Psychological care, patient education, orthotics, ergonomics and prevention strategies for neck pain: a systematic overview update as part of the ICON project

Objectives: To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1°/2° neck pain prevention for adults with acute-chronic neck pain. Search Strategy: Computerized databases and grey literature were searched (2006-2012). Selection Criteria: Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review. Main Results: We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: - 0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial. Reviewers' Conclusions: Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions

Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP

INFLUENCE OF FELDENKRAIS METHOD ON SPINE HEALTH IN PROFESSIONAL ORCHESTRAL MUSICIANS. PILOT STUDY/INFLUENZA DEL METODO FELDENKRAIS SULLA SALUTE DEL RACHIDE IN MUSICISTI ORCHESTRALI PROFESSIONISTI. STUDIO PILOTA

Obiettivo: Lo scopo di questo studio è stato quello di esaminare se il Metodo Feldenkrais fosse utile per migliorare la flessibilità muscolare e ridurre il dolore alla schiena in musicisti orchestrali professionisti. Materiali e metodi: Diciassette partecipanti sono stati reclutati da un orchestra sinfonica di Palermo (Italia) e divisi casualmente in un gruppo di controllo (C, n = 8) e un gruppo Feldenkrais (F, n = 9). Il primo non ha partecipato al protocollo Feldenkrais e a qualsiasi altra attività fisica; mentre il secondo ha preso parte ad un programma costituito da quattro lezioni di gruppo di Consapevolezza Attraverso il Movimento (CAM) eseguito 2 ore alla settimana per 4 settimane. Al fine di valutare lo stato di salute della colonna vertebrale, abbiamo usato il sit-and-reach test ed il trunk lift test. Le differenze all'interno di ogni gruppo e tra il gruppo C e il gruppo F sono state rispettivamente esaminate con il test di Wilcoxon e quello di Mann-Whitney; e considerate significative con p ≤ 0,05. Risultati: La flessibilità muscolare del bicipite femorale e della regione lombare, e la forza, la flessibilità e la resistenza dei muscoli estensori del tronco era leggermente aumentata nel gruppo F rispetto al gruppo C dopo il protocollo Feldenkrais; anche se questa variazione non era statisticamente significativa. Diversamente, il gruppo C ha mostrato una riduzione del 5% in entrambi i test dopo 4 settimane. Dopo il protocollo Feldenkrais, l’altezza del gruppo F era significativamente maggiore rispetto a prima del trattamento. Inoltre, abbiamo trovato che il numero dei partecipanti, che hanno dichiarato di avere dolore forte e frequente alla schiena e agli arti, diminuiva durante il periodo di svolgimento del protocollo Feldenkrais. Questo effetto era maggiore nella regione cervicale rispetto a quella lombare e agli arti superiori. Conclusioni: I nostri risultati mostrano che il Metodo Feldenkrais ha effetti positivi sulla flessibilità muscolare e supporta l'uso di questo metodo per sciogliere le tensioni e le contrazioni muscolari che possono causare dolore nei musicisti orchestrali professionisti.Objectives: The aim of this study was to explore whether Feldenkrais Method was useful for improving muscular flexibility and reducing back pain in professional orchestral musicians. Materials and methods: Seventeen participants were recruited from a symphony orchestra of Palermo (Italy) and randomly divided in a control group (C, n=8) and a Feldenkrais group (F, n=9). The first didn’t participate in the Feldenkrais protocol and any other physical activity; while the second took part into a program consisting of four Awareness through movement (ATM) classes performed 2 hours/week for 4 weeks. In order to assess muscle fitness of spine, we used sit-and-reach and trunk lift test. The differences within each group and between C and F groups were respectively examined with Wilcoxon matched pair test and Mann-Whitney test; and considered significant with p≤0.05. Results: The muscular flexibility of hamstring and low back, and trunk extensor strength, flexibility and endurance slightly increased in F group compared with C group after Feldenkrais protocol even if this variation was not statistically significant. Differently, C group showed a reduction by 5% in both tests after 4 weeks. After Feldenkrais protocol, height of F group was significantly bigger than before treatment. Moreover, we found that the number of participants, who stated to have strong and frequent pain in the back and limbs, decreased during performing the Feldenkrais protocol. This effect was bigger in the cervical than lumbar spine and upper limbs.Conclusion: Our outcomes illustrate that Feldenkrais method has positive effects on muscle flexibility and supports the use of this method for dissolving muscle tensions and contractions that can cause pain in professional orchestral musicians

Efficacy of kinesio taping in reducing low back pain: a comprehensive review

Introduction: Kinesio taping is rehabilitative technique used to facilitate the body’s natural healing process while providing support and stability to muscles and joints, without restricting their range of motion. We conducted a thorough literature search and evaluation to clarify whether kinesio taping is effective in reducing lower back pain. Methods: Cochrane Library, CINAHL, COBIB.SI, PubMed and Science Direct were searched using Boolean operators search strings of different keywords such as: adult, low back pain, Kinesio tape, Kinesio taping, kinesiotaping, effects. The search was limited to full-text articles published from 2011 to 2016. Results: A total of 137 records were identified, 123 abstracts screened, and 14 full-text articles assessed for eligibility. Finally, nine publications were selected using CASP tool: eight randomized clinical studies and one literature review. The key variables from collected data were the subject characteristics, taping technique, control interventions, instrument, and outcome. Conclusions: The effect of Kinesio taping in reducing low back pain is positive, but was not statistically significant in analyzed studies. Taping therapy may therefore be used as a supplementary method to conventional physical therapy procedures, and may be important for patients because of its easy accessibility and safe

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

AbstractObjectivesThe purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.MethodsA comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.ResultsTwenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.ConclusionsPreliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients

Prescription of activity for low back pain: What works?

This paper provides evidence-based guidelines for the prescription of activity in the management of non-specific low back pain (NSLBP). The 62 clinical trials published between 1966 and 1997, identified by a search of the Medline and Cinahl databases, were reviewed to provide the basis for the guidelines. The available evidence suggests that physiotherapists should advise patients with acute and sub-acute NSLBP to avoid bed rest and to return to normal activity using time rather than pain as the guide to activity resumption. While structured exercise programs have not been shown to provide a benefit for acute NSLBP, there is strong evidence to support their use for patients with sub-acute and chronic NSLBP and in the prevention of NSLBP

MINIMIZING THE ADVERSE EFFECTS OF WORK ENVIRONMENT IN UPPER LIMB: A LITERATURE REVIEW

Introduction: Occupational problems are highly prevalent and act as impediments to effective labor. As per the statistics by WHO, in the year 2003, it was seen that back injuries shared the highest proportion in occupational disorders (60%), followed by neck and upper limb. Body: In the upper limb, any joint, be it the shoulder, elbow, wrist or hand, can be affected. Variable structures ranging from the tendon, ligament, nerve or muscle can be involved leading to problems effectuating in the form of pain, tenderness, swelling, and functional deficits. Common problems seen are carpal tunnel syndrome, muscle sprain-strain, and osteoarthritis in joints, etc. Management: ULMSDS can be prevented by incorporating activity in daily life awhile also keeping a check on posture. At workplace, architectural adjustments and changes in physical and social environment can help prevention exacerbation of upper limb conditions. Regular rest intervals can also be included to avoid prolonged fixation of joints in one position. Conclusion: This paper focuses on ULMSDS in an attempt to improve the quality of life through various intervention strategies within the work organization thus enhancing work quality and output of the companies. Article visualizations