Effects of combining ergonomic interventions and motor control exercises on muscle activity and kinematics in people with work-related neck-shoulder pain.

PURPOSE: This study compared the effects of "Ergomotor" intervention and conventional physiotherapy, on influencing the motor control in the neck-shoulder region in people with work-related neck-shoulder pain (WRNSP). METHODS: 101 patients (age range 20-54 years) diagnosed with chronic WRNSP were randomized into control (CO) group (n = 50) and Ergomotor (EM) group (n = 51). Each group received a 12-week intervention. Participants in CO group received treatment for pain relief and general exercises. EM group received individualized motor control training and advice of ergonomic modifications at their workplaces. RESULTS: At post-intervention, EM group showed significant reduction of bilateral upper trapezius muscle activity during active neck movements (left: 40-35%, right: 35-27%) and functional tasks such as lifting a weight forward-backward (left: 31-21%, right: 22-14%) and upward-downward (left: 26-23%, right: 20-13%). Cervical erector spinae also showed significant decrease in muscle activity during some phases of the functional tasks (left: 13-6%, right: 10-2%). In contrast, CO group did not show such changes in muscle activity at post-intervention. EM group also showed significant increase in movement velocity and acceleration during active neck movements in all directions (from 18 to 31%), while CO group only showed significant increase in movement velocity in some directions. Both groups reported significant but similar reduction in pain scores, at post-intervention and 1-year follow-up. CONCLUSIONS: The present results provided some evidence to support the positive and sustainable benefits of integrating motor control training into the workplace postures and motions.

Using cervical movement velocity to assist the prediction of pain and functional recovery for people with chronic mechanical neck pain.

BACKGROUND: Impaired cervical kinematics particularly the movement velocity had been consistently found in people with neck pain. The recovery and potential of cervical movement velocity in assisting the prediction of recovery in individuals with chronic neck pain remained unknown. This study investigated the application of cervical movement velocity to predict the outcomes of pain intensity and functional disability for a cohort of participants with chronic mechanical pain after completion of a 12-week intervention program. METHODS: Cervical movement velocity when performing neck motions in the anatomical planes, pain intensity and functional disability score were assessed before and after the physiotherapy program. Correlations between kinematic and clinical outcomes, and validity of applying the peak velocity values of the cervical spine measured at baseline for prediction of recovery of pain and function after the physiotherapy program were examined (n = 68). FINDINGS: Significant improvements were found in the peak values of cervical velocity in all movement planes, pain intensity and functional disability score at post-program reassessment (p < 0.001). Significant negative correlations between peak values of cervical movement velocity and pain intensity (for specific directions, r = -0.163 to -0.191), and functional disability were found (for all directions, r = -0.158 to -0.282). Area under the Receiver Operating Characteristics curve was >0.6 for cervical extension, flexion and right rotation velocity for predicting functional recovery post-program. INTERPRETATION: These findings suggest that cervical velocity of selected planes measured at baseline may inform the prediction of recovery of functional disability but not pain intensity in people with chronic mechanical neck pain.

Effects of Ergomotor Intervention on Improving Occupational Health in Workers with Work-Related Neck-Shoulder Pain.

(1) Background: Work-related neck and shoulder pain (WRNSP) are common problems, and past occupational research has focused on ergonomic interventions such as adjusting workstations while physiotherapists have traditionally focused on teaching exercises to improve posture and movement control in the clinical setting. The current study aimed to integrate these two approaches and evaluate the immediate and long-term effects of such interventions on occupational exposure outcomes. (2) Methods: A total of 101 patients diagnosed with WRNSP were randomized into 2 groups: Control (CO) group (n = 50) and ergomotor (EM) group (n = 51). Participants in the control group had 12 weeks of usual care (conventional physiotherapy) while participants in the EM group received an integrated program with tailor-made motor control training and ergonomic advice for 12 weeks. (3) Results: Both groups achieved significant improvement in pain and functional outcomes at post-intervention. The EM group also reported significantly improved scores in terms of perceived exertion in the job-related physical demands (JRPD) and the short form workstyle questionnaires compared to the control group. (4) Conclusions: The results suggest that ergomotor intervention may be more effective in producing favorable occupational health outcomes compared to conventional physiotherapy.

Comparing the effectiveness of integrating ergonomics and motor control to conventional treatment for pain and functional recovery of work-related neck-shoulder pain: A randomized trial.

BACKGROUND: Work-related neck and shoulder pain (WRNSP) is highly prevalent among patients who seek physiotherapy treatment. Clinicians may tend to focus on teaching home exercises and provide general advice about workplace improvement. The present study investigates the short- and long-term impact of an intervention approach that emphasizes on integrating the motor control re-education with ergonomic advice. METHODS: Participants diagnosed with WRNSP (n = 101) were randomly assigned into two groups in this randomized controlled trial. The Ergo-motor Group (EM, n = 51) received an integrated intervention with ergonomic advice/modifications and motor control training individualized for each participant based on their specific work demands. Control Group (CO, n = 50) received treatment for pain relief and general exercises of their necks at a designated physiotherapy clinic. Neck pain intensity and functional outcome measures were assessed before, immediately and 1-year after the 12-week intervention programmes. Global Rating of Change Score was used to evaluate the perceived recovery at 1-year follow-up. RESULTS: Both groups reported significant reductions in pain and functional disability scores at post-intervention (EM, n = 44; CO, n = 42) and 1-year follow-up (EM, n = 40; CO, n = 38); however, no significant between-group differences were found (p > 0.05). Significantly higher rating in global recovery score was reported in EM group at 1-year follow-up (p < 0.05). CONCLUSIONS: Intervention integrating ergonomic advice/modification with motor control exercise was found to be equally effective as pain relief and general exercise for pain and functional recovery. However, at 1-year follow-up, such integrated approach resulted in significantly better global recovery perceived by people with WRNSP. SIGNIFICANCE: Integrating ergonomic intervention and motor control training achieved similar reduction in pain and functional outcomes compared to conventional physiotherapy at post-intervention and at 1-year follow-up, for patients with moderate level of work-related neck-shoulder pain and mild degree of functional disability. The Ergo-motor Group reported significantly better perceived overall recovery at 1-year follow-up.

Managing postmastectomy lymphedema with low-level laser therapy.

OBJECTIVE: We aimed to investigate the effects of low-level laser therapy (LLLT) in managing postmastectomy lymphedema. BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common complication of breast cancer treatment that causes various symptoms, functional impairment, or even psychosocial morbidity. A prospective, single-blinded, controlled clinical trial was conducted to examine the effectiveness of LLLT on managing PML. METHODS: Twenty-one women suffering from unilateral PML were randomly allocated to receive either 12 sessions of LLLT in 4 wk (the laser group) or no laser irradiation (the control group). Volumetry and tonometry were used to monitor arm volume and tissue resistance; the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was used for measuring subjective symptoms. Outcome measures were assessed before and after the treatment period and at the 4 wk follow-up. RESULTS: Reduction in arm volume and increase in tissue softening was found in the laser group only. At the follow-up session, significant between-group differences (all p < 0.05) were found in arm volume and tissue resistance at the anterior torso and forearm region. The laser group had a 16% reduction in the arm volume at the end of the treatment period, that dropped to 28% in the follow-up. Moreover, the laser group demonstrated a cumulative increase from 15% to 33% in the tonometry readings over the forearm and anterior torso. The DASH score of the laser group showed progressive improvement over time. CONCLUSION: LLLT was effective in the management of PML, and the effects were maintained to the 4 wk follow-up.