Effect of proprioceptive neuromuscular facilitation and cranio-cervical flexor training on pain and function in chronic mechanical neck pain: A randomized clinical trial.

BACKGROUND: Chronic neck pain is known to be caused by the weakness of the deep neck flexors and disturbances in the mechanoreceptors and the proprioceptors of the cervical spine. Proprioceptive neuromuscular facilitation (PNF) is hypothesized to balance the relative stiffness and weakness of the muscles and activate the mechanoreceptors and proprioceptors. OBJECTIVE: To investigate PNF techniques and the craniocervical flexor training (CCFT) techniques for pain and function in chronic neck pain. METHODS: A randomized clinical trial was conducted on 66 chronic mechanical neck pain patients randomly assigned to either the PNF or CCFT groups using block randomization for a duration of 4 weeks. Numerical Pain Rating Scale (NPRS), Neck disability Index (NDI) and Active cervical range of motion (ACROM) were measured at baseline and after 4 weeks of intervention. Data were analysed using independent t test and MANOVA. RESULTS: The mean difference scores for NPRS and NDI were 2.18 and 15.72 in PNF group and 2.26 and 15.76 in the CCFT groups, respectively. Both the groups showed a change that was statistically significant. Also, the mean differences for the ACROM in all the planes in both the groups were statistically significant. However, the between group changes did not reveal any statistical significance in this study except for the right rotation in the CCFT group (p = 0.01). CONCLUSIONS: This study concluded that the PNF treatment is also beneficial to pain and function in treating chronic mechanical neck pain patients as its results stand similar to the CCFT treatment, which is already established to be a reliable tool to treat this condition.

Utility of next-generation sequencing in genetic testing and counseling of disorders involving the musculoskeletal system-trends observed from a single genetic unit.

BACKGROUND: Disorders involving the musculoskeletal system are often identified with short stature and a range of orthopedic problems. The clinical and genetic heterogeneity of these diseases along with several characteristic overlaps makes definitive diagnosis difficult for clinicians. Hence, using molecular testing in addition to conventional tests becomes essential for appropriate diagnosis and management. METHODS: Comprehensive clinical examination, detailed pretest and posttest counseling, molecular diagnosis with next-generation sequencing (NGS), genotype-phenotype correlation and Sanger sequencing for targeted variant analysis. RESULTS: This manuscript reports a molecular spectrum of variants in 34 orthopedic cases referred to a single genetic unit attached to a tertiary care hospital. The diagnostic yield of NGS-based tests coupled with genetic counseling and segregation analysis was 79% which included 7 novel variants. In about 53% (i.e. 18/34 cases), molecular testing outcome was actionable since 8 of the 18 underwent prenatal diagnosis, as they were either in their early gestation or had planned a pregnancy subsequent to molecular testing, while ten cases were premaritally/prenatally counseled for the families to take informed decisions as they were in the reproductive age. CONCLUSIONS: The report highlights the importance of NGS-based tests even in a low resource setting as it helps patients, families and healthcare providers in reducing the economic, social and emotional burden of these disorders.