Orientador: Fausto Bérzin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T23:38:38Z (GMT). No. of bitstreams: 1 Oliveira_RobertaLucianode_M.pdf: 1611854 bytes, checksum: f51e1f9fe05d8141e2a091ad90cc8093 (MD5) Previous issue date: 2011 / Resumo: A disfunção temporomandibular (DTM) ocasiona entre outros sintomas a dor orofacial. É comum, também, a ocorrência de queixa dolorosa na região cervical, o que leva à sobreposição de sinais e sintomas entre a articulação temporomandibular (ATM) e a coluna cervical. Este estudo teve por finalidade comparar o padrão de atividade eletromiográfica e a presença e intensidade da dor dos músculos cervicais de mulheres com e sem DTM, durante movimentos cervicais. Foram investigadas 37 mulheres classe I de Angle com faixa etária entre 18 e 35 anos de idade e índice de massa corpórea de 18 a 25 kg/m². O grupo de DTM foi formado por 20 voluntárias com diagnóstico de DTM miogênica, com ou sem deslocamento de disco pelo teste do ?Research Diagnostic Criteria for Temporomandibular Disfunction? (RDC/TMD) e o grupo controle constou de 17 mulheres sem DTM. Para obtenção do sinal eletromiográfico foi utilizado o equipamento ADS1200 da Lynx Tecnologia Eletonica Ltda. de oito canais, portátil, ganho de 1 a 16000, placa conversora Analógica/Digital com 16 bits de resolução e um pré-amplificador com ganho de 20 vezes acoplado a eletrodos passivos bipolar auto-adesivos, descartáveis, de formato circular, feitos de Ag/AgCl com distância inter eletrodo fixa de 10 mm. Foi utilizada freqüência de amostragem de 2000 Hz para cada canal e filtro passa banda de 20 - 500 Hz. O sinal foi coletado por seis segundos nos músculos esternocleidomastóideo (ECM), trapézio superior e cervicais posteriores bilaterais e o eletrodo de referência foi colocado no punho sobre o processo estilóide da ulna. Foram realizados movimentos isotônicos de flexão cervical e elevação dos ombros e isométrico de flexão, extensão cervical e elevação de ombros, além do repouso. Foram analisadas as variáveis pelo root mean square (rms) e calculado os índices de assimetria e co-contração. Utilizou-se exame clínico para determinar presença, local e intensidade da dor cervical. As comparações das médias para as variáveis observadas no experimento foram através do teste t de Student para duas amostras independentes e os cálculos foram executados através do sistema SAS. A presença de dor cervical no grupo de DTM foi mais freqüente do que no grupo Controle com 75% e 25% respectivamente. A dor foi maior no grupo DTM à palpação de todos os músculos avaliados com diferença estatística entre os grupos. Durante a movimentação da coluna cervical, a dor também foi maior no grupo DTM em todos os movimentos com exceção da extensão suboccipital. Não houve diferença estatística durante contração isométrica e repouso. O índice de assimetria apresentou valores de 8,4% a 14% no grupo DTM e 6,8% a 16,6% para controle, sem diferença estatística entre os grupos. Na isotonia o grupo DTM teve valores mais baixos para a ação do ECM com atividade constante dos cervicais posteriores e razão de co-contração de 0,59 e 0,49 em DTM e controle respectivamente (p<0,05). Os dois sistemas estão interligados e precisam ser avaliados nos tratamentos das DTMs e disfunções cervicais / Abstract: The temporomandibular disorder (TMD) among many symptoms causes orofacial pain. It is also common, the incidence of neck pain complaint, which leads to overlapping signs and symptoms of temporomandibular joint (TMJ) and cervical spine. This study aimed to compare the patterns of electromyographic activity and the presence and severity of pain in the cervical muscles of women with and without TMD during neck movements. We investigated 37 women with class I Angle aged between 18 and 35 years of age and body mass index from 18 to 25 kg / m². The TMD group was formed by 20 volunteers diagnosed with myogenic TMD, with or without disc displacement tested by the "Research Diagnostic Criteria for Temporomandibular Dysfunction" (RDC / TMD) and control group consisted of 17 women without TMD. To obtain the electromyographic signal it was used the equipment ADS1200 Lynx Electronics Technology Ltd. with eight-channel, portable, gain of 1 to 16,000. Board analog / digital converter with 16 bit resolution and a preamplifier with a gain of 20 times passive bipolar electrodes attached to self-adhesive, disposable, circular shape, made of Ag / AgCl electrode with fixed inter distance of 10 mm. It was used a sampling frequency of 2000 Hz for each channel and band pass filter 20 to 500 Hz, and the electromyographic signal was collected during six seconds in the sternocleidomastoid (SCM), upper trapezium and posterior cervical muscles and a bilateral reference electrode was placed on the wrist on the process ulnar styloid. Isotonic movements were performed for cervical flexion and shoulder elevation and isometric contraction for cervical flexion, cervical extension and elevation of the shoulders, and also at rest. The variables were analyzed through root mean square (rms) and it was calculated the asymmetry index and the co-contraction rate. We used clinical examination to determine presence, location and intensity of neck pain. Comparisons of means for the variables were observed in the experiment by Student's t test for two independent samples and the calculations were performed using the SAS system. The presence of neck pain in the TMD group was more frequent than in the control group with 75% and 25% respectively. The pain was higher in the TMD group for all muscles assessed by palpation with a statistical difference between groups. During movement of the cervical spine, the pain was also higher for TMD in all movements except the suboccipital extension. There was no statistical difference during isometric contraction and rest. Asymmetry index showed values of 8.4% to 14% in the TMD group and 6.8% to 16.6% for control, there was no statistical difference between the groups. For the isotonic movements TMD group had lower values of root mean square in the ECM muscle with constant activity of the posterior cervical muscles and co-contraction ratio of 0.59 and 0.49 respectively in control and TMD (p <0.05) / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

M.Tech. (Chiropractic) / Aim of this study was to compare which treatment either Proprioceptive Neuromuscular Facilitation or chiropractic manipulation, whether by itself or in combination, was more effective and beneficial in the treatment of mechanical neck pain. The effectiveness was measured by the use of a Visual Analogue Scale, Vernon- Mior Neck Pain and Disability Index questionnaire and the measurement of cervical spine range of motion using an analogous cervical spine range of motion inclinometer (CROM). The questionnaire and the measurements were taken prior to the treatments at the first, fourth and seventh consultations.Thirty participants who met the inclusion criteria were randomly placed into three groups of equal size (10 participants each). Group one received a Proprioceptive Neuromuscular Facilitation (PNF) stretching protocol to the cervical spine. Group two received a chiropractic manipulation to the cervical spine. Group three received a combination treatment, first receiving chiropractic manipulation and then a PNF stretching protocol to the cervical spine. Participants were treated six times out of a total of seven sessions, over a maximum of a three week period.Subjective data was collected at the beginning of the first, fourth and seventh consultations. This was done by means of a Visual Analogue Scale and a Vernon-Mior Neck Pain and Disability Index Questionnaire, in order to assess pain and disability levels. Objective data was collected by means of measuring cervical spine range of motion using a cervical range of motion (CROM) inclinometer. Analysis of collected data was performed by a statistician from STATKON, a department of the University of Johannesburg.Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with reference to pain and disability. Statistically significant changes were seen in all three groups with reference to pain and disability. Group 3 was shown to improve the most with regard to pain and disability. Group 1 had statistically significant improvement with regard to cervical range of motion in the ranges of left and right rotation. Group 2 experienced a decrease range of cervical motion with regard to extension. As the study consisted of a small group of participants further, more extensive studies are needed...

M.Tech. (Chiropractic) / The aim of the study was to compare the efficacy of treating the active levator scapulae trigger point (TP1) with either chiropractic adjustments combined with ischemic compression or chiropractic adjustments combined with ultrasound therapy in physically active people in order to determine which of the two treatment protocols was superior.This study was a comparative study consisting of two groups of fifteen participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. The International Physical Activity Questionnaire, a clinical case history, full physical examination, a cervical regional examination and examination of the levator scapulae muscle for an active central trigger point (TP1) were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received cervical spine chiropractic adjustments combined with ischemic compression to the active levator scapulae trigger point. Group 2 received cervical spine chiropractic adjustments combined with ultrasound therapy to the active levator scapulae trigger point. Subjective and objective readings were based on the above treatment protocols.Treatment consisted of seven consultation sessions over a three week period. There were six treatment visits with the seventh visit used only for data collection. There were two treatments each week with at least two days in between visits. The third week consisted of three visits with the last visit used only for data collection. Subjective data was collected from the Vernon-Mior Neck Pain and Disability Index Questionnaire and the Numerical Pain Rating Scale. Objective data was collected from the pressure algometer readings. Subjective and objective data was collected before treatment on the first and fourth visits and on the seventh final data collection visit. Analysis of the data collected was done by a statistician. The chiropractic adjustments used were based on motion palpation findings on the treatment visits and re-assessed on each visit.Clinically significant improvements regarding neck pain and disability and trigger point severity were seen in both Group 1 and Group 2 over the three week period. Group 2 showed greater improvements in all subjective and objective readings over the three weeks compared to Group 1.

Background: Chronic neck pain is a problem that may be prevented and treated by physical activity. Little is known about effective interventions to increase physical activity in workers with neck pain. Objective: To evaluate the effects of an intervention aimed at increasing physical activity among workers with chronic neck pain. Design: A 10-week randomized controlled study in a population of 35 (intervention n= 19, control n= 16) workers. Physical activity was assessed using a tri-axial accelerometer pre and post the intervention. Outcomes: Daily steps, metabolic equivalent, proportions of time spent sitting/lying, standing and walking, and sit-to stand transitions. Linear mixed model was used to analyze the intervention effect (group × time) adjusted for the baseline value for each outcome. Results: There was no significant intervention effect on steps, metabolic equivalent, walking or sit-to stand transitions. There were significant intervention effects on decreased time spent sitting/lying (p=0.010) and increased standing (p=0.017).   Conclusion: No differences between intervention and control groups were found in parameters of total physical activity. However sedentary time decreased substantially in intervention group and was replaced by standing time. Larger studies using objective assessments of physical activity and sedentary behavior, investigating the effects of changes in PA and sedentary behavior on pain and health outcomes, in a working population with chronic neck pain are recommended. / Bakgrund: Kronisk nacksmärta är ett problem som kan vara möjligt att förebygga och behandla med fysisk aktivitet. Det finns begränsad kunskap om effektiva interventioner för att öka fysisk aktivitet hos arbetstagare med nacksmärta. Syfte: Att utvärdera effekten av en intervention riktad mot att öka fysisk aktivitet hos en grupp arbetstagare med kronisk nacksmärta. Design: En 10 veckors randomiserad kontrollerad studie i en population av arbetstagare med kronisk nacksmärta, n= 35 (interventionsgrupp n=19, kontrollgrupp n= 16). Fysisk aktivitet mättes med triaxiell accelerometer före och efter interventionen.  Utfallsmått: Antal steg per dag, metabolisk ekvivalent, förändringar i proportionerna mellan tid i sittande/liggande, stående och gående och antal uppresningar från sittande till stående. Resultat: Det fanns ingen signifikant interventionseffekt avseende steg, metabolisk ekvivalent, tid i gående eller antal uppresningar från sittande. Tid i sittande/liggande minskade signifikant (p=0,010) och tid i stående ökade, också signifikant (p=0,017).  Slutsats: Det fanns ingen skillnad mellan grupperna i total fysisk aktivitet. Däremot minskade tiden i sittande/liggande markant och ersattes av tid i stående. Större studier med objektiva mätningar av fysisk aktivitet och stillasittande beteende som också undersöker effekter av förändringar i fysisk aktivitet på smärta och hälsovariabler bland arbetstagare med kronisk nacksmärta rekommenderas. / STIMUL

Title: Comparison of the effectiveness of manual therapy and therapy using exercises in muscle postural ligations for painful neck syndromes. Objective: The main aim of this work is to compare commonly used physiotherapeutic techniques, exercise and mobilization, (manipulation) techniques in chronic, painful neck syndromes. Methods: The study involved a total of 30 probands with chronic neck pain, randomly divided into three groups of 10. In the first group the subject was health exercise, in the second group therapy with mobilization (manipulations) techniques and in the third group was a combination of both therapies. Probands were individually treated in five visits, 30 minutes for one visit. The evaluation methods were NRS, NDI and goniometry. The data was evaluated in Microsoft Office Excel. Results: The results showed that after 5 therapies there was a statistically significant reduction in pain on the NRS scale in all three groups. Within the NDI questionnaire there was a very small reduction in the ADL limitation, for all three groups, the changes were statistically significant. There were no changes in goniometry in any of the groups and changes were not statistically significant. Keywords: chronic neck pain, cervical spine, exercise, mobilization, NDI

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Aim: There is a paucity in the literature regarding the effectiveness of the Impulse Adjusting Instrument® (IAI) in treating myofascial trigger points (MFTPs) and regarding the effectiveness between dry needling and the IAI in the treatment of MFTPs. There are many limitations and an array of contraindications for dry needling. Therefore, an alternative method should be sought as this will be beneficial to the patient. Thus, the aim of this study was to determine the effectiveness of the IAI compared to dry needling in the treatment of MFTPs found in the upper trapezius muscle. Methodology: This study was a randomised single-blinded clinical trial. This study consisted of 41 participants between the ages of 18 and 40 who were divided into two groups. The participants were randomly allocated into their respective groups using a blinded allocation method that was drawn up by the statistician. Groups were divided into dry needling (Group one (n=18)) and IAI (Group two (n=23)) treatment groups. Subjective neck pain level was determined using a numerical pain rating scale (NRS). The neck disability index (NDI) subjectively assessed the effect neck pain had on the participants’ activities of daily living before and after treatment. The Patients Global Impression of Change (PGIC) tool was used to determine the participants’ subjective impression of treatment outcomes since the beginning of the treatment. Objective pain pressure thresholds (PPT) were measured with an algometer. Objective cervical range of motion (CROM) in lateral flexion (LF) was measured with a goniometer. Each participant had four visits over a two week period, which included three treatments and a final visit for final measurements. Data was analysed using IBM SPSS version 23. Repeated measures ANOVA was used to examine the effect on each outcome measure. Directional trends in effectiveness were drawn up using profile plots to assess the direction and trends of the effects. A p value of < 0.05 was considered to be statistically significant. Results: Intra-group and inter-group statistical analysis revealed all subjective measurements improved in both groups with no significant differences between the groups. With respect to objective measurements, there was no statistical improvement in LF CROM and dry needling had no improvement in PPT. Impulse Adjusting Instrument trigger point therapy showed an increase in PPT, however, when compared to dry needling there was no statistical difference in PPT. Conclusion: The conclusion for this study states that the trends in each of the outcomes suggest that the IAI is as effective as dry needling for the treatment of MFTPs. / M

M.Tech. (Chiropractic) / Neck pain is a common and costly complaint in society and many are made to believe that their neck pain is caused by pinched nerve, compressed disk, arthritis or displaced cervical vertebrae, when in reality the pain may be solely due to referral from myofascial trigger points in overworked or traumatized muscles of their upper back and shoulders. Travel and Simons (1999) demonstrated trapezius muscle of the neck, back and shoulder as the main cause of mechanical neck pain and stiffness. The aim of this study was to compare the effects of trigger point therapy using an activator instrument versus myofascial dry needling in combination with cervical spine adjustment in the treatment of those with acute or chronic neck pain associated with active trigger point 1 (TrP 1) or trigger point 2 (TrP 2) of upper trapezius muscle, with regards to pain and disability, pressure pain threshold and cervical spine range of motion. The clinical study consisted of forty participants, from the ages of 18 and 45, randomly allocated into two groups of twenty individuals each. Potential participants were examined and accepted based on inclusion and exclusion criteria. Group 1 received activator trigger point therapy to upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine, and group 2 received myofascial dry needling of upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine. Participants were treated four times over a period of two weeks. Subjective data was collected using the Vernon-Mior Neck Pain and Disability Index and a Visual Analog Scale. Objective data was collected using an algometer to measure pressure pain threshold of trapezius TrPs muscles, and a goniometer to measure cervical spine range of motion. All data was collected at the first and third visits prior to treatment, and at the fifth visit. The statistical analysis was conducted using nonparametric tests. Friedman’s test was used to assess whether neck pain, disability, cervical spine range of motion and pressure pain threshold varied over the three time intervals. Wilcoxon Signed Ranks Pair test was used for assessment of comparability of the results in each group separately, and the Mann-Whitney U test was used for comparison of the accumulated data in the two groups.

M.Tech. / Purpose: This study aims to compare the effects of Chiropractic manipulative therapy of the cervical spine in conjunction with SpiderTech therapy in the treatment of chronic neck pain with regards to pain, disability and cervical spine range of motion. Method: This study consisted of two groups of 15 participants between the ages of eighteen and forty, ensuring equal male to female and age ratios. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic manipulative therapy to restriction(s) of the cervical spine, with the SpiderTech Neck Spider applied to the posterior aspect of the neck. Group received chiropractic manipulative therapy to restriction(s) of the cervical spine only. Procedure: Treatment consisted of 6 treatment sessions with an additional follow up consultation, with two consultations being performed per week interval. Subjective data and objective data was taken at the beginning of the first, fourth and seventh sessions. The subjective data collected was in the form of a Numerical Pain Rating Scale and a Vernon- Mior Neck Pain and Disability Index. Objective data consisted of cervical spine range of motion readings taken using a Cervical Range of Motion measuring instrument (CROM). Analysis of collected data was performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data gathering only. Results: Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 and group 2 with reference to cervical spine range of motion. Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability and cervical spine range of motion. However, the combined treatment group (group 1) had a clinically greater effect than that of the manipulation only group. Conclusion: The results show that both Chiropractic manipulative therapy, as well as Chiropractic manipulation in conjunction with the SpiderTech Neck Spider are effective treatment protocols in decreasing pain and disability and increasing cervical spine range of motion in patients with chronic neck pain. However, neither treatment protocol proved to be preferential. When compared to Chiropractic manipulative therapy alone, SpiderTech therapy in conjunction with Chiropractic manipulative therapy has a clinically larger effect on neck pain, disability and range of motion of the cervical spine.

M.Tech. (Chiropractic) / Mechanical neck pain is the most common type of cervical spine pain encountered. It is also referred to as simple or non-specific neck pain and is common in all groups of people (Plaugher, 1993). A majority of individuals with neck pain do not experience a resolution in their pain and disability and this thus results in chronicity (Cote, Cassidy, Carrol and Kristman, 2004). Chiropractic manipulative therapy (CMT) is a specific form of articular manipulation, especially of the vertebral column. This is performed either manually, mechanically, actively or passively in order to restore normal articular alignment and function (Gatterman, 2005). Proprioceptive neck exercises are designed to retrain the cervical musculature to regain its position sense in space. Specific exercises are designed to locate the head to a neutral position and then to do a series of movements in other planes, and then to return the head to the neutral position (Revel, Minguet, Gergoy, Valliant and Manuel, 1994). Chiropractic manipulative therapy does have documented positive effects on the proprioceptive system within the cervical spine (Palmgren, 2006) as does proprioceptive exercises (Sarig-Bahat, 2003; Revel, Minguet, Gergoy, Vaillant, Manuel, 1994). The desired effects of combining both these treatments would be to increase the response rate in patients suffering from chronic mechanical neck pain. The aim of this study was to compare the effects of Chiropractic manipulative therapy (CMT) and proprioceptive neck exercises as stand-alone treatment protocols, as well as a combination treatment protocol with regards to neck pain, disability, cervical spine range of motion and Head Repositioning Accuracy (HRA). Participants were recruited from the University of Johannesburg Chiropractic Day Clinic. They were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of advertisements that were placed around the respective campuses of the University of Johannesburg as well as by word of mouth. Thirty participants, who presented with chronic mechanical neck pain, volunteered for this randomised comparative clinical study. The participants, aged between 18 - 40, were randomly divided into three groups of ten, with a half female to male ratio. Group 1 received Chiropractic manipulative therapy to the restricted joints in the cervical spine, Group 2 received proprioceptive neck exercises and Group 3 received a combination of both treatments. Participants were treated for a total of 6 visits over a three week period. Subjective and objective measurements were taken at the beginning of visits 1, 4 and at a final visit 7 during which only measurements were taken. Subjective measurements consisted of the Vernon-Mior Neck Pain and Disability Index (VMNPDI) and the Numerical Pain Rating Scale (NPRS) to assess the participants‟ neck pain and disability as well as their perception of pain. Objective measurements were obtained by using the Cervical Range of Motion device (CROM) as well as measuring the Head Repositioning Accuracy (HRA) as described by Revel, Andre-Deshays and Minguet (1991). Based on the results of the study, it could be concluded that both Group 1 (Chiropractic manipulative therapy to the restricted joints in the cervical spine) and Group 3 (a combination of cervical spine manipulation and proprioceptive neck exercises) can be used effectively to treat chronic mechanical neck pain and improve HRA. Group 1, 2 and 3 showed statistical improvements in certain areas and clinical improvements in all areas over time. It could not be statistically concluded whether one treatment is superior to the other, although clinically, Group 1 and Group 3 seemed to be more effective. Considering that Group 3 is a combination of cervical spine manipulation and proprioceptive neck exercises, it could be considered as a valid treatment protocol for chronic mechanical neck pain and improving HRA and could thus be used in a clinical setting.

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.