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International Journal of Physical Education, Sports and Health 2021; 8(3): 345-352
P-ISSN: 2394-1685
E-ISSN: 2394-1693
Impact Factor (ISRA): 5.38
IJPESH 2021; 8(3): 345-352
© 2021 IJPESH
www.kheljournal.com
Received: 02-03-2021
Accepted: 05-04-2021
Athira Varghese
Post Graduate Student, BCF
College of Physiotherapy,
Maravanthuruthu, Kerala, India
KS Sharad
Professor, Principal, BCF College
of Physiotherapy,
Maravanthuruthu, Kerala, India
R Rejeesh Kumar
Associate Professor, BCF College
of Physiotherapy,
Maravanthuruthu, Kerala, India
S Manivannan
Professor, Vice Principal, BCF
College of Physiotherapy,
Maravanthuruthu, Kerala, India
Corresponding Author:
Athira Varghese
Post Graduate Student, BCF
College of Physiotherapy,
Maravanthuruthu, Kerala, India
Efficacy of therapeutic neck and shoulder exercise for
pain relief among handloom workers
Athira Varghese, KS Sharad, R Rejeesh Kumar and S Manivannan
Abstract
Background: Handloom industry is an ancient hand craft industry in India, and it represents the Indian
weaver’s artistic and aesthetic ability to make the products by handlooms. It is the second largest source
of rural employment after agriculture. Work related musculoskeletal disorders (WMSDs) are the major
health problem among handloom workers in both industrialized and industrially developing countries.
Handloom industry need long time static manual labour, the employees in this industry have to be
involved in long time static working postures which lead to work related musculoskeletal disorders. In
addition to static working posture, the fixed awaked positions and repetitive working also leads to the
musculoskeletal and neurological disorders.
Objectives: The purpose of this study is to find out the efficacy of therapeutic exercise in reducing non-
specific neck and shoulder pain among handloom workers.
Design: Pre test post test experimental design.
Methods: The study population included 30 patients fulfilling both inclusion & exclusion criteria. They
were divided into 2 groups in which Group A [experimental] and Group B [control]. Informed consent
was obtained from each subject prior to participation. A brief description about the procedure was given
to the subjects before commencing the study. A total of 30 subject were divided equally into two groups
by random sampling method, Group A [n=15] &Group B [n=15]. Group A continued with their normal
exercise and they had undergone stretching and strengthening. Group B had not undergone any treatment
they stay physically active.
Results: A 20-week Therapeutic Neck and shoulder exercise program will not reduce the neck and
shoulder pain among handloom workers.
Keywords: therapeutic neck, shoulder exercise, handloom workers
Introduction
Handloom industry is an ancient hand craft industry in India, and it represents the Indian
weaver’s artistic and aesthetic ability to make the products by handlooms. It is the second
largest source of rural employment after agriculture
[1]
. Throughout the world there are about
4.60 million handlooms are there out of which about 3.9 million are situated in India
[2]
.
Usually weaving communities have crowded, poorly ventilated and poorly lighted rooms.
Weavers needs to work under unhygienic conditions which will leads to health problems. In
present situation, the handloom weavers are the poorest community, least respected, socially
and economically deprived living in rural area and almost living like an island in the Indian
society
[3]
. Work related musculoskeletal disorders (WMSDs) are the major health problem
among handloom workers in both industrialized and industrially developing countries
[4]
.
WMSDs are defined as acute or chronic diseases that cause pain or dysfunction due to the
accumulation of micro traumas due to work that leads to the excessive loading of muscles,
ligaments, tendons, intervertebral discs, cartilages, bones and the related nerves and blood
vessels
[5]
. Handloom industry need long time static manual labour, the employees in this
industry have to be involved in long time static working postures which lead to work related
musculoskeletal disorders. In addition to static working posture, the fixed awaked positions
and repetitive working also leads to the musculoskeletal and neurological disorders. During
work the weavers attain postures without giving considerations to their individual capacity
which contributes to stress and trauma.
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The main activities of handloom weavers are weaving,
cutting, adjustment of handloom, arrangement of threads, and
spindle insertion. Musculoskeletal disorders in the upper
limbs (also known as repetitive strain injuries or cumulative
trauma disorders) continue to have an important place in
reported illness suffered in the work place
[6]
. Among
handloom workers neck and shoulder pain are the most
frequent health complaints
[7]
. There are lot of studies
emerged for physical exercise for treating neck and shoulder
pain, while moderate to strong evidence for the effectiveness
of strength training for relieving neck pain among office
workers exists
[8]
recommendations for handloom workers are
not readily available.
Many strategies have been recommended for managing such
presentations most common among these are resistance
training and stretching of work specific muscle groups.
Resistance training is an effective tool for improving muscle
strength. Progressive overload principle is universally
accepted to create the greatest gains in strength
[9]
.
Progressive resistance training should preferably be done
using resistance equipment such as dumbbells or weight cuffs
a variety of exercise can be designed for all the muscle
groups. Resisted exercise by using dumbbells allow self-
selected movement based on anatomy unlike machines which
confine the movement
[10]
.
In addition to strengthening exercise stretching and flexibility
exercises also plays an important role in reduction of risk of
work related musculoskeletal disorders. Studies suggest that
there are beneficial effects of stretching including increased
flexibility, improving circulation, improving range of motion
with in the joints, improving posture, and also in stress relief
[11]
.
The aim of this study is to find out the efficacy of therapeutic
exercise in reducing non- specific neck and shoulder pain
among handloom workers.
Materials and Method
1. Stop watch
2. Chair
3. Inch tape
4. Dumbbells
Procedure
The study population included 30 patients fulfilling both
inclusion & exclusion criteria. They were divided into 2
groups in which Group A [experimental] and Group B
[control]. Informed consent was obtained from each subject
prior to participation. A brief description about the procedure
was given to the subjects before commencing the study. A
total of 30 subject were divided equally into two groups by
random sampling method, Group A [n=15] &Group B [n=15].
Group A continued with their normal exercise and they had
undergone stretching and strengthening. Group B had not
undergone any treatment they stay physically active.
Group A Experimental Group
Fifteen subjects randomly selected to participate in the
therapeutic exercise program form the experimental group.
The subjects were allowed to continue with their ongoing
physical activities as usual. After taking the base line values
on the outcome tools they were initiated into the strength
training program. The final score had taken after 20 weeks of
participation in therapeutic exercise routine. The exercise
routine were include 4 dumbbell exercises. Front raise, lateral
raise, reverse flies, shrugs and wrist extension and stretching
of muscles of trapezius, Rotator cuff, Pectoralis major,
Triceps muscles.
During the intervention period the training load was
progressively increased according to the principles of
progressive overload and both linear (week 1-12) and
undulating periodization (week 13-20) strategies were used
throughout the training programme. It was taken 20 minutes,
three sessions per week. In linear periodization training load
was gradually increased over time while training volume
(total number of repetitions) was decreased systematically.
In undulating periodization, the manipulation of training
volume and training load was on a weekly basis. Relative
loadings was progressively increased from 15 repetitions
maximum (RM; ~ 75% of maximal intensity) at the beginning
of the training period to 8-12 RM (~75-85% of maximal
intensity) during the later phase.
Stretching exercises was aimed at gaining full length stretch
of the chosen muscles. The stretch held for 10 sec and this
cycle was repeated 5 times.
Fig 1: Front Raise
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Fig 8: Trapezius Stretching
Fig 9: Pectoralis Major Muscle Stretching
Group B. Control Group
The control group includes 15 subjects, they were instructed
to stay physically active and follow their ongoing activities.
For both groups pre-test values were taken on the first day &
the post-test values were taken after the total study duration of
20 weeks.
Statistical Analysis
Demographic profile
Age Distribution
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Height Distribution
Weight Distribution
Statistical analysis of shoulder pain and disability index using t-tests
Mean, S.D. and t-value to compare the pre-test SPADI scores between Experimental and Control Groups using t-test
Group
Pre-test Mean
S.D.
Difference in mean
n
t
df
table value
p-value
Experimental
48.57
6.27
0.46
30
0.248
28
2.05
p = 0.806
Control
49.03
3.49
The Mean column in the t test table displays the mean pre-test
shoulder pain and disability index scores in experimental and
control group respectively. The standard deviation column
displays the standard deviation of the scores in two groups.
The difference (0.46) shows the difference between mean in
two groups (48.57&49.03). Since the t-value0.248, is less
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than the table value 2.05, p-value> 0.05, there is no
significant difference in pre-test SPADI scores between the
experimental and the control groups. So we can consider the
groups as homogenous in the base line level.
Mean, S.D. and t-value to compare the post-test SPADI scores between Experimental and Control Groups using t-test
Group
Mean
S.D.
Difference in mean
n
t
df
table value
p-value
Experimental
39.84
5.53
10.55
30
5.95
28
2.05
p <0.05
Control
50.39
4.07
The Mean column in the t test table displays the mean post-
test shoulder pain and disability index scores in experimental
and control group respectively. The standard deviation
column displays the standard deviation of the scores in two
groups. The difference (10.55) shows the difference between
post-test mean in two groups (39.84 & 50.39). Since the t-
value5.95, is greater than the table value 2.05, p-value< 0.05,
there is significant difference in post-test shoulder pain and
disability index scores between the experimental and the
control groups. The SPADI scores in the experimental group
is significantly low.
Hence therapeutic exercise program has significant high
effect as compared with those in the control group.
Statistical analysis of pain using t-tests
Comparison of Pre & Post pain in experimental and control groups
Mean, S.D. and t-value to compare the pre-test pain scores between Experimental and Control Groups using t-test
Group
Pre-test Mean
S.D.
Difference in mean
n
t
df
table value
p-value
Experimental
6.33
1.11
0.4
30
1.05
28
2.05
p = 0.301
Control
5.93
0.96
The Mean column in the t test table displays the mean pre-test
pain scores in experimental and control group respectively.
The standard deviation column displays the standard
deviation of the scores in two groups. The difference (0.4)
shows the difference between mean pre-test in two groups
(6.33&5.93). Since the t-value1.05, is less than the table value
2.05, p-value> 0.05, there is no significant difference in pre-
test pain scores between the experimental and the control
groups. So we can consider the groups as homogenous in the
baseline level.
Mean, S.D. and t-value to compare the post-test pain scores between Experimental and Control Groups using t-test
Group
Mean
S.D.
Difference in mean
n
t
df
table value
p-value
Experimental
4.27
0.29
2.06
30
5.63
28
2.05
p <0.05
Control
6.33
0.89
The Mean column in the t test table displays the mean post-
test pain scores in experimental and control group
respectively. The standard deviation column displays the
standard deviation of the scores in two groups. The difference
(2.06) shows the difference between post-test mean in two
groups (4.27&6.33). Since the t-value 5.63, is greater than the
table value 2.05, p-value< 0.05, there is a significant
difference in post-test pain scores between the experimental
and the control groups. The pain in the experimental group is
significantly low.
Hence therapeutic exercise programs significant high effect as
compared with control group.
Discussion
The purpose of this study was to find out the efficacy of
therapeutic neck and shoulder exercise for pain relief among
handloom workers. The therapeutic exercise included warm
up exercise, stretching of the neck muscles and shoulder
muscles and strengthening exercise according to the protocol
of progressive overload principle.
In this study two handloom weaving factories were taken into
consideration. Subjects were selected after screening for
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fulfilment of the Inclusion and Exclusion criteria. 30
employees were selected randomly and equally divided into 2
groups- Control group and Experimental group.
Control group continued with their usual activities without the
therapeutic exercise program and experimental group
underwent therapeutic exercise program for neck and
shoulder pain. The treatment duration was 30 minutes thrice
in a week.
On statistical analysis of Numeric Pain rating scale scores, the
mean pre-treatment pain score of control and experimental
group was 6.33 and 5.93 and mean post treatment pain scores
of control and experimental group was 4.27 and 6.33
respectively. This result shows that there is an increase of -0.4
units of pain in control group and a decrease of 2.06 units of
pain in experimental group; which indicates that there is a
considerable decrease in pain in experimental group.
Bruno et al., (2008) found that maintaining static posture for a
prolonged time as seen in occupational setting compresses the
veins and capillaries inside muscles thereby causing micro-
lesions from the absence of oxygenation and nutrition.
Handloom workers needs static working postures for
prolonged durations which leads to compression of veins and
capillaries, which in turn leads to decreased oxygen supply to
the muscle and decreased waste removal, this causes muscle
imbalance, fatigue, discomfort and pain as a result of
disruption of tissues. Stretching lengthens the muscles which
are shortened, deprived of oxygen, makes the muscle pliable,
increases oxygen supply, remove waste products thus
decreasing pain.
On statistical analysis, the mean pre-treatment SPADI scores
of control and experimental group were 48.57 and 39.84and
mean post treatment SPADI score of control and experimental
group was49.03 and 50.39 respectively. Since there is a
significant difference existing between the pre-test and post-
test SPADI scores among individuals in the experimental
group.
From the statistical analysis we understood that experimental
group who were undergone stretching and strengthening have
more effects than that of persons who didn’t undergone
therapeutic exercise
The mechanism for which can be similar to the one explained
by Magnusson et al., 1996. In their study they found that
stretching reduces pain and following that there is consequent
improvement in function by elongation of the muscle tendon
unit, reduction in peak force, decrease in rate of force
production and tensile stress on the muscle tendon unit, and
alteration of the visco- elastic property of the muscle-tendon
unit, thus resulting in less tight tissue.
On the basis of the finding is can be assumed that the
Handloom workers must be engaging in regular and
systematic exercise routines such that they can prevent the ill
effects of prolonged static posture which is an integral part of
their profession.
Conclusion
Statistically it is observed that, the stretching and
strengthening exercise leads to a significant improvement in
strength and decrease neck and shoulder pain of the subjects
under study. Based on the performed study, it can be
concluded that stretching and strengthening exercise therapy
can be performed as a daily routine to improve strength and to
decrease pain on neck and shoulder.
References
1. Moshiur Rahman, Manzurul Haque Khan, Irin Hossain,
Shazly Bari, M MAktaruzzaman. ‘Musculoskeletal
Problems among Handloom Workers’ Texila
International Journal of Public Health, 2017, 5(3).
2. Geethashree Bori, Musculo-skel et al. Problems of
Women Weavers in Handloom Industry of Lakhimpur
District, Assam International Journal of Scientific and
Research Publications, 2016, 6(12).
3. Sangeeta Pandit, Prakash Kumar, Debkumar Chakrabarti.
‘Ergonomic problems prevalent in Handloom units of
North East India’ International Journal of Scientific and
Research Publications, 2013, 3(1).
4. Neeraja T, Bhargavi A, Manjulatha C. ‘musculoskeletal
disorders and visual strain among handloom weavers’
published online, 2016.
5. Musculo-Skel et al. problems in Iranian Hand wooven
Carpet industry.
6. Tae-Won Jang, Jung-Wan Koo, Jaechul Song. ‘Work
Related musculoskeletal diseases and the workers
compensation’ Journal of Korean medical science.
7. Prasun Banerjee, Somnath Gangopadhyay. ‘A study on
the Prevalence of upper extremity repetitive strain
injuries among the handloom workers’ Ergonomics and
work physiology laboratory, department of physiology,
university college of science and technology, university
of Calcutta, 2003.
8. The Assessment of Occupational Ergonomic Risks of
Handloom Weaving In North Thailand.
9. Mette K Zebis, Lars L Andersen, Mogens T Pedersen,
Peter Mortensen, Christoffer H Andersen, Mette M
Pedersen et al. ‘Implementation of Neck/shoulder
exercise for pain relief among Industrial workers. A
randomized controlled trial’Zebis et al. BMC Musculo-
skel et al. Disorders 2011;12:205.
10. Shereen Louw, Shale Makwela, Yolandi Brink.
‘Effectiveness of exercise in office workers with neck
pain: A systematic review and meta-analysis’ South
African journal of physiotherapy.
11. Effect of specific resistance training on forearm pain and
work disability in industrial technicians cluster
randomized controlled trial.
12. Imperio Lombardi Jr, Anjela Guarnieri Magri Anna
Maria Fleury, Antonio Carlos Da Silva. ‘Progressive
Resistance Training In Patients With Shoulder
Impingement Syndrome: A Randomized Controlled Trial
2008.
13. Phil Page. ‘Current Concepts in Muscle Stretching for
Exercise and Rehabilitation’ international Journal of
Sport Physical Therapy, 2012.
