Sleep ergonomics are increasingly prescribed as an adjunct treatment to chronic neck pain. Postulated benefits to maintaining the ideal sleeping posture are improved tissue repair in and around the facet joints, decrease in tension of associated musculature and better quality sleep.
The purpose of this study was to determine if the inclusion of a visco-elastic polyurethane (VEP) pillow could benefit the chiropractic treatment of chronic neck pain.
The study took place at a chiropractic training clinic in Johannesburg.
Participants were randomly assigned to either a chiropractic treatment only group (CHI) (
Both the CHI and CHI+P groups significantly (
Findings of this study suggest that a VEP pillow could be included as an adjunct management tool to chiropractic treatment of chronic neck pain.
Neck pain is a common health problem with approximately 70% of the population suffering from its debilitating effects at some point in their lives (Bronfort et al.
The aetiology of chronic neck pain is complex with considerations encompassing the structural cause of the pain being the cervical facets, capsule, ligaments and/or musculature (Ita et al.
Recent findings suggest that daily ergonomics, such as standing, sitting and sleeping postures, need to be addressed as an adjunct management tool irrespective of the type of treatment that an individual is undergoing for neck pain relief (Canivet et al.
Chiropractic spinal manipulation has been shown to be beneficial in the treatment of chronic neck pain (Bronfort et al.
The aim of this study was to determine if there is any additive effect to the inclusion of a VEP pillow with chiropractic treatment for chronic neck pain.
This study used a 3-week quantitative pre- and post-test experimental design with random group allocation, whereby one group received chiropractic manipulation (CHI) and was compared with another group that received chiropractic manipulation combined with the use of a VEP foam cervical spine pillow (CHI+P).
A total of 30 participants, both men and women, between the ages of 18 and 38 years, diagnosed with chronic neck pain who presented to the chiropractic clinic took part in this study (
Visco-elastic polyurethane Memory Foam® pillow (62 cm × 40 cm × 12 cm).
Demographic and baseline characteristics of participants in each group.
Variable | Chiropractic treatment only group (CHI) ( |
Chiropractic treatment with visco-elastic polyurethane foam cervical spine pillow group (CHI+P) ( |
---|---|---|
Age distribution (years) | 22–30 | 22–38 |
Mean age (years) | 25.13 ± 2.13 | 26.07 ± 4.30 |
Females ( |
7 | 8 |
Males ( |
8 | 7 |
Note: Data are presented as mean ± SD.
Subjective, quantitative data were collected during the trial between February and May 2013 by means of the Numerical Pain Rating Scale (NRS) (Farrar et al.
In addition, the present study utilised the NDI, which is a valid and reliable (Ackelman & Lindgren
Participants in both groups underwent a total of six chiropractic treatments performed by the researcher over a 3-week period between February and May 2013. Chiropractic treatments consisted of chiropractic manipulation of the cervical spine using a diversified technique (Esposito & Phillipson
Data analysis was performed by an independent statistician using raw scores provided by the researcher. Normality of distribution was determined for all variables using the Shapiro–Wilk test. Non-parametric tests were utilised to determine the effects of chiropractic treatments compared to chiropractic treatment combined with a VEP pillow on the patient’s perception of neck pain. The Friedman test was used to determine if a change occurred from pre- to post-test within each group, while the Wilcoxon signed-rank test was utilised to determine if a change took place within each group (i.e. visit 1 to visit 4 or from visit 4 to visit 7). The Mann–Whitney
The protocol was designed according to the ethical norms set out in the 1961 Helsinki Declaration (modified in Edinburgh in 2000) and the study was approved by the university’s Research Ethics Committee. Written informed consent was obtained from the participants after they were explained the purpose of the study, measurement procedures and the possible negative events that could be encountered during the study. University of Johannesburg Research Ethics Committee; AEC 13-01-2013; 4 March 2013.
The Mann–Whitney
Numerical Pain Rating Scale percentage changes following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment protocol in patients with chronic neck pain caused by cervical facet syndrome.
Changes in chronic neck pain caused by cervical facet syndrome following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment protocol.
Variable | Chiropractic treatment only group (CHI) ( |
Chiropractic treatment with visco-elastic polyurethane foam cervical spine pillow group (CHI+P) ( |
||||
---|---|---|---|---|---|---|
Consultation 1 | Consultation 4 | Consultation 7 | Consultation 1 | Consultation 4 | Consultation 7 | |
NRS score | 5.27 ± 1.94 | 4.27 ± 1.58 |
2.87 ± 1.19 |
5.93 ± 1.22 | 2.93 ± 1.75 |
1.60 ± 1.30 |
NDI score | 10.93 ± 5.50 | 6.33 ± 2.58 |
4.20 ± 2.18 |
13.40 ± 4.82 | 6.40 ± 5.33 |
3.80 ± 4.28 |
Data are presented as mean ± SD.
, Consultation 4 statistically significant (CHI:
, Consultation 7 statistically significant (CHI:
, Consultation 7 statistically significant (CHI:
NRS, Numerical Pain Rating Scale; NDI, Vernon–Mior Neck Pain and Disability Index.
Both the CHI and CHI+P were found to be homogenous at the commencement of the study (
Vernon–Mior Neck Pain and Disability Index percentage changes following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment protocol in patients with chronic neck pain caused by cervical facet syndrome.
The purpose of this study was to determine if the inclusion of a VEP pillow could benefit the chiropractic treatment of chronic neck pain. In this regard, the present study demonstrated that both the CHI and CHI+P groups improved their mean NRS and NDI scores. These findings are not unusual in that it has previously been demonstrated that chiropractic manipulation is effective in the treatment of chronic neck pain (Bryans et al.
While the benefits of cervical pillows on reducing neck pain are well documented (Erfanian et al.
While the concomitant use of a pillow with chiropractic treatment is a novel finding, many studies exist that attempt to improve the efficacy of chiropractic manipulation with the addition of additional therapies in a multimodal form of therapy (Bryans et al.
Some limitations should be noted in this study that may have had an influence on the results. Chance cannot be excluded because of the small sample size. The small sample does allow for some insights, but no definitive conclusions can be made. Potential researcher bias should also be considered as an influence in the results, ideally researcher blinding should have occurred for treatment groups as well as measurements. Also, tighter external variables could have been controlled for, such as occupation and age of the participants. The low mean age of the participant sample may have made them more receptive to treatment than the average population suffering with chronic neck pain.
While the findings of the present study are novel and have important implications for clinical treatment and therapeutic guidelines, future studies should make use of additional objective measures, such as surface electromyography (sEMG) of cervical musculature, pressure algometer readings of the cervical facets and cervical range of motions, to aid the clinical findings. In addition, future studies should be of a longer duration to maximise benefits because individuals take time to adapt to newly introduced pillows and sleeping posture. In this regard, Gordon et al. (
Combining the mechanical and pain inhibitory effects of cervical manipulation with the supportive properties of the VEP foam pillows may be beneficial to the patient compared to chiropractic treatment alone. While both the chiropractic treatment and the combined treatment proved effective, the clinical performance of the CHI+P group with regard to NRS indicates a potential synergistic effect of the VEP foam pillow with cervical manipulation in the treatment of chronic neck pain. There were trends in the clinical analysis of the NDI, which also indicated some additional benefit. Further research is warranted.
The authors would like to thank Sleep Active South Africa for sponsoring the pillows. This study would not have been possible without their support. The authors would also like to thank Dr M. Nel for the contributions.
The authors have declared that no competing interest exists.
All the authors equally contributed to this work.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.