This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
Surgical Treatment of Haglund Triad by Using Complete Detachment and Reattach...skisnfeet
This study evaluated the surgical outcome of treating the Haglund triad, which includes retrocalcaneal exostosis, insertional Achilles tendinosis, and retrocalcaneal bursitis, using a standardized approach of complete detachment and reattachment of the Achilles tendon. Seventeen patients underwent this surgery and reported significant pain reduction, high satisfaction rates, and good functional outcomes post-operatively based on questionnaires and clinical scoring systems. Complications were few and minor in most cases.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
This study examined the intertester reliability of using James Cyriax's system for assessing patients with shoulder pain. Two experienced physical therapists independently evaluated 21 cases of painful shoulders using Cyriax's evaluation method. They classified the cases into specific shoulder lesions or indicated that the case did not fit the Cyriax model. The therapists agreed on the classification for 19 of the 21 cases, showing 90.5% agreement. Statistical analysis found "almost perfect" agreement between the therapists. Both therapists also agreed on the same 4 cases that did not fit the Cyriax model. The results demonstrate that Cyriax's evaluation can be a highly reliable method for assessing patients with shoulder pain.
This study examined the active self-correction of spinal curvatures in 249 children (136 females, 113 males aged 10-14 years) in response to the command "straighten your back". Spinal angles were measured in standing and sitting positions both spontaneously and after the command. In standing, the command significantly increased sacral slope and decreased lumbar lordosis, thoracic kyphosis, and lower and upper thoracic kyphosis. In sitting, the command significantly changed sacral slope and lumbar lordosis from kyphotic to lordotic and significantly reduced thoracic kyphosis and flattened lower thoracic kyphosis. There were some gender differences in self-correction of lumbar lordosis and upper thoracic kyphosis
This study compared the outcomes of two rehabilitation protocols for patients with Achilles tendinopathy: an exercise training group that was allowed to continue tendon-loading activities like running and jumping, and an active rest group that was not allowed such activities during the first six weeks. Both groups followed the same progressive strengthening program after the initial period. The study found no significant differences in outcomes between the groups, as both showed significant improvements on patient-reported and functional measures from baseline to 12-month follow-up. The results suggest that continuing tendon-loading activity during rehabilitation, using a pain-monitoring model, does not have negative effects.
This document provides information on managing ataxia in multiple sclerosis (MS) through a multidisciplinary rehabilitation approach. It discusses the importance of managing ataxia to minimize social isolation and maximize quality of life. Assessment involves evaluating multiple body systems that can contribute to ataxia in MS. Interventions discussed include exercises to challenge balance, activities to improve coordination, strategies to compensate for impairments, and considerations for mobility aids, posture, eating, and cooling techniques. Evidence is presented supporting long-term rehabilitation to maximize potential and slow deterioration.
This study examined the reliability of classifications derived from Cyriax's resisted testing in subjects with painful shoulders and knees. Two physical therapists evaluated subjects' shoulder and knee motions under maximal isometric resistance twice. They rated contractions as strong or weak and noted any pain. Intrarater reliability for the knee was generally acceptable but not for the shoulder. Interrater reliability was generally not acceptable for either. More training and standardized resistance may improve reliability.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
This document outlines a study to investigate the causes and treatment of shoulder pain in stroke patients. The study will examine clinical and functional factors related to shoulder pain occurrence, and how functional condition influences pain intensity. It will evaluate differences in muscle activity between affected and unaffected shoulders, and between patients with and without pain. The study will assess stroke patients for spasticity, functional ability, pain levels, impingement, joint stability, and muscle activity to clarify factors linked to shoulder pain. The goal is to develop effective prevention and physiotherapy protocols for shoulder pain in both inpatient and home-based settings.
Cerebellar ataxia is a common symptom in multiple sclerosis that can cause motor and cognitive signs. Cerebellar lesions and ataxia are associated with poorer prognosis. Symptoms vary depending on the location of lesions within the cerebellum and connections. While training programs have shown benefits for motor function in cerebellar degenerations, the effects of specific oculomotor training in MS are unclear. Recovery from cerebellar damage may occur through substitution within the cerebellum or recruitment of other brain areas through mechanisms like synaptic plasticity.
Scapular positioning and motor control in children and adults a laboratory st...lichugojavier
1) The study compared clinical measures of scapular positioning and motor control between adults (n=46) and children (n=59).
2) It found that children had significantly greater scapular upward rotation but smaller forward shoulder posture than adults when controlling for height.
3) The study also found no significant differences between children and adults in visual observation of scapular tilting or winging, or on the Kinetic Medial Rotation Test, a measure of scapular motor control. The results provide reference values for interpreting clinical tests of the scapula in adults and children.
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adol...CrimsonPublishersOPROJ
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study by Joanne Yip in Orthopedic Research Online Journal
This study examined 2442 patients with idiopathic scoliosis to determine the prevalence of back pain and underlying pathological conditions. The key findings were:
1) 23% of patients reported back pain at initial presentation and an additional 9% reported back pain during follow-up.
2) Back pain was associated with older age, skeletal maturity, post-menarchal status, and history of injury.
3) 9% of patients with back pain had an underlying pathological condition such as spondylolysis, spondylolisthesis, or syrinx.
4) While a painful left thoracic curve or abnormal neurological findings predicted underlying conditions, only a minority of patients with these findings actually had a condition
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
Difference in Early Results Between Sub-Acute and Delayed ACL reconstruction:...Henrik Illerström
This randomized controlled trial compared outcomes of sub-acute ACL reconstruction (within 8 days of injury) versus delayed ACL reconstruction (6-10 weeks post-injury). At 3 months, there were no differences in range of motion between groups. At 6 months, the sub-acute group showed less thigh muscle atrophy and better functional strength on hop tests, though isokinetic strength was similar. Both groups improved significantly on KOOS scores after reconstruction, with no differences between groups. The study suggests sub-acute ACL reconstruction is safe and may help preserve strength compared to delayed reconstruction.
MSK HQ outcomes from patients attending cognitive behavioural and exercise i...Andrew Bateman
This poster was produced as part of the output by Alex Theobald's research internship. It demonstrates an engagement with item level data that emerges from our interactions with Musculoskeletal (MSK) outpatients. Patient reported outcomes like this deserve careful collation and analysis and I think that Alex has done a great job presenting the findings from his study.
In Cambridgeshire Community Services NHS Trust we are aiming to increase research activity throughout all of our services. It was very pleasing that this poster was accepted for presentation at a prestigious PROMS conference.
This document discusses cervical disc herniation, including epidemiology, symptoms, diagnostic imaging, conservative and surgical treatment options, and rehabilitation guidelines. It provides an overview of the structures involved in cervical disc herniation, risk factors, common symptoms of nerve root compression, and imaging tools used for diagnosis. Conservative treatments discussed include medications, modalities, cervical traction, posture correction, and muscle strengthening. Surgical options covered are anterior/posterior decompression and fusion or disc arthroplasty. Post-surgical rehabilitation guidelines are also outlined.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Patellar resurfacing compared with nonresurfacing in tkarosenmd
This study compared patellar resurfacing versus non-resurfacing in total knee arthroplasty (TKA) patients over 10 years. At initial follow-up, resurfacing reduced anterior knee pain but this effect diminished over time. By 10 years, there was no significant difference in outcomes like function, range of motion, or satisfaction between the resurfaced and non-resurfaced groups, though non-resurfaced patients reported less anterior knee pain. While resurfacing lowered revision rates in the short term, outcomes were similar between groups in the long run. Factors like pre-existing pain, patella degeneration, obesity, and gender did not predict which patients would benefit most from resurfacing.
This study evaluated the quality of life of 30 patients with chronic nonspecific low back pain who underwent one of three physical therapy treatments: isostretching, global postural reeducation (GPR), or a combination of the two. Quality of life was assessed before treatment, after 3 months of treatment, and 2 months post-treatment using the SF-36 questionnaire and a pain scale. Both physical therapy techniques significantly reduced pain and improved quality of life, with greater pain reduction when techniques were combined. At follow-up, GPR was more effective at maintaining improvements in pain, while isostretching was more effective for quality of life. The physical therapy techniques effectively treated chronic low back pain by reducing pain and improving quality of life
The posterior
spinal fusion is then
performed with bone
graft placed between
the transverse
processes. An
instrument assistant is
used to maintain
correction during the
procedure.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
Final Construct: The final
construct shows the
anterior and posterior
instrumentation
connected together with
the spinal fusion
performed between the
transverse processes.
This provides a rigid
three column construct to
correct and stabilize the
spinal deformity.
Dr. Clayton Stitzel, 1
This randomized controlled trial examined the effects of two modified posterior shoulder stretching exercises (PSSEs) on shoulder mobility, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). 67 patients with SIS and internal rotation deficit were assigned to receive either a modified cross-body stretch, modified sleeper stretch, or a control treatment of modalities and exercises without PSSEs. Both stretching groups demonstrated greater improvements in pain with activity, internal rotation range of motion, function, and disability compared to the control group. However, there was no significant difference between the two stretching groups. All treatments led to improvements in pain, shoulder mobility, function, and disability.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
The document summarizes a study that evaluated health-related quality of life (HRQoL) in patients who underwent surgery for lumbar disc herniation. The study found:
1) HRQoL as measured by the EQ-5D improved 2 years after surgery but did not significantly improve further after 5 more years.
2) 85% of patients reported improved EQ-5D scores 2 years after surgery and 91% reported improved scores at long-term follow up of 5-8 years.
3) Greater leg pain and lower quality of life at baseline were predictors of greater improvement in quality of life after surgery.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
This study aimed to assess the long-term outcomes of lumbar fusion versus non-specific physiotherapy for chronic low back pain. 294 patients were randomized to fusion or physiotherapy and followed for an average of 12.8 years.
Using various analytic approaches, success rates based on patient's global assessment of improvement were in the 65% range for fusion patients, compared to 31-37% for physiotherapy patients. However, secondary outcomes like disability and pain scales showed similar levels of improvement between groups. The discrepancies between primary and secondary outcomes means the study provides only Level II evidence regarding recommending fusion for non-specific low back pain.
This randomized clinical trial compared the effectiveness of anterior versus posterior glide joint mobilization techniques for improving shoulder external rotation range of motion in patients with adhesive capsulitis. Twenty subjects with primary adhesive capsulitis and external rotation deficits were randomly assigned to receive either anterior or posterior glide mobilization plus therapeutic ultrasound and exercise over six sessions. Shoulder external rotation range of motion was measured initially and after each session. The group receiving posterior glide mobilization showed significantly greater improvement in external rotation range of motion compared to the group receiving anterior glide mobilization. Both groups had significant decreases in pain.
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
This document provides background information and literature review for a study comparing the effectiveness of kinesio taping and exercise for shoulder impingement syndrome. It introduces shoulder impingement as a common shoulder problem caused by inadequate space for rotator cuff tendons. The literature review summarizes previous studies that found scapular taping, therapeutic kinesio taping, and exercise programs can reduce pain and improve function in impingement. Outcome measures to be used in the proposed study include VAS (visual analog scale) for pain, DASH scale for function assessment, and goniometry for range of motion measurements.
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
1. This document discusses various topics related to degenerative conditions of the lumbar spine including lumbar stenosis, degenerative spondylolisthesis, and degenerative scoliosis.
2. It provides an overview of conservative and surgical treatment options and reviews the evidence regarding the effectiveness of different surgical techniques.
3. Key points include that surgery appears to be more effective than conservative care for pain and function in adults with isthmic or degenerative spondylolisthesis. Instrumented fusion with decompression may also be more successful than decompression alone for degenerative spondylolisthesis with spinal stenosis.
Shoulder pain is common in patients with spinal cord injuries, affecting 30-60% of individuals. The most common causes are chronic impingement syndromes and rotator cuff tears. Two randomized controlled trials found that home exercise programs focused on scapular and rotator cuff strengthening can significantly reduce shoulder pain in patients with chronic spinal cord injuries. The programs lasted 8-12 weeks and included exercises like side-lying external rotation and prone horizontal abduction. Strengthening the scapular stabilizer and rotator cuff muscles may help address biomechanical factors that contribute to shoulder impingement in manual wheelchair users.
This randomized controlled trial evaluated the immediate effects of a thoracic spine manipulation (TSM) on shoulder pain and scapular kinematics in individuals with and without shoulder impingement syndrome (SIS). Fifty subjects with SIS and 47 asymptomatic subjects were randomly assigned to receive either TSM or a sham intervention. Shoulder pain was reduced after both TSM and the sham intervention in those with SIS. Scapular kinematics changed minimally in both groups after the interventions. The study found an immediate reduction in shoulder pain following TSM in individuals with SIS, but observed only small changes in scapular kinematics that were not considered clinically meaningful.
This study evaluated the ability of rasterstereography to detect changes in posture induced by different neuromuscular stimulation techniques and proprioceptive insoles. 27 healthy volunteers underwent rasterstereography to measure 14 posture parameters under 6 test conditions: normal stance, foot elevation, foot exercises, loose jaw, biting, and wearing proprioceptive insoles. Rasterstereography measurements had low variability. Several posture parameters showed significant changes between test conditions, indicating that neuromuscular stimulation and insoles induce detectable postural shifts. Proprioceptive insoles specifically altered lateral spine deviation, demonstrating rasterstereography's sensitivity to subtle posture variations.
Este estudo comparou os efeitos do uso de palmilhas customizadas e pré-fabricadas em trabalhadoras que permaneciam em posição estática por longos períodos. Ambas as palmilhas reduziram os níveis de dor nos pés e coluna lombar após oito semanas, porém aumentaram a pressão máxima e média nos pés. Não houve diferença significativa entre os grupos nos dados de pressão plantar ou nos níveis de dor.
This randomized controlled trial compared the effectiveness of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain. The trial found that:
1) SMT had a statistically significant advantage over medication in reducing pain up to 1 year after treatment based on participant-reported pain levels.
2) HEA was as effective as SMT, with no important differences in pain reduction between the two treatments at any time point.
3) Both SMT and HEA were more effective for reducing neck pain than medication in both the short and long term.
This study examined the effectiveness of computer-designed insoles in reducing low back pain among 58 employees whose jobs involved extensive walking. The employees were randomly assigned to use either the computer-designed insoles or placebo insoles for 5 weeks, then switched to the other insole for another 5 weeks. Those using the computer-designed insoles experienced a greater reduction in reported low back pain according to a standardized questionnaire, with average pain decreasing by 1.49 points compared to a decrease of 0.31 points for those using placebo insoles. 81% of employees preferred the computer-designed insoles as more effective and comfortable than the placebo insoles. The results suggest computer-designed insoles more effectively reduce low back pain in workers whose
This systematic review analyzed 12 controlled trials that compared the effects of different insoles on postural balance. The insoles studied included vibrating insoles, textured insoles, insoles with different densities, and insoles with wedges or sensors. Most studies found that the insoles improved postural balance and reduced sway, especially in the anteroposterior direction. Textured insoles and vibrating insoles showed benefits by increasing sensory input from the feet. While insole rigidity did not influence balance, soft gel insoles and insoles with spikes were found to improve postural control. The review concluded that insoles can provide benefits that favor better postural balance and control.
This study examined changes in the diffusion of water within lumbar intervertebral discs before and after spinal manipulative therapy in patients with low back pain. Nineteen patients underwent MRI scans before and after a single treatment. Patients who reported over a 2-point reduction in pain ("responders") had a significant post-treatment increase in water diffusion at lumbar levels L1-2, L2-3, and L5-S1, compared to non-responders. This suggests increased water diffusion within intervertebral discs may be related to reductions in low back pain following spinal manipulative therapy.
This meta-analysis reviewed 16 randomized controlled trials comparing the effectiveness of motor control exercises (MCE) to other treatments for chronic or recurrent low back pain. The analysis found that MCE was superior to general exercise in reducing both disability in the short, intermediate, and long term, and pain in the short and intermediate term. MCE was also superior to minimal interventions like advice or placebo for both pain and disability outcomes at all time periods. Compared to spinal manual therapy, MCE demonstrated superior results for reducing disability but not pain. The studies varied in quality but provided evidence that MCE can better improve pain and disability for low back pain over the short to long term compared to other common treatments.
More from Podoposturologia Palmilhas Posturais (8)
Pharmacotherapy of Asthma and Chronic Obstructive Pulmonary Disease (COPD)HRITHIK DEY
This PowerPoint presentation provides an in-depth overview of the pharmacotherapy approaches for managing asthma and Chronic Obstructive Pulmonary Disease (COPD). It covers the pathophysiology of these respiratory conditions, the various classes of medications used, their mechanisms of action, indications, side effects, and the latest treatment guidelines. Designed for students, healthcare professionals, and anyone interested in respiratory pharmacology, this presentation offers a comprehensive understanding of current therapeutic strategies and advancements in the field.
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A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
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EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
2. 2 Amorim et al Journal of Manipulative and Physiological Therapeutics
Scapular Dyskinesis and Neck Pain Month 2014
balance and repercussion in several systems, often with
rheumatologic, neurological, and respiratory symptoms.12
Segmental exercises are static stretching exercises of
conventional physical therapy, which consists of stretching
a single muscle or small group of muscles up to a tolerable
point and sustaining the position for a certain period,
usually during 30 seconds. 13,14 Several randomized
clinical studies tested the effectiveness of GPR relative to
other interventions (eg, static stretching) in conditions such
as chronic neck pain, ankylosing spondylitis, and tempo-romandibular
joint disorders,15–17 but not in SD associated
with neck pain. For this reason, it is essential to study the
effectiveness of GPR relative to SE (stretching exercises)
in these patients.
Muscular changes (eg, on the superior trapezius and
pectoralis) and postural abnormalities (kyphosis or lordo-sis)
seem to be risk factors for SD and cervical pain. 1,2
There are studies that show the effectiveness of SE in
treatment of neck pain18 and SD,19,20 but few show the
effectiveness of GPR in these patients. Thus, a study is
needed to compare the effectiveness of GPR with SE of
conventional physical therapy in patients with SD
associated with cervical pain. Therefore, the aim of this
study was to assess the effectiveness of GPR, relative to
SE, in the treatment of SD with neck pain. This study
particularly focused on the function of neck and arms, on
pain, and on the quality of life.
METHODS
A preliminary randomized clinical study was performed.
Randomization was conducted by randomly picking
identical opaque envelopes with intervention assignment.
Two groups were defined: GPR group (n = 18) stretched the
anterior and posterior muscular chains, and SE group (n = 18)
conducted stretching exercises. The time frame of this study
was from July 2010 to February 2011.
Patients were referred to the study by a shoulder
specialist (medical orthopedist) in the Faculty of Medical
Sciences of Santa Casa of Misericordia of São Paulo,
São Paulo, Brazil. Inclusion criteria were as follows: SD as
per the scapular malposition, inferior medial border
prominence, coracoid pain and malposition, and dyskinesis
of scapular movement (SICK) Scapula Rating Scale,2 in
association to chronic neck pain (pain for at least 3 months).
Exclusion criteria included cervical stenosis, myelopathy,
prolapsed intervertebral disk (as confirmed by magnetic
resonance imaging), and/or winged scapula due to lesions
of the long thoracic nerve or spinal accessory nerve, as
documented by electromyography.
A total of 36 patients with SD and neck pain were
included, with age ranging from 18 to 65 years. Of them, 30
completed the study (6 patients withdrew consent for work-related
reasons). The flow of the study is described in
Figure 1. During the study, the patients did not receive other
treatment modalities.
This study was approved by the Ethics Committee of
Santa Casa de Misericórdia de São Paulo (Project no. 92/10).
All participants signed informed consent forms. The clinical
trial registration number is NCT01568840.
Outcome Measures
Function of the Upper Extremity. The upper extremity was
assessed using the validated Portuguese version of the
Disabilities of the Arm, Shoulder, and Hand questionnaire.
The Disabilities of the Arm, Shoulder, and Hand question-naire
is a self-administered, region-specific outcome
instrument developed as a measure of self-rated upper-extremity
disability and symptoms. Items ask about
difficulties while performing different physical activities
due to arm, shoulder, or hand problem (21 items); the
severity of spontaneous pain; activity-related pain; tingling;
weakness and stiffness (5 items); as well as impact on social
activities, work, sleep, and self-image (4 items). Each item
has 5 response options. The scores for all items are then
used to calculate a scale score ranging from 0 (no disability)
to 100 (most severe disability).21,22
Function of the Neck. Neck function was estimated using
the Neck Disability Index (NDI), translated and adapted
to Portuguese by Cook et al.23 The NDI consists of 10
questions, with 6 possible responses (from 0 to 5), reflecting
the burden of neck pain on pain, daily activities, work,
reading, concentration, driving a car, sleeping, and leisure.
Total NDI score ranges from 0 to 50; and based on the scores,
the patients are categorized into the following: no disability
(0-5), mild disability (6-14), moderate disability (15-24),
severe disability (25-34), and totally disabled (35-50).23–25
Pain Severity. Pain severity was measured using a visual
analogical scale, where a 10-cm scale without numbers is
presented to patients. On the left extremity, the scale is labeled
no pain; on the right extremity, it is labeled maximum pain.
Patients marked on the line the severity of pain at the time
of assessment.26
Health-Related Quality of Life. Quality of life was assessed
using the Short Form (SF)–12, the abbreviated version of
the SF-36.27 The SF-12 consists of 12 questions measuring
physical and mental health. Time to complete the SF-12 is
around 2 minutes. Score ranges from 0 to 100, and higher
scores reflect better quality of life.28
Assessments were taken at baseline and at 10 weeks and
were identical at both time points. The therapist was trained
in obtaining all assessments.
Interventions
Interventions for both groups were performed by
the same physical therapist, who is a specialist in GPR
technique and trained specifically for the application of
3. Journal of Manipulative and Physiological Therapeutics Amorim et al 3
Volume xx, Number Scapular Dyskinesis and Neck Pain
Fig 1. Study flowchart. GPR, global postural reeducation; SE, segmental exercises.
GPR and SE. Sessions happened once a week for 10 weeks,
lasting 60 minutes each. The objectives of the treatment were
explained to the patients in the GPR and SE groups. At the
first 10 minutes of sessions, patients rested (supine position)
with all limbs relaxed. Manual therapy maneuvers were made
associated to breathing exercises to stretch the fasciae that
recover the scapulae, shoulders, and cervical spine muscles.
After that, stretching treatment (global or segmental) was
conducted for another 40 minutes. 29 Procedures are
described in Figure 2 and shown in Figure 3. 14–17,20,30–32
Statistical Analysis
Differences between sample characteristics across groups
were compared using the t test (parametric variables) or the
χ2 test (categorical data). Data were summarized using mean,
standard deviation, and percentiles.
Pre-post treatment analyses were compared using the
Wilcoxon signed rank test for quantitative nonparametric
variables. Between-group comparisons were conducted
using the Mann-Whitney test. The significance level
adopted was α b .05.
Global Postural Reeducation
- During the global stretching session, care was taken to avoid postural compensation (due to tension increase
in response to muscular tightness) on specific body segments; and patients maintained free breathing, with
no breath holding. At each session, patients maintained two different postures (20 minutes each).
- To stretching of the posterior muscular chain, patients were positioned in the supine position; and the goal
was to achieve the final stretching position with adducted upper limbs and lower limbs at 90° hip flexion
supported by a hanging strap. Gradual knee extensions were progressively performed (respecting patient's
limit) until tolerated, with ankle in dorsal flexion, keeping the occipital, lumbar region, and sacrum
stabilized, as rectified as possible (Fig 3A).
- To stretching of the anterior muscular chain, patients were positioned in the supine position and with upper
limbs abducted at 30° and supine forearms. Pelvis was kept in retroversion, whereas the lumbar spine
remained stabilized. Hips were flexed, abducted, and laterally rotated, with the soles of the feet touching
each other. Lower limbs were progressively extended to maximum knee extension, while maintaining the
tibiotarsal angle at 90°, with relaxed toes and lumbar region fully touching the table; and at the end of the
exercises, the arms reached 140° of abduction (Fig 3B).
.
Segmental exercises
- Patients performed segmental stretching exercises for the cervical spine, head and upper limbs, in passive
form. Each stretching position was held for 30 seconds, keeping a slow breathing and avoiding
compensations. Exercises were bilaterally repeated for 3 sets after a 10-second rest pause. Patient's limits
and possibilities were taken into account.
- Static segmental stretching targeting the shoulder (elevator muscle of scapulae, lateral, medial and anterior
muscles of arms).
- Static segmental stretching targeting the muscles of the neck (posterior, lateral, anterior, and rotators).
Fig 2. Description of global postural reeducation and segmental exercises.
4. 4 Amorim et al Journal of Manipulative and Physiological Therapeutics
Scapular Dyskinesis and Neck Pain Month 2014
Sample size was calculated to identify 20% in pain
improvement (SD = 2 points), with a power of 80%, at the
5% significance level. Required sample was 17 patients
per group.
RESULTS
Table 1 displays the characteristics of the sample.
No significant differences were seen for baseline anthropometric
and clinical variables (P N .05).
For pre-post treatment comparisons, patients in the GPR
group had significant improvements in the function of
upper extremities, function of neck, pain, and the physical
domain of quality of life (P b .05).
As for the SE group, significant improvements were seen
for function of upper extremities, function of neck, and
severity of pain (P b .05).
When contrasting groups, significantly superior im-provement
was seen in patients receiving GPR vs SE for
severity of pain and for quality of life (physical domain of
SF-12). No significant differences were seen for the other
variables (Table 2). No adverse events were reported for
this study.
DISCUSSION
Although both GPR and SE improved functionality of
upper extremity, function of neck, and pain in patients
with SD and neck pain, quality of life only improved in the
GPR group.
Scapular dyskinesis may result as a consequence of
various reasons but may exacerbate preexisting conditions
of the shoulder. 33 Its association with pain is well
known and may be due to shortening and stiffness of the
trapezius and pectoralis muscles, as well as accentuation of
the thoracic kyphosis and/or cervical lordosis.1,2 These
changes may in turn impact daily life activities, therefore
compromising the quality of life of a sizeable number
of patients. 15,34,35
The improvement in pain and function found in
this study after both interventions may be explained by
global stretching of muscular chains and by segmental
stretching of individual muscles or small muscular
groups. Global postural reeducation involves active
Fig 3. Global postural reeducation exercises (A, posterior muscle
chain; B, anterior muscle chain).
Table 1. Sample Characteristics
Variables
GPR (n = 15)
Mean (SD)
SE (n = 15)
Mean (SD) P Value
Age (y) 40.0 (11.2) 36.4(12.6) .34 a
Weight (kg) 67.0 (8.2) 64.9 (9.1) .51 a
Height (cm) 1.66 (0.1) 1.63 (0.1) .38 a
BMI (kg/cm2) 24.21 (1.6) 24.22 (2.4) .99 a
n (%) n (%)
Sex
Female 10 (66.7) 11(73.3) .50 b
Male 5 (33.3) 4 (26.7)
Scapula injured
Right 5 (33.3) 4 (26.7) .89 b
Left 6 (40.0) 6 (40.0)
Bilateral 4 (26.7) 5 (33.3)
Work posture
Sitting 12 (80.0) 12 (80.0) .99 b
Standing 1 (6.7) 1 (6.7)
Both 2 (13.3) 2 (13.3)
Physical activity
Active 3 (20.0) 1 (6.7) .29 b
Sedentary 12 (80.0) 14 (93.3)
Work
Active 12 (80.0) 15 (100.0) .11 b
Absent 3 (20.0) 0 (0.0)
Cervical alignment
Normal 3 (20.0) 4 (27.0) .58 b
Hyperlordosis 10 (64.0) 8 (53.0)
Rectification 2 (13.0) 3 (20.0)
BMI, body mass index; GPR, global postural reeducation; SE, segmental
exercises.
a P value for t test.
b P value for χ2 test.
5. Journal of Manipulative and Physiological Therapeutics Amorim et al 5
Volume xx, Number Scapular Dyskinesis and Neck Pain
Table 2. Inter- and Intragroup Comparisons for Clinical Variables: Functionality, Pain, and Quality of Life
and prolonged stretching for 20 minutes, which requires
good self-perception and attention to execute the
method; the second intervention involves short episodes
of stretching (30 seconds) that, although requiring
attention as well, are easier to learn and execute. 13,15,17.
A systematic review of the effectiveness of different
types of exercises for prevention and cure of neck pain
has shown that stretching exercises increase the
flexibility of joint structures, neck muscles, and range
of joint motion, and encourages circulation and
oxygenation in joints, muscles, and muscle tendon
units.18 In addition, randomized clinical studies found
that stretching exercise reduced discomfort in neck pain
workers compared with those who received deep
breathing,31 and found that stretching exercise once or
twice a day under the supervision of a physiotherapist
increased improvement index compared with only
receiving education.32 Bronfort et al36 have shown
positive results in associating exercises with manual
therapy for relieving pain. Some studies indicate the
effectiveness of GPR and static stretching exercises in
reducing pain and in improving range of motion and
quality of life in conditions such as chronic neck
pain, ankylosing spondylitis, and temporomandibular
joint disorders.15–17
Some similarities exist between the 2 treatment
methods and may explain why patients in both groups
had improved pain and function. Time of intervention
was similar (60 minutes), and therapist was the
same; therefore, patient/therapist dynamics were likely
similar. Additionally, all patients received the same
instructions and supervision, including on how to
avoid muscular compensation, respiratory techniques,
and others 11,15,17
Our findings are supported by previous studies, which
also reported improvement of quality of life after GPR due
to changes in the corporal representation and increased self-perception,
which are associated with well-being and better
postural conscience.11,15–17
We emphasize that both groups were oriented to
perform exercises while in a slow breathing rhythm. In the
GPR, they were asked to conduct slow, gentle, and
prolonged expirations, which not only improve subse-quent
inspirations but also seem to increase well-being
and quality of life per se. 15 Finally, the differential
improvements in GPR relative to SE may be due to the
fact that the first also addresses risk factors for SD with
neck pain by decreasing muscular tension at the level of
the superior trapezius and pectoralis as well as by
realigning the cervical and dorsal spine.1,2,19,20,34 None-theless,
we found that GPR and SE are effective in
treating specific musculoskeletal disorders.
Limitations of the Study
The study limitations were as follows. There were
few patients included in this study. Some patients
withdrew consent for work-related reasons and left the
study. There was an absence of a control group. The
assessment was unblinded. Future studies should be
larger; include a control group, blinding, and a long
term of follow-up assessment; and test combination of
interventions, such as stretching exercises and specific
stabilization exercise for the scapula muscles in patients
with SD.
CONCLUSION
For this group of patients with SD associated with
neck pain, GPR and SE had similar effects on
functionality of the neck and upper extremity. Global
postural reeducation was superior to SE in improving
pain and quality of life.
Variables
GPR (n = 15) SE (n = 15)
P b
Pretreat Posttreat
P
Pretreat Posttreat
Mean (SD) Mean (SD) Mean (SD) Mean (SD) P
Function
Neck (0-50) 22.5(10.31) 11.07(8.70) .001 a 21.27(9.78) 17.23(11.82) .023 a .134
Arm, shoulder, and hand
(0-100)
21.16(11.80) 12.88(11.59) .001 a 25.66(18.06) 21.94(18.76) .023 a .281
Pain (0-10) 5.73(1.83) 2.6(0.99) .001 a 6.07(2.25) 5.0(2.59) .004 a .003 b
Quality of life (0-100)
Domains Physical 43.33(9.78) 48.98(7.43) .010 a 40.37(8.16) 42.28(9.49) .279 .049 b
Mental 54.21(7.53) 55.48(5.70) .061 50.65(6.89) 51.63(7.57) .795 .025 b
GPR, global postural reeducation; Pretreat, before treatment; Posttreat, immediately after treatment; SE, segmental exercises.
a Statistically significant difference (Wilcoxon signed rank test).
b Statistically significant difference (Mann-Whitney test): intergroups.
6. 6 Amorim et al Journal of Manipulative and Physiological Therapeutics
Scapular Dyskinesis and Neck Pain Month 2014
FUNDING SOURCES AND POTENTIALCONFLICTS OF INTEREST
No funding sources or conflicts of interest were reported
for this study.
CONTRIBUTORSHIP INFORMATION
Concept development (provided idea for the research):
C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Design (planned the methods to generate the results):
C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Supervision (provided oversight, responsible for orga-nization
and implementation, writing of the manuscript):
C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Data collection/processing (responsible for experi-ments,
patient management, organization, or reporting
data): C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Analysis/interpretation (responsible for statistical
analysis, evaluation, and presentation of the results):
C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Literature search (performed the literature search):
C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Writing (responsible for writing a substantive part of the
manuscript): C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
Critical review (revised manuscript for intellectual
content, this does not relate to spelling and grammar
checking): C.S.M.A., M.E.C.G., A.P.M., V.L.S.A.
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Practical Applications
• This study found that GPR and SE had
similar effects on functionality of the neck
and upper extremity in patients with SD and
neck pain.
• In this preliminary study, GPR was superior
to SE in improving pain and quality of life.
• Because GPR was superior to SE in some
parameters, using GPR as an initial strategy
to treat patients with SD and neck pain is
reasonable.
• Because both methods were similar in most
parameters, patient’s preference and providers’
experience should possibly drive initial approach.
7. Journal of Manipulative and Physiological Therapeutics Amorim et al 7
Volume xx, Number Scapular Dyskinesis and Neck Pain
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