Effect of Global Posture Reeducation and of Static Stretching on Pain, Range of Motion, and Quality of Life in Women with Chronic Neck Pain: A Randomized Clinical Trial

PURPOSE: Compare the effect of conventional static stretching and muscle chain stretching, as proposed by the global posture reeducation method, in the manual therapy of patients with chronic neck pain. METHODS: Thirty-three female patients aged 35 to 60 years old, 31 of whom completed the program, were randomly divided into two groups: The global posture reeducation group (n=15) performed muscle chain stretching, while the conventional stretching group (n=16) performed conventional static muscle stretching. Both groups also underwent manual therapy. Patients were evaluated before and after treatment and at a six-week follow-up appointment and tested for pain intensity (by means of visual analog scale), range of motion (by goniometry), and health-related quality of life (by the SF-36 questionnaire). The treatment program consisted of two 1-hour individual sessions per week for six weeks. Data were statistically analyzed at a significance level of p<0.05. RESULTS: Significant pain relief and range of motion improvement were observed after treatment in both groups, with a slight reduction at follow-up time. Quality of life also improved after treatment, except for the global posture reeducation group in one domain; at follow-up, there was improvement in all domains, except that both groups reported increased pain. There were no significant differences between groups CONCLUSION: Conventional stretching and muscle chain stretching in association with manual therapy were equally effective in reducing pain and improving the range of motion and quality of life of female patients with chronic neck pain, both immediately after treatment and at a six-week follow-up, suggesting that stretching exercises should be prescribed to chronic neck pain patients

Estabilização segmentar da coluna lombar nas lombalgias: uma revisão bibliográfica e um programa de exercícios

When treating low-back pain, traditional exercises for strengthening abdomen and trunk erector muscles have been criticised for their submitting spinal structures to high loads, thereby increasing the risk of new injury. Recent studies have pointed to the effectiveness of segmental stabilisation in treating low-back pain, less damaging since it is done in neutral position. Current research suggests that, unless the trunk deep stabilizers are correctly activated, recurrence of pain is more often noticed. This is a review of 47 articles and books published between 1984 and 2006, resulting from a search in PubMed database by means of key words lumbar stabilization, lumbar multifidus and transversus abdominis muscles. Literature has established a link between low-back pain and poor control of deep trunk muscles, particularly the lumbar multifidus and transversus abdominis muscles; some studies also point out the quadratus lumborum and diaphragm muscles as lumbar stabilizers. By drawing on the reviewed material, we suggest exercises of subtle and specific synchronized isometric contractions for these lumbar stabilisers, which act directly upon pain relief by increasing lumbar spine stability.No tratamento de lombalgias, exercícios tradicionais de fortalecimento dos músculos abdominais e extensores do tronco têm sido alvo de críticas por submeter a coluna vertebral a altas cargas de trabalho, aumentando o risco de nova lesão. Estudos recentes comprovam a eficácia da estabilização segmentar como tratamento para a lombalgia, sendo menos lesiva por ser realizada em posição neutra. Pesquisas sugerem que, sem a ativação correta dos estabilizadores profundos do tronco, as recidivas do quadro álgico são notadas com muita freqüência. Este estudo procedeu à revisão da literatura sobre o tratamento das lombalgias mediante estabilização da coluna e propõe exercícios para seu tratamento baseados na estabilização segmentar lombar. Na base PubMed, por meio dos descritores estabilização lombar, multífido lombar, transverso do abdome e os equivalentes em inglês, foram selecionados 47 artigos e livros publicados entre 1984 e 2006. A literatura estabelece um elo entre lombalgia e escasso controle dos músculos profundos do tronco, em especial o multífido lombar e o transverso do abdome; estudos também indicam os músculos quadrado lombar e diafragma como estabilizadores lombares. Propõem-se assim exercícios de contrações isométricas sincronizadas, sutis e específicas, que atuam diretamente no alívio da dor por meio do aumento da estabilidade do segmento vertebral

Respiratory muscle strenght and functional capacity in fibromyalgia

Background: Fibromyalgia (FM) is a complex syndrome with skeletal muscle impairment. However, respiratory muscles responses are unknown. Purpose: we aimed to study strength resistance in both respiratory and skeletal muscles in FM and healthy controls. Methods: fifteen women with FM - FG group - (50 ± 11 years) and 10 healthy controls - CG - (48 ± 11 years) underwent clinical evaluation, skeletal muscle strength and resistance tests, respiratory tests, six-minute walk test and step test. Results: both groups were similar in demographic and anthropometric variables. Respiratory muscle strength was significantly lower in FG (46 ± 6 cm HO) compared to CG (80 ± 8 cm HO; p < 0.05). Similarly, 22 skeletal muscle (71 ± 8 vs 167 ± 24 repetitions, p < 0.05) and respiratory muscle strength (29 ± 4 vs 56 ± 6 repetitions, p < 0.05) were lower in FG compared to CG. Moreover, CG showed greater distance on 6 - minute walk test (551 ± 36 vs 460 ± 86 m; p < 0.05) and higher number of steps (102 ± 9 vs 76 ± 13 steps; p < 0.05). Only FG showed significantly correlation between skeletal muscle and respiratory muscle strength (r = 0.64; p < 0.001). Conclusion: FM syndrome showed an impairment in both respiratory muscle strength and resistance, which could impair exercise tolerance in these patients

Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS