M.Tech. (Chiropractic) / Purpose: Patients presenting with mechanical cervical spine pain demonstrate myofascial trigger points of the surrounding cervical spine musculature (De Las Penas, Alonso-Blanco, Alguacil-Diego and Miangolarra-Page, 2006). Myofascial trigger points, from specifically the cervical spine musculature, have been seen to be involved to a large extent with not only the local mechanical cervical spine pain but also the accompanying referred pain patterns and symptoms (De Las Penas, Alonso-Blanco and Miangolarra-Page, 2007). The purpose of this study is to compare the efficacy of ischaemic compression and laser therapy respectively, applied to an active myofascial trigger point in participants with acute mechanical cervical spine pain associated with an active trapezius myofascial trigger point TP1, with regards to pain, activities of daily living, pressure pain threshold and cervical spine range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and the laser group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1. Treatment was applied to the active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each participant was treated six times over a period of two consecutive weeks. Prior to initiation of the treatment, each participant was requested to complete the Vernon-Mior Neck Pain and Disability Index questionnaire and the Visual Analogue Scale. Algometer readings were obtained over the trapezius myofascial trigger point 1, bilaterally. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion: flexion, extension, lateral flexion, and rotation. Ischaemic compression and laser therapy, group 1 and group 2 respectively, then each received treatment of the active trapezius myofascial trigger point 1, for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th, and at the 7th final consultation.

Purpose: The upper trapezius to serratus anterior muscle activation ratio is essential for optimal shoulder function. An alteration of this ratio, specifically a decrease in upper trapezius and increase in serratus anterior activation, is a main area of focus in shoulder rehabilitation (Kibler, 1998; Paine & Voight, 1993). Electromyography (EMG) biofeedback has been shown to be an effective rehabilitation technique to address many musculoskeletal disorders but there is limited research on the retention of improvements seen with EMG biofeedback (Ma et al., 2011; Lim et al., 2014; Weon, et al., 2011). The purpose of this study was to determine if EMG biofeedback can be used to improve scapular control by decreasing the upper trapezius to serratus anterior activation ratio. A secondary purpose was to determine if these predicted improvements in the ratio can be retained beyond the timeframe in which the treatment is provided. Methods: Twenty college aged (age=21.75±1.77) subjects (10 males, 10 females) volunteered to participate in this study. Subjects were randomized to the exercise only group or EMG biofeedback group. The exercise only group performed three exercises twice a week for four weeks with supervision. The EMG biofeedback group performed the same exercises twice a week for four weeks with the addition of watching EMG biofeedback on a computer monitor with the instructions to decrease the upper trapezius activation and increase the serratus anterior activation by adjusting the corresponding lines on the monitor. The percent maximal voluntary contraction (MVC) for each muscle during each exercise was measured on visit one, visit nine (after the four weeks of practice) and visit ten (after a two-week retention period). The ratio and the individual muscle changes were analyzed using multi-factor ANOVAs against group, exercise, and group by exercise interaction. Results: There was no significant effect of any of the variables on the ratios visit one to visit nine, nor when comparing visit nine to visit ten. The was a significant effect of group on the upper trapezius when comparing visit one to visit nine (p=0.007) with no effect seen comparing visit nine to visit ten. There was also a significant effect of group on the serratus anterior activation for both visit one to visit nine (p=0.000) and visit nine to visit ten (p=0.001). Conclusion: EMG biofeedback did not decrease the upper trapezius to serratus anterior activation ratio, but the individual muscle activation changes indicate that EMG biofeedback is effective at altering muscle activation rates in individual muscles and that those changes can be retained beyond the timeframe of the intervention. Additional research is needed with more subjects and in populations with shoulder pathologies to further investigate the effectiveness of this concept.

No description available.

Prolonged computer work is associated with high rates of neck and shoulder pain symptoms, and as computers have become increasingly more common, it is becoming critical that we develop sustainable interventions targeting this issue. Static muscle contractions for prolonged periods often occur in the neck/shoulder during computer work and may underlie muscle pain development in spite of rather low relative muscle load levels. Causal mechanisms may include a stereotypical recruitment of low threshold motor units (activating type I muscle fibers), characterized by a lack of temporal as well as spatial variation in motor unit recruitment. Based on this theory, although studies have postulated that individuals with chronic neck-shoulder pain will show less variation in muscle activity compared to healthy individuals when engaged in repetitive/monotonous work, this has seldom been verified in empirical studies of actual computer work. Studies have rarely addressed temporal patterns in muscle activation, even though there is a consensus that temporal activation patterns are important for understanding fatigue and maybe even risks of subsequent musculoskeletal disorders. This study applied exposure variation analysis (EVA) to study differences in temporal patterns of trapezius muscle activity as individuals with and without pain performed computer work. The aims of this study were to: Assess the reliability of EVA to measure variation in trapezius muscle activity in healthy individuals during the performance of computer work; Determine the extent to which healthy subjects differ from those with chronic pain in trapezius muscle activity patterns during computer work, measured using EVA. Thirteen touch-typing, right-handed participants were recruited in this study (8 healthy; 5 chronic pain). The participants were asked to complete three 10-minute computer tasks (TYPE, CLICK and FORM) in two pacing conditions (self-paced, control-paced), with the healthy group completing two sessions and the pain group completing one. Activation of the upper trapezius muscle was measured using surface electromyography (EMG). EMG data were organized into 5x5 EVA matrices with five amplitude classes (0-6.67, 6.67-20, 20-46.67, 46.67-100, >100% Reference Voluntary Exertion) and five duration classes (0- 1, 1-3, 3-7, 7-15, >15 seconds). EVA marginal distributions (along both amplitude and duration classes) for each EVA class, as well as summary measures (mean and SD) of the marginal sums along each axis were computed. Finally, “resultant” mean and SD across all EVA cells were computed. The reliability in EVA indices was estimated using intra-class correlation coefficients (ICC), coefficient of variation (CV) and standard error of measurement (SEM), computed from repeated measurements of healthy individuals (aim 1), and EVA indices were compared between groups (aim 2). Reliability of EVA amplitude marginal sums ranged from moderate to high in the self-paced condition and low to moderate in the control-paced condition. The duration marginal sums were moderate in the self-paced condition and moderate to high in the control-paced condition. The summary measures (means and SDs) were moderate to high in both the self-paced and control-paced condition. Group comparisons revealed that individuals with chronic pain spent longer durations of work time in higher EVA duration categories, exhibited larger means along the amplitude, duration and in the resultant, and higher EVA SD in the amplitude and duration axes as compared to the healthy group. To our knowledge, this is the first study to report on the reliability of EVA applied specifically to computer work. Furthermore, EVA was used to assess differences in muscle activation patterns as individuals with and without chronic pain engaged in computer work. Individuals in the pain group seemed to exhibit prolonged sustained activation of the trapezius muscle to a significantly greater extent than controls, even though they did not experience pain during the performance of the computer tasks (as obtained through self-reports). Thus, these altered muscle recruitment patterns observed in the pain subjects, even in the absence of task-based pain/discomfort, are suggestive of chronic motor control changes occurring in adaptation to pain, and may have implications for the etiology of neck and upper-limb musculoskeletal disorders. / Master of Science / This study aims to assess the reliability of exposure variation analysis (EVA) to measure variation in trapezius muscle activity in healthy individuals during the performance of computer work, and to determine the extent to which healthy subjects differ from those with chronic pain in trapezius muscle activity patterns during computer work, measured using EVA. Muscle activation was recorded for eight healthy individual and five suffering from chronic neck-shoulder pain. The data were then categorized into amplitude and continuous time categories, and summary measures of resulting distributions were calculated. These measures were used to assess the reliability of participant responses to computer work of healthy individuals, as well as quantify differences between those with and without chronic pain. We found that individuals with pain activated their neck-shoulder muscles for longer continuous durations than healthy individuals, thus showing an inability to relax their muscles when performing work.

Dissertation completed in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: Mechanical neck pain is a common complaint characterized by pain, limited range of motion and myofascial trigger points. The most common treatments for it are manual therapy and drug therapy. The former includes massage and exercise therapy and more specific to this study spinal manipulation and dry needling. The latter includes non-steroidal anti-inflammatories (NSAIDs) and analgesics. Manipulation assists in increasing range of movement and reduces muscle spasm, while dry-needling inactivates trigger points and decreases local and referred pain. NSAIDs reduce pain and muscle spasm by inhibiting inflammatory pathways. Traumeel®S is a commonly used, safe and well tolerated homoeopathic anti-inflammatory with similar efficacy as NSAIDs but without the adverse gastrointestinal effects. It has also been shown to be highly effective in the treatment of myofascial pain. Methodology: This study was designed as a randomized comparative clinical trial. Fourty participants between ages 18-55 years of age were randomly allocated to two groups of twenty participants each. Group A received spinal manipulation and dry needling in trapezius trigger point two; while Group B received spinal manipulation and Traumeel®S solution injection in trapezius trigger point two. The study took place over a period of two weeks and involved four consultations. Subjective and objective readings were taken at every consultation. Subjective tools included the Numerical pain rating scale (NRS) and Canadian Memorial Chiropractic College (CMCC) neck disability index. Objective tools included the pressure algometer and cervical range of motion (CROM-II) goniometer. SPSS version 20.0 was used in the data analysis. A p-value of <0.05 was considered as statistically significant. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that the effectiveness of spinal manipulation and dry needling versus spinal manipulation and Traumeel®S Injectable solution in the treatment of mechanical neck pain associated with trapezius myofascial trigger points is equivalent to each other. No statistically or clinically significant changes were noticed between the groups.

Made available in DSpace on 2016-04-27T18:12:07Z (GMT). No. of bitstreams: 1 Andrea Pereira da Silva.pdf: 1030140 bytes, checksum: ef451cee972be44cd6cf942ce64d3dd2 (MD5) Previous issue date: 2015-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The elastic bandage as therapeutic instrument is a resource already in use for long time in areas such as Physiotherapy, but has only recently started to gain ground in the Speech Language Pathology for both clinic use and research. It has been used as auxiliary treatment for a number of musculoskeletal dysfunctions in the field of orofacial motility with excellent clinic results. Its application is diversified and, according to a clinical and therapeutic evaluation, can be used to increase or decrease the neuron excitement of a muscle. Despite of the elastic bandage vast usage possibility, it s use in Speech Language Pathology is still empiric once there are so few studies about this theme. Objective: to verify the elastic bandage effect on healthy adult s trapezius muscle through surface electromyography and a qualitative questionnaire. Method: 51 healthy adults participated from 20 to 35years old, 21 male and 30 divided randomly into three groups: G1 Group with tensioned elastic bandage, G2 Group with non-tensioned elastic bandage and G3 Control group that did no use the elastic bandage. For the data as acquisition a pre-bandage, with-bandage and 24h-after-bandage electromyography evaluations were performed on G1 and G2 subjects. For both groups was also applied a questionnaire. For the G3 subjects two electromyography evaluations were performed with a 24hour interval. The resulting data was loaded to an Excel spreadsheet where statistic crosses were performed considering the stages within the groups and crossing between groups. Results: There were no significant differences on the electromyography data during the tasks Rest (R) and maximum voluntary contraction (MVC) in any groups, immediately after placing the bandage and after 24hours on the groups that used this resource. Comparing G1, G2 and G3 there wasn t any evidence of significant differences on analyzed variables. Confronting G1 and G2 during the pre-bandage and with-bandage stages difference was found only during the left side MVC. In the questionnaire, the most part of the G1 group reported a relaxing sensation during sleep. Conclusion: The sample subjects that used the elastic bandage did not show significant result on the electromyographic signal of the evaluated muscle. However, regarding the self-reported questionnaire a big part of the subjects that used the bandage tape affirmed having a relaxing feeling / A utilização da bandagem elástica como instrumento terapêutico é um recurso novo na Fonoaudiologia que começa a ganhar espaço na clínica e na pesquisa, apesar de já ser utilizada há muito tempo em outros campos como por exemplo na Fisioterapia. Tem sido utilizada como auxiliar no tratamento de diversas disfunções musculoesquelética na área da motricidade orofacial com excelentes resultados clínicos. Sua aplicação é diversificada e conforme a avaliação clínico-terapêutica, pode ser usada para aumentar ou diminuir a excitação neuronal do músculo. Apesar da vasta possibilidade de utilização da bandagem elástica, na Fonoaudiologia esse uso ainda se dá de forma empírica, uma vez que temos poucos estudos sobre o tema. Objetivo: verificar o efeito da bandagem elástica no músculo trapézio de adultos saudáveis por meio de eletromiografia de superfície e de um questionário qualitativo. Método: participaram deste estudo 51 adultos saudáveis na faixa etária de 20 a 35 anos. 21 sujeitos do gênero masculino e 30 do feminino, divididos de forma randomizada em três grupos: G1 grupo que utilizou bandagem elástica com tensão, G2 grupo que utilizou bandagem elástica sem tensão e G3 grupo controle, que não utilizou a bandagem. Para a aquisição dos dados foram realizadas avaliações eletromiográficas no pré-uso da bandagem, com a bandagem e após 24 horas o uso da bandagem nos sujeitos do G1 e G2. Para os dois grupos também foi aplicado um questionário. Para os sujeitos do G3 foram realizadas duas avaliações eletromiográficas com o intervalo de 24 horas entre si. Os dados foram inseridos em uma planilha Excel onde foram realizados os cruzamentos estatísticos considerando os momentos dentro do mesmo grupo e o cruzamento entre os grupos. Resultados: não houve diferenças significativas nos dados eletromiográficos nas tarefas de repouso (R) e contração voluntária máxima (CVM) em nenhum um dos grupos após 24hs e imediatamente após a colocação da bandagem nos grupos que utilizaram este recurso. Na comparação entre G1, G2 e G3 também não foi evidenciado diferenças significativas para as variáveis analisadas. Na confrontação entre o G1 e o G2 nos momentos pré e durante, houve diferença entre os dois grupos apenas na variável CVM do lado esquerdo. No questionário a maioria dos sujeitos do grupo G1 referiram sensação de relaxamento durante o sono. Conclusão: os sujeitos da amostra que utilizaram a bandagem não apresentaram resultado significativo no sinal eletromiográfico do músculo avaliado. Em relação ao questionário autorreferido a maioria dos sujeitos da amostra que utilizaram a bandagem afirmaram sensação de relaxamento

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

<p>Repetitive and monotonous work is frequently associated with neck and shoulder pain and negative psychosocial factors inducing stress reactions. The present thesis concerns the relations between psychophysiological and subjective stress reactions, muscle activity measured by surface electromyography (SEMG) in the trapezius muscle, and neck and shoulder pain in women performing repetitive and monotonous work. In Study I cardiovascular and subjective stress reactions were investigated during computer work in a laboratory setting. The findings indicated that heart rate variability is a more sensitive and selective measure of mental stress compared with blood pressure recordings. Study II explored the relations between stress reactions and muscle activity during supermarket work. The results showed that perceived negative stress reactions may have a specific influence on muscle activity in the neck and shoulder region, which can be of importance for work-related musculoskeletal disorders in repetitive and monotonous work. In Study III the association between SEMG activity patterns and neck and shoulder pain was investigated during cash register work. It was found that pain-afflicted women had a different muscle activation pattern (more static, more co-contraction, less muscle rest) compared with pain-free women. Study IV was a follow-up study evaluating the introduction of job rotation among female cashiers. The results indicated positive effects on diastolic blood pressure, muscle activity, and partly on neck and shoulder pain, although perceived stress was unchanged. It was concluded that job rotation seems to have a limited effect on chronic neck and shoulder pain, but may be an effective preventive measure. The empirical findings are particularly relevant for women who, compared with men, more often perform repetitive and monotonous work and are also more often affected by neck and shoulder pain.</p>

Repetitive and monotonous work is frequently associated with neck and shoulder pain and negative psychosocial factors inducing stress reactions. The present thesis concerns the relations between psychophysiological and subjective stress reactions, muscle activity measured by surface electromyography (SEMG) in the trapezius muscle, and neck and shoulder pain in women performing repetitive and monotonous work. In Study I cardiovascular and subjective stress reactions were investigated during computer work in a laboratory setting. The findings indicated that heart rate variability is a more sensitive and selective measure of mental stress compared with blood pressure recordings. Study II explored the relations between stress reactions and muscle activity during supermarket work. The results showed that perceived negative stress reactions may have a specific influence on muscle activity in the neck and shoulder region, which can be of importance for work-related musculoskeletal disorders in repetitive and monotonous work. In Study III the association between SEMG activity patterns and neck and shoulder pain was investigated during cash register work. It was found that pain-afflicted women had a different muscle activation pattern (more static, more co-contraction, less muscle rest) compared with pain-free women. Study IV was a follow-up study evaluating the introduction of job rotation among female cashiers. The results indicated positive effects on diastolic blood pressure, muscle activity, and partly on neck and shoulder pain, although perceived stress was unchanged. It was concluded that job rotation seems to have a limited effect on chronic neck and shoulder pain, but may be an effective preventive measure. The empirical findings are particularly relevant for women who, compared with men, more often perform repetitive and monotonous work and are also more often affected by neck and shoulder pain.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-19T13:41:01Z No. of bitstreams: 1 Fabiana Sarilho de Mendonca.pdf: 960484 bytes, checksum: be95fe89cc95556dccc9a63e7868ac13 (MD5) / Made available in DSpace on 2018-06-19T13:41:01Z (GMT). No. of bitstreams: 1 Fabiana Sarilho de Mendonca.pdf: 960484 bytes, checksum: be95fe89cc95556dccc9a63e7868ac13 (MD5) Previous issue date: 2015-12-15 / Although the low level light therapy (LLLT) irradiation is indicated for a variety of musculoskeletal disorders like muscle fatigue, tissue repair and as anti-inflammatory agent, its effects on muscle activity are still poorly understood. The objective of this study was to evaluate the immediate effect of LLLT of irradiation on the nerve conduction velocity and electromyographic activity of the muscle upper trapezius (UT) in healthy subjects. Twenty healthy women (mean age 23.54  2.51) were included in this study, cross-over, controlled, randomized, double blind. Each volunteer has received two types of treatment with continuous LLLT (LLLT) and the other one with LLLT placebo (LLLTP). The treatment order was randomized by raffle, being included an interval of 7 days between each laser intervention (wash-out) to prevent residual effects. The surface electromyography (EMG) was used to verify the nerve conduction velocity (CV) and muscle activity UT during shoulder elevation in isometric contraction to 5 different levels of contraction (10, 15, 20, 25, 30% of maximum voluntary contraction), via visual feedback provided through a driving line. The collects of the EMG signal were performed before and after 30 minutes of treatment (LLLT or LLLTP). In the analysis of variance for repeated measures (ANOVA) it was possible to observe a significant decrease in the amplitude of the EMG signal to treatment with LLLT (p = 0.0001) but not to the placebo treated group (p < 0.05). Regarding of the CV, no change was observed for both treatments (LLLT: p > 0.05; LLLTP: p > 0.05 - ANOVA). In this study it could be observed an immediate effect of LLLT irradiation on the amplitude of the electromyographic signal of the trapezius muscle descending fibers in healthy individuals, but not on the nerve conduction velocity. / Embora a irradiação com laser de baixa potência (LBP) seja indicada para vários tipos de disfunções musculoesqueléticas como fadiga muscular, reparo tecidual e como agente anti-inflamatório, seus efeitos sobre a atividade muscular ainda são pouco conhecidos. O objetivo desse estudo foi avaliar o efeito imediato da irradiação do LBP sobre a velocidade de condução nervosa e a atividade eletromiográfica do músculo trapézio fibras descendentes (TFD) em indivíduos saudáveis. Vinte mulheres saudáveis (idade média: 23,54  2,51) foram incluídas nesse estudo, cruzado, controlado, randomizado duplo cego. Cada voluntária recebeu 2 tipos de tratamento com LBP (LBP) contínuo e outra com LBP placebo (LBPP). A ordem de tratamento foi randomizada por sorteio, sendo incluído um intervalo de 7 dias entre cada intervenção de laser (wash-out) para evitar efeitos residuais. A eletromiografia (EMG) de superfície foi utilizada para verificar a velocidade de condução nervosa (VC) e atividade no músculo TFD durante a elevação do ombro em contração isométrica em 5 diferentes níveis de contração (10, 15, 20, 25, 30% da contração voluntária máxima), por meio de feedback visual proporcionado por uma linha de treino. As coletas do sinal EMG foram realizadas antes e após 30 minutos do tratamento (LBP ou LBPP). Na análise de variância para medidas repetidas (ANOVA) foi possível observar diminuição significativa na amplitude do sinal EMG para o tratamento com LBP (p = 0,0001) porém não para o grupo tratado com LBPP (p < 0,05). Em relação à VC, nenhuma alteração foi observada para ambos os tratamentos (LBP: p > 0,05; LBPP: p > 0,05 - ANOVA). Nesse estudo foi possível observar um efeito imediato da irradiação com LBP sobre a amplitude do sinal eletromiográfico do músculo trapézio fibras descendentes em indivíduo saudáveis, porém, não sobre a velocidade de condução nervosa.