table 10] expressed the SF-36 questionnaire, within the group by the dependent t-test demonstrated only the pain parameter was improved in Group B (P = 0.0152). Statistical analysis between the groups by the independent t-test showed significant changes only in energy, emotional well-being, pain, and general health parameters.
|Table 9: Within group comparison of pretest and posttest component scores of short form 36 in Group A and Group B by dependent t-test|
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|Table 10: Between group comparison of Group A and Group B with pretest and posttest component scores of short form 36 by independent t-test|
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| Discussion|| |
The purpose of this study was to see how DEP and MaRhyThe affected FHP, and the results showed that FHP was significantly improved in terms of CVA, CCFE, and pain levels. FHP causes anterior neck and shoulder muscles to tense and posterior neck extensors to shorten, as well as kinematic impacts on the scapular position. To correct this musculoskeletal imbalance, strengthening and stretching are widely advocated in the literature.
Exercises are a prominent modern treatment for common ailments. In this study, a neck dynamic exercise program was recommended for patients with forwarding head posture which has already been proven to be effective. These exercises help individuals improve their posture, reduce tension, and boost their self-confidence. Physiological responses to stress exerted on muscular tissue result in increased muscle strength during exercise. For adaptations to occur, the stress imposed must be an overload, the overload principle helps surpass a threshold for an adaptive response to the exercise leading to muscle fibers expansion in diameter, which is known as hypertrophy. Hypertrophy is caused by an increase in the quantity and size of myofibrils inside muscle fibers, as well as an increase in myosin contractile protein, capillary density per muscle fiber, and connective tissue density. In addition, the quantities of creatinine, adenosine triphosphate, glycogen, and glycolytic enzyme activity in muscle fibers rise biochemically.
MaRhyThe©, when coupled with DEP and conventional physiotherapy, was found to be effective in the treatment of FHP in this study. When compared to stretching in studies, MaRhyThe© combined with conventional physiotherapy is beneficial for the treatment of frozen shoulder, with improvements in pain, disability, and ROM. A single session of MaRhyThe© has been shown in a study to be effective in patients with plantar fasciitis and found the therapy to help reduce pain, improve skin temperature, and improve functional activities.
MaRhyThe© creates oscillation that is comparable to typical cellular vibration of 8–12 Hz, which promotes oxygen delivery to the cells and so re-establishes nourishment supply through better microcirculation, according to the matrix concept. Soft-tissue structures relax, as a result, lowering discomfort and indirectly improving tissue mobility and tone. Improved tone and mobility of the paracervical muscles may aid in the alignment of the spine, resulting in less FHP, pain relief, and a better QoL.
The current study is in agreement with a previous study in regards to the reduction of pain and function in myofascial trigger points in the trapezius muscle. To maintain straight shoulders and an open chest, the middle trapezius and rhomboid muscles in the upper back pull the scapulae (shoulder blades) backward. Hunched shoulders and an FHP are made worse by the weak trapezius and rhomboid muscles, which also causes the shoulder blades to lean forward. In addition, these muscles' trigger sites and persistent FHP are related. MaRhyThe© was discussed to increase blood circulation by 35%. As blood circulation improves following MaRhyThe© application, metabolic waste products and other biochemicals are eliminated, resulting in a normalization of pH and the restoration of cell metabolism. As a result, ATP is created, which is necessary for the actin-myosin separation during the muscle's relaxation phase. As a result, the trigger point is deactivated, and the muscle resumes its regular function. The interchange of metabolites and nutrients is strengthened at the cellular level thanks to MaRhyThe©, which creates an uneven pressure distribution and activates the ECM thus correcting the faulty posture and reducing the associated complaints., The study's shortcomings appear to lie in in-group heterogeneity.
| Conclusion|| |
It was determined that both deep exercise programs and MaRhyThe© when combined with conventional physiotherapy are effective in treating FHP. However, MaRhyThe© with conventional physiotherapy was found to be superior in reducing pain and improving ROM, strength, and QoL. This study also provides preliminary evidence that adding MaRhyThe© to conventional physiotherapy may be beneficial in improving FHP and QoL.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee KJ, Han HY, Cheon SH, Park SH, Yong MS. The effect of forward head posture on muscle activity during neck protraction and retraction. J Phys Ther Sci 2015;27:977-9.
Lee MH, Park SJ, Kim JS. Effects of neck exercise on high-school students' neck-shoulder posture. J Phys Ther Sci 2013;25:571-4.
Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: A randomized, controlled 10-week trial. J Man Manip Ther 2005;13:163-76.
Kim BB, Lee JH, Jeong HJ, Cynn HS. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol 2016;30:31-7.
Kim DH, Kim CJ, Son SM. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong public health and research perspectives 2018;9:309.
Gurudut P, Welling A, Chodankar A. Effect of self-care exercises in forward head posture on craniovertebral angle and craniocervical flexion endurance: A pilot study. Indian J Phys Ther Res 2020;2:25.
Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther 2003;8:10-20.
Kendall F. Muscles Testing and Function. Baltimore, MD.: Williams & Wilkins; 2005.
Mason D. Exercise in rehabilitation. In: Porter S, editor. Tidy's Physiotherapy. 14th
ed. London: Churchill Livingstone; 2008. p. 414-9.
Randoll UG, Henning FF. Cell biological basics, theory and practice. Pt Zeitschrift Physiotherapeuten 2009;6:1-6.
Mamania J, Anap D, Tanksale D. Validity and reliability f 'on protractor' smartphone application for measurement of craniovertebral and cranio-horizontal angle. Int J Physiother 2017;4:207-11.
Kang DY. Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture. J Phys Ther Sci 2015;27:3207-10.
Dresser J, MacIntyre M, Chisholm B, Lawson GE. Is bone tenderness, as measured by manual algometry, associated with vitamin D deficiency? J Can Chiropr Assoc 2014;58:320-7.
Syddall H, Martin H, Harwood R, Cooper C, Aihie Sayer A. The SF-36: A simple, effective measure of mobility-disability for epidemiological studies. J Nutr Health Aging 2009;13:57-62.
Sarı Z, Polat MG, Özgül B, Aydoğdu O, Camcıoğlu B, Acar AH, et al.
The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes. Burns 2014;40:909-14.
Shin H, Kim K, Jung N. Effects of dynamic exercise program using thera-band on craniovertebral angle in adults with forward head posture. J Int Acad Phys Ther Res 2020;11:1960-8.
Çelik D, Türkel N. Comparison of matrix rhythm therapy and stretching exercises on the frozen shoulder: Randomised controlled trial. Turk J Phys Med Rehabil 2016;27:81-8.
Naik V, Singh M. Effects of matrix rhythm therapy (MaRhyThe) in plantar fasciitis – An experimental study. Indian J Phys Ther Res 2019;1:105. [Full text]
Maruthy T, Bindu PH, Kauser MS. Effects of matrix rhythm therapy in patients with myofascial trigger points. J Soc Indian Physiother 2019;3:27-9.
Taspinar F, Aslan UB, Sabir N, Cavlak U. Implementation of matrix rhythm therapy and conventional massage in young females and comparison of their acute effects on circulation. J Altern Complement Med 2013;19:826-32.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]