Demonstration of kinesio taping effect by ultrasonography in neck pain

SUMMARY OBJECTIVE: This study aimed to demonstrate the effectiveness of kinesio taping in nonspecific neck pain and to assess whether ultrasonographic parameters of the upper trapezius muscle can be used in the follow-up of kinesio taping treatment. METHODS: This was a single-blind, prospective, randomized controlled trial study involving 60 participants with nonspecific neck pain. The participants were randomly assigned into two groups. Kinesio taping group (n=29) received a 4-week neck exercise program, with kinesio taping applied twice a week for a total of four times, and the exercise group (n=28) received a 4-week neck exercise program. Participants were evaluated according to pain intensity (Visual Analog Scale), cervical range of motion, and disability (Neck Disability Index). Also, trigger point diameter and upper trapezius muscle thickness were evaluated with ultrasonography. Before and after the therapy, as well as the first month, all measures were taken by an investigator other than the practitioner of the treatment program. RESULTS: The results showed that the Visual Analog Scale and Neck Disability Index scores in the kinesio taping group were statistically significantly improved when compared to the exercise group (p<0.05). In addition, the thickness of the upper trapezius muscle and the diameter of the trapezius muscle trigger point were statistically significantly improved in the kinesio taping group compared to the exercise group (p<0.05). In the kinesio taping group, there was no statistical significance in cervical range of motion as compared to the exercise group. CONCLUSION: The combination of kinesio taping and exercise therapy was effective in reducing nonspecific neck pain and neck disability. Also, this study showed that ultrasonographic evaluation of the trapezius muscle could be used in the follow-up of kinesio taping therapy.

Muscle fiber conduction velocity and EMG amplitude of the upper trapezius muscle in healthy subjects after low-level laser irradiation: a randomized, double-blind, placebo-controlled, crossover study.

Although low-level laser therapy (LLLT) is an important resource for the treatment of non-specific neck pain patients, the dose which presents the greatest therapeutic potential for the treatment of this pathology is still unclear. The present study aimed to evaluate the immediate effect of LLLT on the muscle fiber conduction velocity (MFCV) and electromyographic activity (EMG) of the upper trapezius (UT) muscle in healthy individuals. A total of 20 healthy subjects were enrolled in a randomized, double-blind, crossover study. Active LLLT (820 nm wavelength, 30 mW, energy total 18 J) or placebo LLLT (pLLLT) was delivered on the UT muscle. Each subject was subjected to a single session of active LLLT and pLLLT. Surface electromyography (sEMG) signal of the UT muscle was recorded during five different step contractions of shoulder elevation force (10-30% maximal voluntary contraction) pre- and post-LLLT irradiation. The values of MFCV and sEMG global amplitude (RMSG) were used to calculate the effects of LLLT. The results showed no difference in the MFCV comparing the LLLT and pLLLT groups (F = 0.72 p = 0.39, η p2 = 0.004). However, a significant difference was observed in the RMSG between the LLLT and pLLLT (F 1,2 = 16.66; P < 0.0001, η p2 = 0.09). Individuals who received active LLLT presented a significant decrease in RMSG after laser application (F = 61.28; p < 0.0001, η p2 = 0.43). In conclusion, the 820 nm LLLT, with energy total of 18 J, did not alter the MFCV but significantly reduced the sEMG signal amplitude of the upper trapezius muscle in healthy subjects to a level of up to 30% of maximal voluntary contraction.

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. .

Anatomical basis of the myofascial trigger points of the trapezius muscle / Bases anatómicas de los puntos de gatillo miofasciales del músculo trapecio

This study aimed to bring the trapezius muscle, knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTPs). Although anatomoclinical correlations represent a major feature of MTP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Eight points were identified: In all cases, these locations corresponded to clinically described MTPs. The eight points where common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MPT is useful to achieve a better understanding of the anatomical correlation of MTP and the physiopathology of these disorders and may provide a scientific basis for their treatment, providing useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

El objetivo de este estudio fue correlacionar los sitios de entrada de los ramos del nervio accesorio en el músculo trapecio con placas motoras y los puntos de gatillo miofasciales. A pesar de las correlaciones anatomoclínicas se constituyeren en la principal característica de los puntos de gatillo, no hay informes en la literatura describiendo sobre la distribución de los ramos del nervio accesorio y su relación anatómica con los puntos de gatillo. Ambos músculos trapecio de doce cadáveres adultos fueron disecados por los autores (profesores de anatomía y estudiantes de postgrado en Medicina) para observar el punto exacto donde los ramos del nervio accesorio espinal penetraban en el vientre muscular. La disección se llevó a cabo respetando las capas estratigráficas para preservar la inervación del músculo ubicada profundamente a éste. Ocho puntos fueron identificados: En todos los casos correspondieron a la descripción clínica de los puntos gatillo miofasciales y eran comunes a todos los cadáveres. Esta correlación anatomoclínica entre la ramificación del nervio espinal accesorio y los puntos de gatillo miofascial es útil para una mejor comprensión de la fisiopatología de los puntos gatillo y puede proporcionar una base para un abordaje diagnóstico y terapéutico racional para estos trastornos.

Tratamento do estresse psicológico pela acupuntura, avaliado pela eletromiografia do músculo trapézio / Psychological stress treated by acupuncture and evaluated by trapezius muscle electromyography

JUSTIFICATIVA E OBJETIVOS: O estresse é considerado um fenômeno da vida moderna, que pode estar presente na vida de todas as pessoas, independente de idade, sexo, classe social ou profissão. Esta pesquisa foi realizada visando propor um tratamento alternativo para o estresse, pelo tratamento com acupuntura, avaliando eletromiograficamente o músculo trapézio, direito e esquerdo, de indivíduos portadores de estresse psicológico, uma semana antes das avaliações e após a acupuntura. MÉTODO: Para a realização deste estudo foram selecionados 10 voluntários, submetidos a um questionário que avaliou os sinais de estresse psicológico. O músculo estudado foi o trapézio por refletir melhor os sinais de estresse. Este foi estudado bilateralmente e a ação muscular foi captada no repouso e durante atividade isométrica, realizando-se movimentos de elevação e abaixamento. Em cada uma das 10 sessões de acupuntura foi realizado o agulhamento do ponto C7; pontos obtidos a partir de um pentagrama e pontuar pontos de confluência do meridiano distinto afetado no pentagrama. RESULTADOS: Os valores de RMS, quando comparados antes e após o tratamento com acupuntura, no repouso e em elevação da escápula foram estatisticamente significativos (p < 0,01). CONCLUSÃO: Os músculos apresentaram menor atividade eletromiográfica após o tratamento, mostrando assim a eficácia da acupuntura em indivíduos portadores de estresse psicológico.

BACKGROUND AND OBJECTIVES: Stress is a modern life phenomenon and may be present in the lives of anyone, regardless of age, gender, social class or profession. This research aimed at proposing an alternative treatment for stress with acupuncture, evaluating by electromyography right and left trapezius muscles of patients under psychological stress one week before evaluations and after acupuncture. METHOD: Participated in this study 10 volunteers submitted to a questionnaire to evaluate signs of psychological stress. The trapezius muscle was selected for best reflecting stress signs. The study was bilateral and muscle action was captured at rest and during isometric activities with raising and lowering movements. The following points were needled during each one of the 10 acupuncture sessions: C7 point, points obtained as from a pentagram and confluence points of the distinct meridian affected on the pentagram. RESULTS: RMS values, compared before and after acupuncture treatment, at rest and with elevation of the scapula were statistically significant (p < 0.01). CONCLUSION: Muscles have shown less electromyographic activity after treatment, thus showing the efficacy of acupuncture for patients under psychological stress.

O efeito da eletroacupuntura no tratamento da dor muscular / The electroacupunture effect for the treatment of muscular pain

A eletroacupuntura é um recurso bastante utilizado na prática clínica para alívio da dor muscular, apesar do restrito número de pesquisas avaliando sua efetividade. Desta forma, este trabalho inclui dois capítulos, sendo o primeiro intitulado Electroacupuncture and the muscle pain threshold: a review, no qual foi realizada a revisão crítica da literatura, com o objetivo de verificar a efetividade da eletroacupuntura no tratamento da dor muscular. As bases de dados pesquisadas foram ISI, Pubmed, Scielo, Scopus, Cochrane, Bireme de 1977 a Janeiro de 2010 para artigos contendo as palavras chave electroacupuncture AND muscle AND pain. Apesar dos estudos avaliados apresentarem diferenças metodológicas, o que dificultou a comparação entre os resultados, todos consideraram que a EA é eficaz no tratamento da dor miofascial. Nenhum dos estudos considerou a influência do ciclo menstrual na avaliação do limiar de dor, nem mesmo o efeito obtido durante o tratamento, apresentando-o apenas antes e após todas as sessões. O segundo capítulo intitula-se Electroacupuncture for myofascial pain in the upper trapezius muscle, que teve como objetivo avaliar longitudinalmente os efeitos da EA no tratamento da dor miofascial da parte superior do músculo trapézio, por meio da Escala Visual Analógica, da algometria digital, da eletromiografia de superfície e do questionário de qualidade de vida SF-36. Os resultados mostraram que a EA foi efetiva no alívio da dor miofascial do músculo trapézio. Foi observado tanto efeito imediato após cada aplicação da EA como também efeito cumulativo especialmente a partir da terceira sessão. A fase pré-menstrual e menstrual parece estar relacionada ao aumento no limiar de dor observado na sexta. Concluiu-se que a EA foi eficaz no alívio da dor miofascial na amostra avaliada.(AU)

The electroacupuncture is a commonly used resource for pain relieving, despite the restrict number of studies evaluating its effectiveness. This work includes two chapters, the first Electroacupuncture and the muscle pain threshold: a review, consisted of a literature critical review regarding the effectiveness of electroacupunture on the muscular pain treatment. The electronic database researched was ISI, Pubmed, Scielo, Scopus, Cochrane, Bireme from 1977 to January 2010, for articles containing the key words electroacupuncture AND muscle AND pain. Although the methodological differences raise difficulties to the analysis of their results, all the evaluated articles considered the method as efficient. Neither regarded the menstrual cycle influence at the pain threshold, nor the effect obtained along the treatment, presenting only the before and after the entire treatment effect. The second chapter, Electroacupuncture for myofascial pain in the upper trapezius muscle, purposed to evaluate the effects of electroacupuncture as a treatment to the upper trapezius myofascial pain on a longitudinal study. The efficacy of the treatment was evaluated in terms of pain intensity using the visual analog scale (VAS), the pressure pain threshold (PPT) by algometry, electromyography (EMG) and the SF-36 questionnaire. The occurrence of influencing factors in the sessions was monitored as was the menstrual cycle of each participant. It was observed both immediate and cumulative effect specially after the third session. The menstrual phase seems to be related to the increase of pain threshold observed on the sixth session. The EA was shown to be a reliable method for pain relief in the trapezius muscle at the evaluated sample.(AU)

Use of electromyography to assess pain in the upper trapezius and lower back muscles within a fatigue protocol / Uso da eletromiografia na análise de dor dos músculos trapézio superior e lombares durante protocolo de fadiga

OBJECTIVE: The aim of this study was to investigate whether muscle fatigue indices obtained using surface electromyography and calculated in the time and frequency domains would be capable of objectively diagnosing pain and discriminating between subjects with and without pain in the upper trapezius muscle and the lower back muscles. METHODS: Forty-seven individuals underwent a muscle fatigue test for thirty-five seconds at 80% of the maximal voluntary contraction (MVC), while EMG and muscle force data were recorded. The RMS value and the median frequency (MF) were calculated within consecutive one-second windows. Linear regression analysis was used to obtain the slope coefficients and the respective y-axis intercept values, which were considered to be localized muscle fatigue indices. RESULTS: In the frequency domain, the slope coefficients were negative for both muscles, while in the time domain, the coefficient for the upper trapezius was positive and the coefficient for the lower back muscles was negative (p<0.01). Significant differences were also found in the frequency domain between subjects with and without pain in the upper trapezius (p<0.01). The subjects with pain had significantly lower force values than the subjects without pain (p<0.05), in both the upper trapezius and the lower back muscles. CONCLUSION: The force values associated with the fatigue indices (MF slope and y-axis intercept) were able to predict the presence of pain in the upper trapezius (p<0.05), but not in the lower back muscles.

OBJETIVO: A proposta do estudo foi investigar se índices de fadiga, obtidos a partir de eletromiografia de superfície, calculados no domínio do tempo e da frequência, são capazes de diagnosticar a dor objetivamente, discriminando entre sujeitos com e sem dor no trapézio superior e nos músculos lombares. MÉTODOS: Quarenta e sete indivíduos foram submetidos a um teste de fadiga muscular por 35s a 80% da contração voluntária máxima (CVM), enquanto EMG e força muscular foram registradas. O valor RMS e a mediana da frequência (MF) foram calculados em janelas consecutivas de 1s. Análise de regressão linear foi utilizada para obter os coeficientes de inclinação e seus respectivos valores de interseção no eixo y, os quais foram considerados índices de fadiga muscular localizada. RESULTADOS: Os coeficientes de inclinação analisados no domínio da frequência apresentaram comportamento similar, sendo negativos para ambos os músculos, enquanto que, no domínio tempo, o trapézio superior apresentou coeficientes positivos, e músculos lombares, coeficientes negativos (p<0,01). Diferenças significativas também foram identificadas no domínio da frequência entre os sujeitos com e sem dor no trapézio superior (p<0,01). Os indivíduos com dor apresentaram valores de força significativamente menores que os sujeitos sem dor (p<0,05), tanto nos músculos lombares quanto no trapézio superior. CONCLUSÃO: Os valores de força associados aos índices de fadiga (inclinação da MF e intersecção do eixo y) foram hábeis para predizer a presença de dor no trapézio superior (p<0,05), mas não nos músculos lombares.

Temporomandibular joint dysfunction and trapezius muscle fatigability

INTRODUCTION: It has been suggested that pain increases trapezius muscle activation in patients with temporomandibular joint dysfunction (TMD). Changes in muscle activation might change muscle resistance to fatigue. The purpose of this study was to evaluate the fatigability of the trapezius muscle in patients with TMD. METHOD: Fourteen patients with TMD (clinically diagnosed and referred by a dentist) and eleven healthy subjects performed a fatigue test consisting of shoulder elevation performed at 70 percent of the maximal voluntary isometric contraction, which was maintained for 30 seconds. Electromyographic signals were obtained from the upper portion of the trapezius muscle (sampling frequency: 2000 Hz/channel). Consecutive segments of three seconds in duration each were extracted from the electromyographic signal and analyzed in the frequency domain using a Fast Fourier Transform algorithm. Linear regression analysis was applied to the consecutive median frequencies for each subject. The slope of the regression line was used to describe muscle fatigability. RESULTS: No changes were observed in fatigability between the right and left trapezius of either group or between the left trapezius of the healthy and TMD groups. The linear regression for median frequencies in the right trapezius of the TMD group showed a slope of -0.15 ± 0.33 (mean ± SD), which was smaller than the slope for the healthy group (-0.44 ± 0.46; p= 0.049). These results suggested that the fatigability of the right trapezius was lower in the TMD group than in the healthy group.

INTRODUÇÃO: Tem sido sugerido que a dor aumenta a ativação do músculo trapézio em pacientes com disfunção temporomandibular (TMD). Mudanças na ativação do músculo podem alterar a resistência à fadiga. O objetivo do estudo foi investigar a fatigabilidade do músculo trapézio em pacientes com TMJ. MÉTODOS: Quatorze indivíduos com TMD (diagnosticados clinicamente e encaminhados pelo especialista odontólogo) e onze indivíduos saudáveis realizaram um protocolo de fadiga que consistiu em uma contração isométrica submáxima de elevação do ombro, em um nível de 70 por cento da contração voluntária máxima, mantida por um período de 30 segundos. O sinal eletromiográfico (EMG) foi obtido da porção superior do músculo trapézio, (taxa de amostragem de 2000Hz/canal). Três segundos consecutivos do sinal EMG foram analisados no domínio da freqüência usando a Transformada Rápida de Fourier (FFT). Uma análise de regressão linear foi aplicada para valores consecutivos da freqüência mediana (MF) de cada sujeito, e a inclinação da regressão linear foi utilizada para descrever a fatigabilidade muscular. RESULTADOS: Nenhuma diferença foi observada na fatigabilidade do músculo trapézio direito e esquerdo para ambos os grupos e entre o trapézio esquerdo do grupo saudável e com TMD. A MF do músculo trapézio direito do grupo com disfunção apresentou valores de inclinação da reta de regressão linear de -0,15 ± 0,33 (média ± SD), os quais foram menores que os valores do grupo saudável (-0,44 ± 0,46; média ± SD; p= 0,049). Esses resultados sugerem que a fatigabilidade do trapézio direito é menor no grupo com TMD do que no grupo saudável.

Avaliação funcional do músculo trapézio e nervo espinhal pós-esvaziamento cervical através da eletroneuromiografia: estudo de 25 pacientes / Functional evaluation of trapezius muscle and spinal nerve after neck dissection through eletro-neuromiography: study of 25 patients

OBJETIVO: Foram estudados 25 pacientes portadores de neoplasias malignas da cabeça e pescoço (20 de vias aerodigestivas superiores e cinco da glândula tireóide), submetidos a esvaziamentos cervicais uni ou bilaterais (33 procedimentos), sendo 15 supra-omohióideos, 11 funcionais e sete em campos alargados. MÉTODO: Através da eletroneuromiografia (ENM), foram avaliados funcionalmente o músculo trapézio e o nervo espinhal após os diferentes procedimentos, aos 30 e 180 dias. RESULTADOS: Foram aferidos para as três formas de linfadenectomia 94 por cento de desnervação do músculo trapézio, severa em 68 por cento e moderada 32 por cento (p = 0,001), portanto valores significativos. Quanto à avaliação do tipo de lesão do nervo espinhal, após 30 dias observou-se lesão de axônio (axonotmese) em 31 dos 33 procedimentos. Com relação à reinervação, esta foi detectada após 180 dias, sendo boa (21 por cento), moderada (72 por cento) e ruim (7 por cento) para valores de p = 0,001 de significância estatística. CONCLUSÕES: A eletroneuromiografia foi um método efetivo na avaliação da unidade neuromuscular e o tipo de esvaziamento cervical conservador não foi determinante de alterações destas estruturas.

BACKGROUND: Twenty fire patients with malignant head and neck neoplasias (20 from superior aerodigestive tract and 5 from thyroid gland), were submitted to 33 unilateral or bilateral neck node dissection (15 supraomohyoid, 11 modified and 7 wide field), at the Head and Neck Service of Hospital Araújo Jorge, Goiânia, Goiás, Brazil. METHOD: Eletroneuromiography (ENM) of the trapezius muscle after spinal nerve dissection. RESULTS: In spite of surgical dissection, 94 percent of trapezius muscle desnervation were detected, being 38 percent severe and 62 percent moderate, (p = 0,001). The degree of lesion for spinal nerve after 30 days, showed axoniumtmese in 31 of 33 procedures, and after 180 days, 21 percent of severe, 72 percent of moderate and 7 percent of unsatisfactory reinervation were diagnosed (p = 0,001). CONCLUSIONS: ENM is an effective method of evaluation of neuromuscular unit (trapezius muscle/spinal nerve) and the type of neck node dissection was not determinant of structural nerve alteration.