Effect of brief daily exercise on headache among adults – secondary analysis of a randomized controlled trial
From: Scand J Work Environ Health. 2011 May 26
This paper investigates secondary outcomes (headache) in a randomized controlled trial with physical exercise among office workers with neck/shoulder pain.
A total of 198 office workers with frequent neck/shoulder pain were randomly allocated to either one of two intervention groups (10 weeks of resistance training with elastic tubing for 2 or 12 minutes per day, 5 times a week) or the control group, which received weekly health information. Secondary outcomes included changes in frequency, intensity, and duration of headache after ten weeks.
Compared with the control group, headache frequency decreased in the 2- and 12-minute intervention groups [0.64 days/week and 0.79, corresponding to a 43% and 56% decrease from baseline, respectively]. Intensity and duration of the remaining headaches were unaffected.
Two minutes of daily resistance training for ten weeks reduces headache frequency among office workers with neck/shoulder pain. The vast number of adult workers suffering from one or two days of weekly headaches and who could potentially comply with and benefit from brief exercise programs stresses the applicability of these findings.
Physiological and clinical changes after therapeutic massage of the neck and shoulders
Man Ther. 2011 May 11. [Epub ahead of print]
Therapeutic massage is often prescribed for musculoskeletal complaints even though little is known regarding the physiological mechanisms responsible for the reported clinical effects of this therapy. Chronic neck pain is one common and costly musculoskeletal disorder often treated with therapeutic massage. A multifaceted condition, the US National Health Interview Survey stated that over 34 million people reported experiencing neck pain in the three preceding months. Several studies have investigated the use of therapeutic massage for neck pain, however, a recent review of the literature on massage and neck pain led to the conclusion that no recommendations for practice could be made from the available research.
Research and clinical reports indicate therapeutic massage may decrease pain and muscle spasm, however, the physiological processes behind these reported effects are still in doubt. Therapeutic massage has been theorized to operate through a combined group of physiological processes which include changes in hormones, neurotransmitters, and blood flow. While some physiological processes (i.e. changes in cortisol level) have received extensive investigation, others critical to understanding the musculoskeletal effects of therapeutic massage have received less study. Research has investigated potential changes in the musculotendonous unit, central and peripheral nervous system effects, mechanical factors, and neurotransmitter influences, however, strong evidence for the physiological mechanisms of action for therapeutic massage remains elusive.
Several studies have suggested that therapeutic massage decreases muscle tension by stimulating sensory receptors which in turn reduce a-motoneurone pool excitability. Using the Hoffmann reflex (H-reflex) these studies have begun to examine the influence of therapeutic massage on the monosynaptic connections between the Ia sensory fibers and the spinal motoneurones. Modulation of afferent input into the spinal cord (with a probable effect on the ascending tracts) could have a direct effect on muscle fiber response. These past studies have provided a base of information on the effect of therapeutic massage on spinal reflexes, and further work in this area is warranted. Studies examining a more clinical therapeutic massage protocol with standardized H-reflex methods would add to our understanding of how a therapeutic massage session influences segmental spinal reflexes.
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Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles
From: Scand J Med Sci Sports. 2011 May 12
Active trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions. Trigger points are hyperirritable spots in skeletal muscle associated with palpable nodules in the taut bands of muscle fibers. When these palpable nodules are stimulated mechanically, local pain and referred pain can be induced together with visible local twitch response.
Trigger points can be either active or latent. An active trigger point is one that refers pain either locally to a large area and/or to another remote location, the local and referred pain can be spontaneous or reproduced by mechanical stimulation which elicits a patient-recognized pain. A latent trigger point does not reproduce the clinical pain complaint but may exhibit all of the features of an active trigger point to a minor degree.
Myofascial pain syndrome due to trigger points can be acute or chronic, regional or generalized; it can also be a primary disorder leading to local or regional pain syndromes or a secondary disorder as a consequence of other conditions. Active trigger points contribute significantly to the regional acute and chronic myofascial pain syndrome, such as lateral epicondylalgia, headache and mechanical neck pain and temporomandibular pain disorders. Active trigger points are also the main peripheral pain generator in generalized musculoskeletal pain disorders, such as fibromyalgia and whiplash syndrome.
The aim of this study was to investigate the presence of mechanical hypersensitivity and active trigger points in the neck-shoulder muscles in elite swimmers with/without unilateral shoulder pain. Seventeen elite swimmers with shoulder pain; 18 swimmers without shoulder pain; and 15 elite athletes matched controls were recruited. Pressure pain thresholds were assessed over the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, scalene, subscapularis and tibialis anterior muscles. Trigger points in the levator scapulae, upper trapezius, infraspinatus, scalene, sternocleidomastoid and subscapularis muscles were also explored.
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Changed activation, oxygenation, and pain response of chronically painful muscles to repetitive work after training interventions: a randomized controlled trial.
From: Eur J Appl Physiol. 2011 Apr 22. [Epub ahead of print]
Trapezius myalgia – chronic pain from the upper trapezius muscle – is the most
frequent type of neck pain among office workers. Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The prevailing view is that sustained low-level activity of the upper trapezius muscle day after day leads to overload of muscle fibers of low-threshold motor units, and eventually pain develops. As a consequence, maximal muscle strength and neural activation may be impaired.
The main criteria for a positive clinical diagnosis of trapezius myalgia are
1) pain in the neck area
2) tightness of the trapezius muscle,
3) palpable tenderness of the trapezius muscle.
Having trapezius myalgia was associated with decreased strength capacity and
lowered activity of the painful trapezius muscle.
The aim of this randomized controlled trial was to assess changes in myalgic trapezius activation, muscle oxygenation, and pain intensity during repetitive and stressful work tasks in response to 10 weeks of training. In total, 39 women with a clinical diagnosis of trapezius myalgia were randomly assigned to: (1) general fitness training performed as leg-bicycling; (2) specific strength training of the neck and shoulder muscles or (3) reference intervention without physical exercise. Electromyographic activity (EMG), tissue oxygenation (near infrared spectroscopy), and pain intensity were measured in trapezius during pegboard and stress tasks before and after the intervention period.
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A Medical-Ergonomic Program for Symptomatic Keyboard/Mouse Users.
From: J Occup Environ Med. 2011 Apr 19. [Epub ahead of print]
To describe the range of ergonomic stressors and effective interventions in otherwise healthy patients diagnosed with upper extremity disorders associated with occupational keyboard/mouse use. Work-related musculoskeletal disorders are widespread among computer users and costly to the health care system. Workstation setup and worker postures contribute to upper-extremity and neck symptoms among computer users. Ergonomic interventions such as work risk analysis and workstation modifications can improve workers’ symptoms
From patients treated in their Medical Ergonomic Program, they report demographic data, symptoms, signs, diagnoses and associated ergonomic stressors and response to medical/ergonomic interventions.
Fifty-six patients had a mean age (range) of 40 (23-61) years with 20 patients younger than 35 years. The most prevalent diagnoses were myofascial pain syndrome of shoulder and neck associated with poor posture, myofascial pain syndrome of forearm extensors followed by thoracic outlet syndrome and carpal tunnel syndrome. Common ergonomic stressors were typing/mousing technique, keyboard height, inadequate seating, and lack of breaks. Improvement occurred in 89% following medical/ergonomic intervention.
Ergonomic education/intervention must be combined with the medical treatment of work-related upper extremity disorders associated with keyboard/mouse use. This lends credence to the importance of examining the work habits and work-related postures of a patient who complains of upper-extremity and neck pain that is exacerbated by work. Providing an ergonomic intervention in concert with traditional physical therapy may be the most beneficial course of treatment.
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Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues
From: Pain. 2011 Mar 16. [Epub ahead of print]
Problems in diagnosing fibromyalgia syndrome among motor vehicle collision patients with whiplash include the following: the predominance of tender points in the neck and shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis.
The present study examined the prevalence of fibromyalgia syndrome in a cohort (N=326) patients with persistent neck pain 3 months after whiplash injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that whiplash patients had a greater proportion of neck and shoulder girdle tender points, relative to distal tender points. Compared with a matched cohort of treatment-seeking fibromyalgia syndrome patients, whiplash patients indicated less distal tender points (mean=7.3 tender points vs mean=5.6 tender points), but were equivalent on neck and shoulder girdle tender points (mean=9.0 tender points vs 9.2 tender points, NS). Baseline prevalence of fibromyalgia syndrome for the whiplash cohort based on ACR criteria was 14% (95% CI=10%-18%), adjusted tender points criterion discounting for neck and shoulder tenderness indicated a prevalence of fibromyalgia syndrome of 8% (95% CI=5%-11%).
Finally, 63% of patients meeting American College of Rheumatology fibromyalgia syndrome criteria at baseline did not meet this criterion at post-treatment (∼6-months after a motor vehicle collision). In conclusion, present criteria used in determining fibromyalgia syndrome may result in spuriously inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after an motor vehicle collision.
Furthermore, the transient nature of fibromyalgia syndrome “symptoms” among whiplash patients should be taken into account before making a final diagnosis. The present criteria used in determining fibromyalgia may result in spuriously inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after motor vehicle collisions.
Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study
From: Appl Psychophysiol Biofeedback. 2011 Mar 2. [Epub ahead of print]
Recent studies focusing on autonomic nervous system dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of autonomic nervous system regulation in development and maintenance of chronic muscle pain.
Research has demonstrated the effectiveness of heart rate variability biofeedback in increasing heart rate variability and reducing the symptoms of different disorders characterized by autonomic nervous system aberration. The study investigated the effects of resonance frequency heart rate variability biofeedback on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress related chronic neck and shoulder pain.
Twelve subjects participated in 10 weekly sessions of resonant heart rate variability biofeedback and were compared to a control group. Subjective reports and heart rate variability measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre and post intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for heart rate variability during relaxation and reactivity to stress.
The present pilot study indicates improvement in perceived health over a 10 week intervention with heart rate variability biofeedback in subjects with chronic neck pain. Increased resting heart rate variability as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on autonomic nervous system regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.
Effectiveness of an educational and physical program in reducing accompanying symptoms in subjects with head and neck pain: a workplace controlled trial
From: J Headache Pain. 2011 Jan 20. [Epub ahead of print]
The objective of this study is to evaluate the effectiveness of an educational and physical program in reducing behavioral or somatic symptoms along with headache, neck and shoulder pain in a working community. A controlled, non-randomized trial was carried out in a working community and 384 employees were enrolled and divided into a study group (Group 1) and a control group (Group 2). The Group 1 received a physical and educational intervention, consisting of relaxation and posture exercises and the use of visual feedback. After 6 months, the intervention was administered to the Group 2. Both groups were then followed for an additional 6 months until the end of the trial. The presence of accompanying symptoms was investigated with a semi-structured interview using a checklist of 20 items, along with headache, neck, and shoulder pain parameters and the prevalence of generalized anxiety disorder and depression, in three clinical examinations at baseline, after 6 months and after 12 months. For each symptom, as well as the presence of any type of symptom, the differences between groups in the prevalence at the clinical examinations following the baseline were evaluated by applying logistic models.
After 6 months, the probability of the presence of any type of symptom was significantly lower in the Group 1 with respect to the Group 2. After 12 months, the pooled estimation did not show any significant difference of symptom prevalence between groups. In conclusion, this is the first longitudinal study relative to accompanying symptoms. Its results suggest the effectiveness of this cognitive program in reducing the burden of physical and psychiatric complaints in a large, working population.
Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial.
From: Pain. 2010 Dec 20. [Epub ahead of print]
Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group).
Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10weeks.
Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points and 4.2 points in the 2-minute group and 1.9 points and 4.4 points in the 12-minute group. Compared with the control group, muscle strength increased 2.0 Nm to 3.5Nm, in the 2-minute group and 1.7Nm to 3.3 Nm, in the 12-minute group.
In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms. In generally healthy adults with frequent neck/shoulder muscle pain, as little as 2minutes of daily progressive resistance training reduces pain and tenderness.
Qigong training and effects on stress, neck-shoulder pain and life quality in a computerised office environment.
Complement Ther Clin Pract. 2011 Feb;17(1):54-7. Epub 2010 Dec 3
Qigong is a Chinese health promoting exercise with a rhythmic pattern of slow movements and breathing affecting the autonomous nervous system. This study was to examine the implementation of Qigong for half an hour daily in a computerised office, and to study effects on health state, general health, neck-shoulder and lumbar spine symptoms and stress after six weeks training
A crossover intervention study with 37 employees randomised in two groups. A questionnaire was completed one week before starting study and every second week during the training period. After 6 weeks the first group stopped and the second group started the training.
There was a small significant improvement of neck pain and disability following therapy.
Qigong training may reduce neck disability in office workers. A longer training period might be needed in further Qigong studies in healthy, normal populations.
