RESUMO
BACKGROUND: The goal of therapeutic exercise is to facilitate a neuromuscular response by increasing or decreasing muscular activity in order to reduce pain and improve function. It is not clear what dosage of exercise will create a neuromuscular response. PURPOSE: The purpose of this study was to assess the effects following a three-week home program of a daily single exercise, the prone horizontal abduction exercise (PHA), on neuromuscular impairments of motor control as measured by scapular muscle EMG amplitudes, strength, and secondarily outcomes of self-reported pain and function between individuals with and without subacromial pain syndrome. STUDY DESIGN: Prospective Case-Control, Pilot Study. METHODS: Twenty-five individuals participated; eleven with shoulder pain during active and resistive motions (Penn Shoulder Score: 77 ± 11) and 14 matched healthy controls (Penn Shoulder Score: 99 ± 27) (p < 0.001). Participants underwent baseline and follow up testing at three weeks including surface electromyography (EMG) of the serratus anterior, upper, and lower trapezius of the involved (painful group) or matched shoulder (control group) during an elevation task and maximal isometric shoulder strength testing. All participants were instructed in a PHA exercise to be performed daily (3 sets; 10 reps). Subjects logged daily exercise adherence. Neuromuscular adaptations were defined by changes in EMG amplitudes (normalized to MVIC) of serratus anterior, upper trapezius, and lower trapezius and strength. Secondary outcomes of self-reported pain and function were also compared between groups following the three-week intervention. RESULTS: After three weeks of a daily PHA exercise, the painful group demonstrated a greater decrease in baseline-elevated EMG amplitudes in the lower trapezius by 7% (95%CI 2.6-11%) during the concentric phase of the overhead lifting task (p 0.006). EMG amplitudes of the healthy control group did not change at three-week follow-up. Additionally, the change in serratus anterior mean EMG amplitude in the painful group -1.6% (IQR -22.9 to 0.8%) was significantly greater (p 0.033) than the healthy group change score, 2.5% (IQR -2.3 to 5.7%) during the eccentric phase (p 0.034). While the painful group was weaker in abduction and flexion at baseline and at follow up, both groups had a significant increase in all strength measures (p≤0.014). Concurrent with increased strength and normalizing EMG amplitudes, the painful group significantly improved on the Penn Shoulder Score with a mean change 9.8 points (95%CI 7.0, 12.6) (p < 0.001). CONCLUSION: In this pilot case-control study, a single home exercise performed daily for three weeks demonstrated neuromuscular adaptations with improvements in muscle activity and strength. These were concurrent with modest, yet significant improvements pain and function in individuals with mild rotator cuff related shoulder pain. LEVEL OF EVIDENCE: 3.
RESUMO
One half of the world's population has Helicobacter pylori infection, with an estimated prevalence of 30 percent in North America. Although it is unclear whether eradication of H. pylori improves symptoms in patients with nonulcer dyspepsia, there is strong evidence that eradication of this bacteria improves healing and reduces the risk of recurrence or rebleeding in patients with duodenal or gastric ulcer. A "test-and-treat" strategy is recommended for most patients with undifferentiated dyspepsia. With this approach, patients undergo a noninvasive test for H. pylori infection and, if positive, are treated with eradication therapy. This strategy reduces the need for antisecretory medications as well as the number of endoscopies. The urea breath test or stool antigen test is recommended. Until recently, the recommended duration of therapy for H. pylori eradication was 10 to 14 days. Shorter courses of treatment (i.e., one to five days) have demonstrated eradication rates of 89 to 95 percent with the potential for greater patient compliance. A one-day treatment course consists of bismuth subsalicylate, amoxicillin, and metronidazole, all given four times with a one-time dose of lansoprazole. In children with documented H. pylori infection, however, all regimens should continue to be prescribed for seven to 14 days until short-course treatment is studied and its effectiveness has been established in this population.
