Neck pain (or cervicalgia) is a common problem, with sixty percent of the population suffering with it at some point in their lives. Neck pain, although felt in the neck, can be caused by many other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, and pinching of the nerves emanating from the cervical spine. Non-Specific Neck Pain is the most common one. This is also known as simple or mechanical neck pain. The causes may be minor strains and sprains to muscles or ligaments in the neck. Bad posture seems to be the major contributing factor in many cases. Neck pain can be caused due to many other physical and emotional health problems as well. The mechanism of pain would be an abnormally large compression force on the articular facet due to altered and sustained pull of the shortened muscles.1 There will be flexion in lower cervical region and extension in upper cervical region. It is a long process brought about by constant and repetitive motion, where the head is leaning to the front. For every inch the head moves forward, it gains 10 pounds in weight as far as the muscles in neck and upper back are concerned because they had to work that much harder to keep head from dropping into the chest.2 Stretching techniques are used to increase the extensibility of the muscle tendon unit and the peri-articular connective tissue. Stretching is used to increase the flexibility. Self-Stretching is also referred to as flexibility exercise or active stretching exercises.3 A computer professional is a person working in the field of Computers. This includes computer programmers and software engineers, computer scientists, computer systems analyst, computer technicians, Data entry operators, Graphic Designers, etc.4 A non specific neck pain is an acute (sudden onset) bout of neck pain which in most cases is not due to a serious disease or neck problem, but most often due to minor sprains or bad posture and in few cases the exact cause for the pain is not clear.5 Ultrasound is a type of sound, and all types of sound consist of waves that transmit energy by alternating compressing and rarefying material. It is sound with frequency greater than 20 KHz. Therapeutic Ultrasound has a frequency between 0.7 and 3.3 MHz to maximise energy absorption at a depth of 2 to 5 cm of soft tissue.6 Ultrasound may be used in a continuous mode where the treatment head continuously produced ultrasonic energy or pulsed where the periods and ultrasound are separated by periods of silence. continuous mode has been recommended for musculoskeletal disorder such as spasm, joint stiffness or pain whereas pulse mode is preferred for soft tissue repair.7The most frequently used ultrasound frequencies are 1 MHz and 3MHz. A 3MHz will lead to more superficial effect and has penetrating depth of 2 cm whereas 1 MHz output targets tissue up to 5em deep.8 The present study was conducted with the objective to find out the effect of Active chin Tuck Exercise and Myofacial Release (MFR) to reduce pain and improvement of Neck Function among the Computer Professionals.

The present comparative studywas done on subjects were diagnosed with Neck pain of computer professionals in OPD of Vidyasagar Institute of Health, Rangamati, Paschim Midnapore,West Bengal And TRA General Hospital, Kolkata. The study period was six months(August 2017 to January 2018) in 2nd year MPT course and study design was Experimental Research Study. Inclusion criteria: Male and female subjects 25 years to 50 years’ age, subjects having neck pain for more than 4 weeks, subjects working on computers for more than 30 hours per week, Neck pain in the cervical region, possibly with referred or radiating pain inthe occiput, nuchal muscles, shoulders and upper limbs without proven structural disorders in the cervical spine, nerve roots or spinal cord. Have been diagnosed with chronic, intractable pain of the upper limb and/or neck related to the cervical spine and/or neuropathic arm pain. Exclusioncriteria:Subjects with any Cervical Anomalies like Cervical Rib, Disc pathology, Subjects with upper or lower motor neuron disorders, Subjects who had undergone any surgery around the neck, Subjects having congenital Short Neck, wry neck, torticollis and Subjects having Asymmetrical spinal curvatures like increased Kyphosis, lordosis and scoliosis. Sample size:A total no of thirty (30) subjects of this study were recruited for this study. Sample size was done based on the number of outcomes measures and previous publication. Study Technique: 30 Subjects with Non-Specific Neck Pain among Computer Professionals were randomly selected who meet inclusion criteria. All subjects were asked to sign the written consent form stating the voluntary acceptance to participate in this study. Then, the pre-participation data [i.e. Age, Sex, Site of pain, duration, Cause, occupation, Medical conditions, Medications, Surgery/Trauma details were collected from all the selected subjects. The subjects were then randomly divided into two groups Group A and Group B, each group containing 15 subjects each. Group A: Received Ultrasound Therapy and active chin tuck exercises for 6 weeks. Group B: Received Ultrasound Therapy and MFR for 6 weeks. Individuals of each group were tested by Visual Analog Scale(VAS) and neck function. Both the groups will receive intensive treatment schedule for 1 hour/day, 5 days/week (Monday to Friday), for consecutive 6 weeks After 6 weeks of treatment procedures all the participants were undergo re-evaluation of pain and neck function using Visual Analog Scale and Copenhagen Neck Function Disability Scale (CNFDS) to obtain specific differences in pain and neck function, and the reading were subjected to statistical analysis. Data analysis: For this study thirty subjects were selected and assigned into two groups each Group had fifteen subjects. Namely Group A and Group B, Group A received Ultra Sound Therapy (1MHZ, Pulse Wave, 1 W/cm2) with Active chin Tuck Exercises and Group B received Ultra Sound Therapy (1MFIZ, Pulse Wave, 1W/cm2) with MFR(Sub occipital muscle release therapy technique). VAS Scale Score and Copenhagen Neck Function Disability Scale (CNFDS) test measurements were taken on the first day prior to the treatment and after eighths weeks of treatment for the both groups. Mean was calculated on the first day and at the end of eighths week to see the average improvement in Pain and Neck function. Standard Deviation was taken to see the variation from their Mean. The probability value was calculated to see the variations within Group from day one to final day of treatment.The observation differences were tested by "PairedT-test" within the Groups and by "unpaired 't'-test" to test the value between two groups. Statistics are performed by using SPSS 23.The level of significance was calculated at p=0.05.

Table 1: Demographics characteristics of the study subjects. (n=30) Agegroup Group A Group B 25-30 4 4 31-35 4 4 36-40 4 4 41-45 3 3 Gender Male 7 8 Female 8 7 Age of the subjects in this study was between 25 to 45 years. The average age of the subjects in group A was 35.8715.83 years and average age of the subjects in group B was 35.80± 5.53 years. And there was no significant difference between the mean age of subjects in both the groups (T=.0321, df=14, p=0.9746).Gender ratio of sample male to female was 07:08 in group A that is 07 males and 08 females participated in the study. Group B consisted of 08 males and 07 females' i.e 08:07 ratio. There was no significant difference between the Gender ratio of the subjects in both the groups ('t'= 0.000, df— I p— 1.0). (Table 1). Table 2: Group A and B, Pre, Post and Mean difference in CNFDS Score. Group Pre Treatment Post Treatment Mean Difference Paired `t' df P Value A 14.8+3.28 12.46+2.67 2.33+0.347 6.718 14 .000 B 16.07+2.15 10.80+2.76 5.27+0.492 10.694 14 .000 The paired ‘t’-test was used for Group A &B Group B Pre and Post intervention CNFDS scores. As seen in the table and figure Statistical analysis showed significant (p<0.05) difference in Neck Function after intervention for both groups. (Table 2) Table 3: Mean difference in CNFDS Score between Group A &B Group Mean Difference sd df P Value Unpaired ‘t’ Inference A vs B 2.333 1.343 28 <.0001 4.8833 Statistically Significant 5.27 1.096 The un-paired ‘t’-test was used between Group A & Group B for Pre and Post test value ofCNFDS Score. Statistical analysis showed significant (p<0.05) difference after intervention for both groups.It also showed that CNFDS score was significantly more in Group B as compared to Group A. (Table 3) Table 4: Group A and B, Pre, Post and Mean difference VAS Score Group Pre Treatment Post Treatment Mean Difference Paired ‘t’ df P Value A 6.53±1.06 5.13+0.92 1.40+0.321 4.3653 14 .000 B 6.47±1,13 2.530.92 3.93±0.267 14.75 14 .000 The paired ‘t’-test was used for Group A & Group B for Pre and Post intervention VAS scores. Statistical analysis showed significant (p<0.05) difference in VAS Score after intervention for both groups. (Table 4) Table 5 : Mean difference in VAS Score between Group A & B. Group Mean Difference sd df P Value Un Paired ‘t’ Inference A vs B 1.40 1.243 28 .000 6.0595 Statistically Significant 3.93 1.034 The un-paired ‘t’-test was used between Group A & B for Pre and Post VAS scoresanalysis. Statistical analysis showed significant (p<0.05) difference in pain relief after intervention for both groups.It also showed that VAS score was significantly more in Group B as compared to Group A. (Table 5).

Results revealed that both groups showed significant reduction in pain and increase in function of non-specific neck pain as measured by VAS scores and Copenhagen Neck Function Disability Scale (CNFDS) at the end of 6t However ultrasound therapy combined with myofascial release technique proved to be more effective in reducing pain and increasing function of nonspecific neck pain in contrast to active chin tuck exercise combined with ultrasound therapy between the groups Neck function was significantly improved in Myofascial Release group and other group, pre and post experiment and between group difference was also significant (p<0.05). Mean and standard deviation of pre and post of group A neck function were pre (21.60±2.03) and post (12.67±1.29) with p value 0.0001. Mean and standard deviation of pre and post of group B for neck function were (20.87±1.96) and (14.07±1.10) with p value 0.0001. Statistical analysis showed significant difference within the groups. VAS scale was significantly decreased in MFR group and other group, pre and post experiment and between group difference was also significant (p<0.05). Mean and standard deviation of group A for VAS were pre (8.13±0.74) and post (2.53±0.74) with p value 0.0001. Mean and standard deviation of pre and post of group B for VAS were (7.8±0.68) and (3.47±0.92) with p value 0.001. Statistical analysis showed significant difference within the groups. Non-Specific Neck pain is common among computer professionals because of as their faulty forward head posture while working on computers, which in turn places constant extension of the upper cervical structures causing tightness of the soft tissues in that area.9 Studies of Jordan Miller et al.10 shows that mobilization, manipulation and soft tissue techniques decreases pain and improve satisfaction in neck pain patients. Ylinen J et al.11concluded that stretching of Sub occipital muscle influenced pain when combined with other treatment techniques/ modalities in the management of neck pain in patients with cervicogenic headache. Hanten et al12stated that manual therapy with home program of active neck retraction (Chin Tucking) exercises in a series of progressions was successful in relieving cervicogenic headache and improving neck function. Moodley M,13 studied and concluded that ultrasound therapy is helpful in treating Mechanical Neck pain. Myofascial release (MFR) is an approach that focuses on freeing restrictions of movement that originate in the soft tissues of the body. It is a form of soft tissue therapy that is intended to reduce pain and increase mobility in patients that are suffering from chronic pain conditions. Secondly by applying pressure and administering fascial release to areas of the body, this therapy aims to improve the health of fascia tissue. Fascia is a connective tissue along with tendons, ligaments, bone, and muscle. A slow gentle pressure allows the body's tissue to reorganize, release physical restrictions and release the body's unconscious holding and bracing patterns. As this technique produces heat and increases blood flow which releases tension from fibrous band of connective tissue it thus results in softening, elongating and realigning the fascia and removing restrictions or blockages in the fascia. It is theorized that the alterations in the tissue texture and tension resulting from myofascial release come from dynamic changes in the connective tissue and neuromuscular systems of the body.14,15 MFR treatment allows the dysfunctional fascia to return to its position of balance. This safe and gentle treatment results in removal of restrictions that prevent free movement as a result it helps to restore motion, relieves and eliminates the soft tissue pain. There are two types of myofascial release techniques direct and indirect. Direct myofascial release technique is applied in order to release the restrictive barrier, in this form technique the tissue is loaded with a constant force until release occurs. Practitioners can use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms of force. It differs from indirect method in which less pressure is applied to the affected area, and a slight twist which allows the fascia to unwind itself This gentle form of traction causes increased blood flow and heat to the area, allowing the body's natural healing mechanisms to take over.15,16 A study conducted on effectiveness of myofascial release vs positional release technique in chronic upper trapezius spasm this was a comparative study in which the MFR group received fine longitudinal stretch which was applied along the course of trapezius muscle followed by ultrasound. But in our study superficial stretch was applied to the entire posterior muscle group.17 A study by Paolo Tozzi et al proved the effect of Fascial release on patients with non-specific cervical or lumbar pain. In this study gross Myofascial Release (MFR) and Fascial Unwinding (FU) were the widely used manual fascial techniques (MFR), in treatment protocols to release fascial restrictions and restore tissue mobility and the effects of MFR on pain perception, the mobility of fascial layers was investigated using dynamic ultrasound (US) in patients with neck pain (NP) and low back pain (LBP).18 Limitations of the study Sample size was small and subjects could not be followed up for longer period of time, to see long term benefit.

The present study provided evidence to support Myofascial Release (MFR)and combined with ultrasound therapy was most effective for improved neck function and pain alleviation. the core muscle release technique, general exercise, and electrotherapy all helped to decrease the alignment angle and VAS score of these treatment methods, however, the myofascial release technique was the most effective for treatment of Non-Specific Neck Pain among Computer Professionals.

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