Document Type : Original Article
Authors
1
Department of Corrective Exercise and Sport Injuries, Faculty of Sport Sciences, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
2
Department of Corrective Exercise and Sport Injuries, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran.
10.22089/rws.2025.17770.1056
Abstract
Extended Abstract
Background and Purpose
Chronic neck pain is a prevalent issue among elderly women, significantly impairing their quality of life and limiting their ability to perform daily activities with ease. Contributing factors include poor posture, degenerative anatomical changes in the cervical spine, and reduced physical activity levels, which collectively result in a diminished neck range of motion (ROM) and persistent discomfort. Elderly women are particularly susceptible due to age-related physiological changes, such as decreased bone density, reduced muscle strength, and connective tissue elasticity, which exacerbate neck pain and stiffness. Non-pharmacological interventions, including aquatic therapy, massage, and corrective exercises, have shown promise in managing chronic neck pain by improving mobility, reducing muscle tension, and enhancing overall functional capacity. However, there is a lack of comprehensive comparative studies evaluating the effectiveness of these interventions specifically in elderly populations. This study aims to assess and compare the impacts of aquatic therapy, massage, and corrective exercises on neck ROM in elderly women with chronic neck pain, with the goal of informing evidence-based, tailored therapeutic strategies to improve clinical outcomes for this demographic.
Methods
A quasi-experimental, pretest-posttest design with a control group was utilized to evaluate the effects of selected interventions on neck ROM in elderly women aged 60–75 years diagnosed with chronic non-specific neck pain. Sixty participants from Isfahan, Iran, were randomly assigned to four groups (n=15 per group): aquatic therapy, massage therapy, corrective exercises, and a control group receiving no intervention. Inclusion criteria required participants to have experienced chronic neck pain for at least three months without identifiable specific pathology, such as tumors or infections. Exclusion criteria included a history of neck or shoulder surgery, recent fractures, neurological symptoms, or inflammatory disorders to ensure participant safety and study validity. Interventions were delivered over an eight-week period, with participants attending three 45-minute sessions per week. Aquatic therapy involved stretching and strengthening exercises performed in a warm-water pool, leveraging water’s buoyancy to reduce joint stress and facilitate pain-free movement. Massage therapy focused on alleviating muscle spasms and trigger points through targeted techniques to promote relaxation, improve circulation, and enhance cervical flexibility. Corrective exercises were designed to improve posture and strengthen deep neck muscles, thereby enhancing joint stability and optimizing cervical function. Neck flexion and extension ROM were measured using a goniometer at baseline and post-intervention to quantify changes in mobility. Demographic and baseline health data were gathered through standardized questionnaires to account for potential confounding variables. Statistical analyses were conducted using IBM SPSS version 21. The Shapiro-Wilk test confirmed data normality, while Levene’s test ensured homogeneity of variance across groups. Analysis of covariance (ANCOVA) was employed to compare post-intervention ROM outcomes across groups, adjusting for baseline scores, with a significance threshold of p ≤ 0.05. Effect sizes (η²) were calculated to evaluate the magnitude of intervention impacts. Ethical approval was obtained from the Islamic Azad University, Khorasgan Branch Ethics Committee (IR.IAU.KHUISF.REC.1403.030), ensuring adherence to ethical research standards and participant safety. This rigorous methodology ensured precise control of confounders, robust data collection, and reliable evaluation of intervention effects.
Results
Statistical analysis revealed no significant baseline differences among the four groups in terms of age, height, weight, or baseline neck ROM (p > 0.05), confirming group comparability. ANCOVA results indicated that all three intervention groups demonstrated significant improvements in neck ROM—both flexion and extension—compared to the control group (p < 0.001). For neck flexion, the corrective exercise group exhibited the largest effect size (η² = 0.62), followed by aquatic therapy (η² = 0.56) and massage therapy (η² = 0.48) (Table 1). For neck extension, corrective exercises again yielded the greatest effect (η² = 0.72), followed by aquatic therapy (η² = 0.49) and massage therapy (η² = 0.39) (Table 2). These results highlight that all interventions significantly enhanced neck mobility, with corrective exercises producing the most substantial improvements, particularly in cervical extension, likely due to their targeted focus on strengthening deep cervical musculature and improving postural alignment.
The superior efficacy of corrective exercises can be attributed to their emphasis on strengthening deep cervical muscles, improving postural alignment, and enhancing joint mechanics, which collectively contribute to greater stability and mobility. Aquatic therapy’s effectiveness stems from water’s buoyant properties, which reduce mechanical loads on joints, enabling pain-free movement and facilitating muscle relaxation. Massage therapy, while effective in reducing muscle tension and spasms, showed comparatively smaller improvements, likely due to its focus on passive relaxation rather than active muscle strengthening. No adverse events were reported across all intervention groups, confirming the safety, feasibility, and tolerability of these non-pharmacological approaches in elderly women.
Conclusion
Aquatic therapy, massage, and corrective exercises each significantly enhance neck range of motion in elderly women with chronic non-specific neck pain, offering viable non-pharmacological treatment options. Corrective exercises demonstrated the most substantial improvements, particularly in cervical extension, due to their targeted approach to posture correction and deep muscle strengthening. These interventions are safe, accessible, and effective in improving mobility and quality of life in this population. Clinicians and rehabilitation specialists should prioritize incorporating corrective exercises into treatment plans, given their superior efficacy, while considering aquatic therapy and massage as complementary approaches to address pain relief and muscle relaxation. Combining these therapeutic modalities may yield synergistic effects, optimizing pain management, functional restoration, and overall well-being in elderly women with chronic neck pain. Future research should explore long-term outcomes and the potential benefits of integrated intervention protocols to further enhance clinical practice.
Keywords: Neck Pain, Corrective Exercises, Massage, Aquatic Therapy, Range of Motion.
Article Message
Chronic neck pain significantly compromises the quality of life and functional capacity of elderly women. This study demonstrates that aquatic therapy, massage, and corrective exercises effectively improve neck range of motion, with corrective exercises producing the greatest enhancement, particularly in extension. These interventions present safe, practical, and evidence-based options for management. Rehabilitation professionals should prioritize corrective exercises and consider integrating complementary methods to maximize therapeutic outcomes. Tailored, non-invasive treatments empower elderly women to regain functional mobility, reduce discomfort, and enhance life quality.
Ethical Considerations
This study was ethically approved by the Islamic Azad University, Khorasgan Branch (ethical code IR.IAU.KHUISF.REC.1403.030). Participants provided informed consent prior to enrollment, and their confidentiality was stringently maintained throughout the research.
Authors’ Contributions
The study concept and design were collaboratively developed by the research team. The team focused on evaluating the comparative effectiveness of aquatic therapy, massage, and corrective exercises on cervical range of motion in elderly women with chronic neck pain. All authors contributed to data collection, analysis, manuscript drafting, and review processes.
Conflict of Interest
The authors declare no conflicts of interest related to this study. No financial or personal relationships with organizations or individuals that could influence the research outcomes were present during the study period. The study was conducted independently, and all interventions were applied without commercial affiliations or external funding that could bias the results.
Acknowledgments
The authors acknowledge and sincerely thank all individuals who participated in and supported this research.
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