Effects of sling system and elastic resistance band exercises on neck function and pain intensity in individuals with non – specific neck pain

Indtroduction: Neck pain is the 4th most common cause of pain-related disability and ranges from 30% to 50% in the general population (1). Conservative methods are still the most important in pain relief. Research is being conducted to find the best way, combining several therapies (2). Studies have shown that active therapy is more effective than passive therapy. During the sling exercise program, the deep muscles surrounding the spine are activated, which maintain balance and posture (3). It restores normal movement patterns and increases the amplitude of movements by unloading the forces of gravity (4). The aim of this study was to compare the effects of a sling system and elastic resistance bands exercises on neck function and pain intensity. Research methods and organization: This study was approved by the Bioethics Center of the Lithuanian University of Health Sciences. (Approval No. 2024-BEC2-987). All participants provided written informed consent. The study was conducted from November to February (2024-2025). 22 patients (6 men and 16 women), aged 25-62 with non-specific neck pain, were enrolled. There were 2 study groups. The average age of the group 1 was 41,55 (26-61) years, and the group 2 was 44,45 (25- 62) years. Inclusion criteria were: negative neurological tests (Spurling, distraction, arm nerves stretching tests); pain intensity is assessed by no more than 5 points on the VAS scale; working-age individuals (18-64); pain lasts longer than 3 months. Exclusion criteria: patients with fractures, infectious or oncological diseases; spinal surgery performed in the last 12 months; taking pain medication. They were randomly assigned into two groups: group 1 (n=11, 4 men 7 women): neck stretching and strengthening exercises + elastic resistance band; group 2 (n=11, 2 men 9 women): neck stretching and strengthening exercises + sling system. The exercises were performed for a total of 7 days, 4 of which were elastic resistance bands or sling system exercises. The training session lasted 30 minutes. Both groups performed exercises to stretch and strengthen the neck and shoulder girdle. Pain intensity was assessed using Visual Analogue Scale, functional condition was evaluated with Neck Disability Index which is designed to assess self-rated physical disability caused by neck pain. Deep neck flexors endurance was evaluated by The Deep Muscle Endurance Test. The analysis of the results was performed using the IBM SPSS Statistics program. Arithmetic mean (m), median (xme), minimum (xmin), maximum (xmax) of the data were calculated. The Mann-Whitney U test was used for independent samples and Wilcoxon for depended samples with a non-normal distribution. Significance level p<0.05. Results: Pain: Before physiotherapy, the pain assessment of the group 1 and the group 2 were 4 (2-5; 4,09) scores. There were no statistically significant differences between groups before physiotherapy (p=1,000; U=60,500). After physiotherapy, the pain assessment of group 1 was 4 (2-5; 3,64) scores, and group 2 was 2 (1-5; 2,45) scores. A statistically significant change was found in group 1 (p=0,025; Z=-2,236) and group 2 (p=0,004; Z=-2,842). After the intervention, there was a statistically more significant change in group 2 (p=0,036; U=30) compared to group 1. Deep neck flexors endurance (in seconds): Before physiotherapy, the endurance of the group 1 was 22 (11-35; 21,73) seconds, and the group 2 was 28 (13-42; 28,27) seconds. There were no statistically significant differences between groups before physiotherapy (p=0.094; U=86). After physiotherapy the deep neck flexors endurance of the group 1 was 26 (16-44; 26,45) seconds, and the group 2 was 31 (17-45; 32,45) seconds. A statistically significant change was found in group 1 (p=0,003; Z=2,952) and group 2 (p=0,003; Z=2,992). Neck Disability Index: Before physiotherapy, the disability score of the group 1 was 9 (4- 21; 11,27) scores, and the group 2 was 7 (2-18; 7,64) scores. There were no statistically significant differences between groups before physiotherapy (p=0.081; U=34). After physiotherapy the neck disability index of group 1 was 8 (4-17; 9,27) scores, and the group 2 was 3 (1-14; 4,45) scores. A statistically significant change was found in group 1 (p=0,005; Z=-2,825) and group 2 (p=0,003; Z=- 2,947). After the intervention, there was a statistically more significant change in group 2 (p=0,010; U=21,500) compared to group 1. Conclusions: After physiotherapy in both study groups pain intensity decreased, and neck functional status improved statistically significantly in patients with non-specific neck pain. Comparing the results of physiotherapy using elastic resistance bands and a sling system, the physiotherapy with sling system was more effective on decreasing neck pain intensity and functional disability in patients with non-specific neck pain.