Dissertations / Theses on the topic 'Cervical pain'

Includes abstract.
Includes bibliographical references.
Chronic musculoskeletal conditions of the spine and periphery are a burden both internationally and in South Africa. There is a socio-economic burden as a consequence of the severity, duration and recurrence of chronic cervical musculoskeletal conditions among information technology and sedentary office workers. However, the precise mechanisms behind chronic cervical disorders remain unclear. It is theorised that the pathophysiological mechanisms in chronic cervical musculoskeletal conditions share a similar theoretical framework to chronic pain itself. The biopsychosocial model of chronic pain accepts the dynamic nature of pain. This model accepts the dual biological and psychosocial components that enhance the experience and maintenance of chronic pain, through central sensitisation. There appears to be a neurophysiological, biomechanical and psychological link between the cervical area and the temporomandibular area. Although numerous studies have implied that individuals with temporomandibular disorders have concurrent cervical dysfunction, there is currently no evidence that individuals with cervical dysfunction exhibit altered muscle activity in the masseter and cervical erector spinae muscles or report teeth clenching habits. Consequently, identification of factors that may contribute to chronic cervical musculoskeletal conditions, stemming from the temporomandibular area, may potentially be lost. The aim of the present study was to explore the activity levels of the cervicomandibular muscles in females with chronic cervical musculoskeletal conditions, who showed no symptoms of temporomandibular disorders. This study had a descriptive cross-sectional correlational design with single-blinding. The telephonic screening process was followed by the signing of informed consent forms. Validated questionnaires were used for categorisation and comparison of the socio-demographic and biopsychosocial profiles of the pain group (n = 20) and the no pain group (n = 22). The screening, informed consent and questionnaires were completed by an assistant. The first of five questionnaires, the adapted Research Diagnostic Criteria History questionnaire, was used as an instrument for exclusion of temporomandibular disorders and the recording of a daytime parafunctional teeth clenching habit. The remaining four questionnaires, listed as the Neck Disability Index, the Computer Usage Questionnaire, the Brief Pain Inventory, and the EuroQol-5D were used for determining levels of cervical disability for categorisation and comparison between groups, as well as for determining levels of pain-related disability, occupational and sporting activity, and health related quality of life.

Background Cervicobrachial pain is a painful condition which, when chronic, might lead to high levels of disability. Limited data from small studies have reported that the lateral glide mobilisation is effective on reducing pain in the short-term. The primary aim of this study was to establish whether the lateral glide mobilisation technique was effective in reducing pain in the long-term. Methods Literature reviews on cervicobrachial pain provided the rational to conduct a phase III trial. An audit and a preliminary study were used to inform methods for the trial. A single-centre randomised clinical trial was conducted on participants with chronic cervicobrachial pain. Participants were randomised to receive either the lateral glide with self-management or self-management alone. The trial was powered to detect a between group difference of 20mm on worst pain on a visual analogue scale (VAS) at 52 weeks follow-up. Results Ninety-nine participants were recruited to the trial. There was a non-significant between-group difference for mean VAS(worst pain) scores at 52 week follow-up (p=0.52; 95% CI -14.72 to 7.44). Conclusion The findings from this trial provided no evidence that the lateral glide was more effective than a comparator in the management of chronic cervicobrachial pain in the long-term.

Background: Neck pain is a major public health with great effects on both the individual and society. Cervical radiculopathy is a relatively common form of neck pain with neurological symptoms. Physical therapy is often the first treatment but there is paucity in literature reviews investigating the effects of physical therapy. Objective: To assess the effects of physical therapy for cervical radiculopathy. Methods: A literature search was conducted in PubMed, CINAHL, PEDro and Web of Science. A total of 12 RCT articles were included in the study. The articles were reviewed based on the aims of the study and the PEDro scale. Results: Eight studies of moderate quality and four high quality. Most studies used the same outcome measures. Most common interventions were traction and manual therapy. Outcomes were varied with some reporting positive effects and others no change. Treatment periods, number of sessions and follow-up varied. In most cases, the positive results wore off at follow-up and differences between groups less pronounced. Conclusions: The quality of RCTs investigating cervical radiculopathy is variable. There is limited evidence suggesting that physical therapy treatment can have a measurable and significant long-term effect on cervical radiculopathy.
Bakgrund: Nacksmärta är ett allvarligt folkhälsoproblem med stor effekt på både den enskilde och samhället. Cervikal radikulopati är en relativt vanlig form av nacksmärta med neurologiska symtom. Fysioterapi är ofta den första behandlingen för detta tillstånd men det är brist på litteraturstudier som undersöker fysioterapins effekter. Syfte: Att undersöka effekterna av fysioterapi för cervikal radikulopati. Metod: Litteratursökningar gjordes i PubMed, CINAHL, PEDro och Web of Science. Totalt inkluderades 12 RCT artiklar i studien. Artiklarna granskades utifrån studiens frågeställningar samt PEDro kvalitetsgranskningsmall. Resultat: Åtta studier var av måttlig kvalitet och fyra hög kvalitet. De flesta studier använde samma utfallsmått och alla uppmätte smärta, funktionshinder och funktion. De två vanligaste behandlingarna var traktion och manuell terapi. Resultaten av insatserna varierade då vissa rapporterade positiva effekter och andra ingen förändring. Behandlingsperioder, antal sessioner samt uppföljning varierade. I de flesta fall, så avtog de positiva resultaten vid uppföljning och skillnaden mellan grupperna blev mindre uppenbara. Konklusion: Denna litteraturöversikt påvisade att kvaliteten på de RCT studier som undersöker cervikal radikulopati varierar. Resultaten visar att det finns begränsad evidens som tyder på att fysioterapi kan ha en mätbar och betydande inverkan på cervikal radikulopati i längden.

Múltiples revisiones científicas han intentado determinar los factores pronósticos en la evolución del latigazo cervical sin llegar a un consenso. Nuestros resultados se han obtenido tras 8 años de estudio en pacientes controlados desde la primera visita en el servicio de Medicina Física y Rehabilitación del Hospital de Mataró. Se han utilizado escalas de valoración fáciles de cumplimentar y cuantificar para poder obtener los resultados en el mismo momento de la consulta. Este hecho es importante, ya que la mayoría de las escalas que se identifican en los artículos publicados son poco prácticas en la consulta diaria por la dificultad que conllevan en su cumplimentación y valoración. Los factores pronósticos que hemos identificado en nuestra muestran han sido: la edad, la presencia de “vértigos”, la intensidad del dolor cervical inicial valorada mediante la escala analógica visual y el grado de funcionalidad cervical inicial valorado mediante el Northwick Park Hospital Neck Pain Questionnaire.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Neck pain has been considered a costly musculoskeletal problem, with impacts on health and quality of life of individuals may be related to repetitive strain and maintenance of postures. These changes cause mechanical and nociceptive disorders of the neck region may cause balance disorders. Maintenance of postural balance occurs through the action of the postural control system, any compromise of this system can lead to body imbalance. The dissertation was divided into two research papers, with different objectives. The first aim was to evaluate the influence of neck pain in women of postural control and verify the relation between pain and the possible changes in sensory systems and body posture and in the second, to investigate the correlation between the intensity of pain, head posture and postural sway. Neck pain group was composed of women, aged between 20 and 50, with neck pain for more than three months and the control group of women without neck pain. For characterization of the groups used interview, neck disability index (NDI) and Visual Analogue Scale. Postural balance was assessed by a force platform with acquisition frequency of 100 Hz. Postural balance with manipulation of the sensory systems was evaluated by Dynamic Posturography Foam-laser. Posture was assessed by the Postural Assessment Software in the sagittal plane right. Normality of variables was checked by Shapiro-Wilk test, and Student t test and Mann Whitney test for comparison between groups. The relationship between variables was assessed by Spearman correlation test. Significance level of 5%. Groups were homogeneous in date demographics. Variables of postural balance showed higher amplitude and velocity of displacement of the center of pressure in the neck pain group, showing greater postural sway in this group. There were significant differences in craniovertebral angle, being lower in symptomatic women, showing forward head posture. In dynamic posturography difference was observed between the groups and the score obtained by the group with neck pain in the six sensory conditions showed that postural balance showed greater impairment. Neck pain and forward head posture have a deleterious effect on postural control in symptomatic women. Pain intensity correlated with the COP sway area and the craniovertebral angle indicating that women with cervical pain had forward head posture associated with a lower postural control.
A dor cervical vem sendo considerada um oneroso problema osteomuscular, com impacto sobre a saúde e qualidade de vida dos indivíduos podendo estar relacionada aos esforços repetitivos e a manutenção de posturas inadequadas. Essas alterações provocam transtornos mecânicos e nociceptivos na região cervical, podendo causar distúrbios do equilíbrio. A manutenção do equilíbrio postural ocorre por meio da atuação do sistema de controle postural e qualquer comprometimento desse sistema pode dar origem ao desequilíbrio corporal. A dissertação foi dividida em dois artigos de pesquisa, com objetivos distintos. No primeiro objetivamos avaliar a influência da dor cervical no controle postural de mulheres e verificar a relação da dor com as possíveis alterações nos sistemas sensoriais e postura corporal e, no segundo, investigar a correlação entre a intensidade da dor, postura da cabeça e oscilação postural. O grupo dor cervical foi composto por mulheres, entre 20 e 50 anos, com dor cervical por mais de três meses e o grupo controle por mulheres sem dor cervical. Para caracterização dos grupos utilizou-se ficha de anamnese, índice de incapacidade cervical (NDI) e Escala Visual Analógica. O equilíbrio postural foi avaliado por uma plataforma de força com fequência de aquisição de 100 Hz. O equilíbrio postural com a manipulação dos sistemas sensoriais foi avaliado pela posturografia dinâmica Foam-laser. A postura foi avaliada pelo Software de Avaliação Postural no plano sagital direito. A normalidade das variáveis foi verificada pelo teste de Shapiro Wilk, e os testes t-student e Mann Whitney para comparação entre grupos. A relação entre as variáveis foi verificada pelo teste de correlação de Sperman. Nível de significância de 5%. Os grupos apresentaram homogeneidade nas variáveis demográficas. Nas variáveis de equilíbrio postural observou-se maior amplitude e velocidade de deslocamento do centro de pressão no grupo dor cervical, demonstrando maior oscilação postural neste grupo. Houve diferença significativa no ângulo craniovertebral, sendo menor nas mulheres sintomáticas, mostrando anteriorização da cabeça. Na posturografia dinâmica observou-se diferença entre os grupos e o escore obtido pelo grupo dor cervical nas seis condições sensoriais demonstrou que o equilíbrio postural apresentou maior comprometimento. A dor cervical e a postura anteriorizada da cabeça têm efeito deletério no controle postural de mulheres sintomáticas. A intensidade da dor apresentou correlação com a área da elipse e com o ângulo craniovertebral indicando que as mulheres com dor cervical apresentaram postura anteriorizada da cabeça associada a um menor controle postural.

Introdução: A prevalência de disfunção musculoesquelética entre trabalhadores usuários de computador (TUC) pode variar entre 10 a 62% e os lugares mais acometidos são os membros superiores, pescoço, cabeça e a coluna vertebral. As queixas musculoesqueléticas nesses trabalhadores apresentam etiologia multifatorial e dentre as principais causas é possível citar aspectos posturais e fatores psicossociais. O Maastricht Upper Extremity Questionnaire (MUEQ-Br) é uma das poucas ferramentas existentes na literatura para avaliar aspectos ergonômicos e psicossociais relacionados ao trabalho com uso do computador. A dor cervical é a queixa musculoesquelética mais comum em trabalhadores de escritório usuários de computador. A coexistência entre dor cervical e disfunção temporomandibular (DTM) é comumente citada na literatura. A adoção da postura em anteriorização da cabeça para uso do computador pode estar associada ao aparecimento de sintomas orofaciais e cervicais. A posição sentada é a mais adotada nos ambientes de trabalho especialmente quando este envolve o uso de computador, entretanto, a manutenção dessa posição por tempo prolongado pode acarretar a adoção de posturas inadequadas e intensificar a sobrecarga nas estruturas do sistema musculoesquelético. Desta forma, a manutenção da postura sentada pode estar relacionada ao desenvolvimento de alterações de postura corporal, DTM e disfunção cervical. Objetivo: O objetivo deste estudo foi verificar associações entre dor cervical, DTM e alterações na postura estática em trabalhadores de escritório usuários de computador com e sem relato de dor cervical crônica. Material e Métodos: A amostra desse estudo foi selecionada a partir da aplicação do Maastricht Upper Extremity Questionnaire que contempla 7 domínios (posto de trabalho, postura corporal, controle do trabalho, demanda de trabalho, pausas, ambiente de trabalho e suporte social), preenchidos por trabalhadores usuários de computador. Participaram deste estudo 52 mulheres trabalhadoras de escritório usuárias de computador em dois grupos: Grupo com dor cervical crônica e incapacidade (GD, n=26 - 36.50 anos - IC95%: 33.40-36.60; 66.37 kg - IC 95%: 62.48-70.26 e 1.62 m - IC95%: 1.60-1.65) e Grupo sem relato de dor cervical (GS, n=26 - 33.81 anos - IC 95%: 33.66-36.95, 71.75 kg - IC95%: 65.90-77.60 e 1.64 m - IC95%: 1.62-1.67). Como critérios de inclusão as funcionárias deveriam exercer a mesma função há pelo menos 12 meses (GD, 110 meses - IC95%: 73-147 /GS, 91 meses - IC95%:63-119) e utilizar o computador ao menos 4 horas por dia durante a jornada de trabalho (GD, 7.46 horas/dia - IC95%: 7.10-7.83 /GS, 7.58 horas/dia - IC95%: 7.23-7.92). No grupo com dor cervical crônica as trabalhadoras deveriam apresentar relato positivo de dor crônica cervical e se enquadrarem nos seguintes critérios: a) dor cervical há pelo menos 3 meses; b) dor de intensidade 3 na maioria dos dias em uma escala numérica de dor (END) (0 a 10, sendo 0 = sem dor e 10 = pior dor possível) e c) limitação funcional, pelo menos leve, no Índice de incapacidade relacionada ao pescoço (NDI): 10-28% (5-14 pontos) - incapacidade leve; 30-48% (15- 24 pontos) - incapacidade moderada; 50-68% (25 35 pontos) - incapacidade severa;72% ou mais (36 pontos ou mais) incapacidade completa. Foram realizadas avaliações clínicas para diagnóstico da DTM por meio do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), avaliação da dor cervical e mastigatória através da palpação manual e algometria por pressão para obtenção do limiar de dor por pressão (LDP) de estruturas crânio-cervicais, bem como avaliação da postura corporal estática dessas trabalhadoras usando a fotogrametria. Os dados demonstraram distribuição normal de acordo com o teste Shapiro Wilks. O teste-t de student para amostras independentes (p<0.05) foi utilizado para comparar a pontuação máxima de cada domínio do MUEQ-Br entre os grupos sem e com dor cervical crônica. Para verificar diferenças entre os valores médios de LDP e palpação muscular entre os grupos de trabalhadores sem dor e com dor cervical crônica e para verificar diferenças entre os ângulos posturais foi utilizado também o teste-t de Student. Para análise das associações entre as variáveis disfunção temporomandibular, incapacidade relacionada à disfunção cervical, cervicalgia e aspectos do trabalho (domínios do MUEQ) foi utilizada a análise de regressão linear múltipla. Para verificação de diferenças entre valores de porcentagem foi utilizado o teste de Qui-quadrado (p<0.05). O pacote estatístico utilizado foi o SPSS versão 22. Resultados: Os resultados deste estudo demonstraram que ao compararmos os domínios do MUEQ-Br, o grupo com dor cervical crônica obteve maior pontuação no domínio postura corporal (GD, 12.58 - IC95%: 11.21-13.94/ GS, 9.42 - IC95%: 8-10.84) e no item queixas (GD, 17.46- IC95%: 14.17-20.75/ GS, 8.58 - IC95%: 6.14-11.02), bem como na pontuação total do questionário (GD, 40.08 - IC95%: 35.01-45.15/ GS, 33.31 - IC95%: 28.99-37.63). Os voluntários com dor cervical apresentaram maior porcentagem de diagnósticos de DTM quando comparados com o grupo sem dor (42.30% vs. 23.07%, p<0.05). O grupo com dor apresentou maior intensidade de dor na palpação manual dos músculos cervicais, trapézio (ponto médio) lado direito (GD, 4.03 - IC95%: 3.02-5.06/ GS, 1.46 - IC95%: 0.69-2.23) e suboccipitais direito (GD, 2.58 - IC95%: 1.64-3.51/ GS, 1.0 - IC95%: 0.42-1.58) e esquerdo (GD, 2.15 - IC95%: 1.21-3.09/ GS, 1.0 - IC95%: 0.46-1.54), porém os valores do LDP não foram significativos para nenhum dos músculos avaliados entre os grupos com e sem dor cervical crônica. Também não foram encontradas diferenças significativas na avaliação postural entre os grupos para os ângulos analisados no plano frontal face e vista anterior e para os ângulos analisados no plano sagital. Na análise de associação entre as variáveis, foi observado que quando a incapacidade foi considerada variável dependente em relação à cervicalgia, total da pontuação do MUEQ-Br (aspectos de trabalho) e DTM, foi observado um R2 = 0.93 e todos os preditores mostraram-se significativos no modelo. Nossos resultados demonstram que a incapacidade cervical é influenciada pela DTM, dor no pescoço e aspectos físicos e psicossociais relacionados ao trabalho com uso do computador. Os trabalhadores com dor cervical apresentaram maior porcentagem de diagnósticos de DTM quando comparados com o grupo de trabalhadores sem dor, bem como a intensidade da dor à palpação dos músculos cervicais mostrou-se significativamente maior nos trabalhadores usuários de computador com dor cervical. Assim, é possível sugerir uma associação entre relato de dor cervical, incapacidade cervical e DTM no contexto de trabalho envolvendo o computador em mulheres com dor relato de dor cervical crônica.
Introduction: The prevalence of musculoskeletal disorders among computer office workers (COW) can vary between 10-62% and the most affected regions affected are the upper extremities, neck, head and spine. Musculoskeletal complaints in these workers have a multifactorial etiology and the main causes are postural aspects and psychosocial factors. The Maastricht Upper Extremity Questionnaire (MUEQ-Br) is one of the few tools available in the literature to evaluate ergonomic and psychosocial aspects of work related to computer use. Neck pain is the most common musculoskeletal complaints in COW. Coexistence between neck pain and Temporomandibular Disorders (TMD) are commonly cited in the literature. The adoption of forward head posture for computer use may be linked to the onset of orofacial symptoms. The sitting position is the most widely adopted in the workplace especially when it involves the use of computer, however, to maintain this position for long periods, the adoption of awkward postures could be necessary, increasing the strain on the musculoskeletal system structures. Thus, maintenance of sitting posture may be related to the development of changes in body posture, TMD and neck disorders. Aim: The aim of this study was to examine associations between neck pain, TMD and changes in static body posture on COW with and without chronic neck pain. Material and Methods: The sample of this study was selected from the application of the Maastricht Upper Extremity Questionnaire which includes seven domains (work station, body posture, job control, job demands, break time, work environment and social support). The study included 52 women which work using computer into two groups: Group with chronic neck pain and disability (NPG, n = 26 - 36.50 years confidence interval 95% (CI): 33.40-36.60; 66.37 kg -CI: 62.48-70.26 and 1.62m - 95% CI: 1.60-1.65) and group without neck pain (WONPG, n = 26 - 33.81 years - CI: 33.66-36.95, 71.75 kg - CI: 65.90-77.60 m and 1.64 - CI: 1.62-1.67). As criteria inclusion, the employees should exercise the same function for at least 12 months (NPG, 110 months - CI: 73-147 / WONPG, 91 months - CI: 63-119) and use the computer for at least 4 hours day during the work day (NPG, 7:46 hours / day - CI: 7.10-7.83 / WONPG, 7:58 hours/day - CI: 7.23-7.92). In the group with chronic neck pain workers should present a positive report of chronic neck pain and falling within the criteria: a) neck pain for at least 3 months; b) pain intensity 3 on most days on a numerical pain scale (NPS) (0-10, where 0 = no pain and 10 = worst possible pain) and c) Neck pain related disability at least mild in the Neck Disability Index (NDI): 10-28% (5-14 points) - mild disability; 30-48% (15- 24 points) - moderate disability; 50-68% (25 - 35 points) - severe disability, 72% or more (36 or more points) - Complete. Clinical assessments for diagnosis of TMD was conducted using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), evaluation of masticatory and neck pain through manual palpation and algometry pressure to obtain the pressure pain threshold (PPT) of craniocervical structures as well as evaluation of the static body posture by the use of photogrammetry. The data showed normal distribution according to the Shapiro Wilks test. The Student\'s t-test for independent samples (p <0.05) was used to compare the maximum score for each domain MUEQ-Br between the groups with and without chronic neck pain. Differences between the mean values of LDP and muscle tenderness between groups of workers without pain and chronic neck pain and to check for differences between the postural angles were verified by student t-test. For analysis of associations between TMD, disability related to neck pain, neck pain and \"aspects of the job\" (domains of MUEQ) a multivariate regression analysis was used. Differences between the percentage values were verified using chi-square test (p <0.05). The statistical package used was SPSS version 22. Results: The results showed that when comparing the domains of MUEQ-Br, the group with chronic neck pain scored highest in the area posture (NPG, 12.58 points - CI: 11.21-13.94 / WONPG, 9.42 - CI: 8-10.84) and complaints item (NPG, 17.46 - CI: 14.17-20.75 / WONPG, 8.58 - CI: 6.14 -11.02), and the total score of the questionnaire (NPG, 40.08 - CI: 35.01-45.15 / WONPG, 33.31 points - CI: 28.99-37.63). The volunteers with neck pain showed a higher percentage of diagnoses of TMD when compared with the group without pain (42.30% vs. 23:07%, p <0.05). The group with pain had higher pain intensity on manual palpation of the neck muscles, trapezius (midpoint) right (NPG, 4.03 - CI: 3.02-5.06 / WONPG, 1.46 - CI: 0.69-2.23) and right suboccipital (WONPG, 2.58 NPS - CI: 1.64-3.51 / WONP, 1.0 - CI: 0.42-1.58) and left (NPG, 2.15 - CI: 1.21-3.09 / WONP, 1.0 - CI: 0.46 -1.54) but the values of the LDP were not significant for any of the muscles tested between the groups with and without chronic neck pain. Also no significant differences were found in postural assessment between groups for the analyzed angles in the frontal plane face and anterior views and angles analyzed in the sagittal plane. The analysis of association between the variables, it was observed that when disability was considered the dependent variable in relation to the neck pain, total score MUEQ-Br (aspects of work) and TMD, we observed a strong association (R2 = 0.93) and all predictors showed significant in the model. Our results demonstrate that cervical disability is influenced by the TMD, neck pain and physical and psychosocial aspects of the computer work. Workers with neck pain showed a higher percentage of diagnoses of TMD when compared with the group of workers without neck pain, and the pain intensity on palpation of the neck muscles was significantly higher in computer workers with neck pain. Thus, it is possible to suggest an association between reporting of neck pain, neck related disability and TMD in the context of work involving the computer in women reporting chronic neck pain.

Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-Esqueléticas.
Introdução: O conhecimento acerca da influência das características dos indivíduos com dor cervical crónica (DCC) no prognóstico dos resultados alcançados com a Fisioterapia é ainda inconsistente, sendo escassos os estudos desenvolvidos neste âmbito. Objetivo: Este relatório pretende determinar se um modelo baseado em fatores de prognóstico é capaz de prever os resultados de sucesso da Fisioterapia, a curto prazo, em utentes com DCC, ao nível da incapacidade funcional, intensidade da dor e perceção global de melhoria. Metodologia: Trata-se de estudo de coorte prospetivo com 112 participantes. Os utentes foram avaliados na primeira semana de tratamento e sete semanas após o início da intervenção. Os instrumentos utilizados foram o Neck Disability Index–Versão Portuguesa (NDI-PT) e a Escala Numérica da Dor (END) nos dois momentos de avaliação, um Questionário de Caracterização Sociodemográfica e Clínica da Amostra na baseline e a Patient Global Impression Change Scale–Versão Portuguesa (PGIC-PT) no follow-up. As características sociodemográficas e clínicas foram incluídas como potenciais fatores de prognóstico e estes foram definidos com base nas diferenças mínimas clinicamente importantes (DMCI) dos instrumentos NDIPT (DMCI≥6) e END (DMCI≥2) e no critério de pontuação ≥5 na PGIC-PT. A análise dos dados foi realizada através do método de regressão logística (backward conditional procedure) para identificar as associações entre os indicadores e as variáveis de resultado (p<0.05). Resultados: Dos 112 participantes incluídos no estudo, 108 completaram o follow-up (média de idade: 51.76±10.19). No modelo multivariado relativo à incapacidade funcional, os resultados de sucesso encontram-se associados a elevados níveis de incapacidade na baseline (OR=1.123; 95% IC 1.056–1.194) e a duração da dor inferior a 12 meses (OR=2.704; 95% IC 1.138–6.424). Este modelo explica 30.0% da variância da melhoria da funcionalidade e classifica corretamente 74.1% dos utentes (sensibilidade: 75.9%; especificidade: 72.0%). O modelo relativo à intensidade da dor identificou apenas a associação do outcome com níveis elevados de intensidade da dor na baseline (OR=1.321; 95% IC 1.047–1.668), explicando 7.5% da variância da redução da mesma e classificando corretamente 68.2% dos utentes (sensibilidade: 94.4%; especificidade: 16.7%). O modelo final referente à perceção global de melhoria apresentou uma associação com a intensidade da dor na baseline (OR=0.621; 95% IC 0.465–0.829), com a presença de cefaleias e/ou tonturas (OR=2.538; 95% IC 0.987–6.526) e com a duração da dor superior a 12 meses (OR=0.279; 95% IC 0.109–0.719). Este modelo explica 27.5% da variância dos resultados de sucesso para este outcome e classifica corretamente 73.1% dos utentes (sensibilidade: 81.8%; especificidade: 59.5%). Conclusões: Utentes com DCC com elevada incapacidade na baseline e queixas de dor há menos de 12 meses apresentam maior probabilidade de obter melhorias ao nível da incapacidade funcional. Elevados níveis de intensidade da dor na baseline predizem resultados de sucesso na redução da dor após sete semanas de tratamento. Utentes com DCC com baixos níveis de dor na baseline, com cefaleias e/ou tonturas e com queixas de dor há mais de 12 meses apresentam maior probabilidade de obter uma melhor perceção de melhoria.
Abstract: Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047- 1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109- 0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.

Thesis (PhD) - Swinburne University of Technology, Faculty of Engineering and Industrial Sciences, 2009.
A thesis submitted for the degree of Doctor of Philosophy, Faculty of Engineering and Industrial Sciences, Swinburne University of Technology, 2009. Typescript. "February 2009". Includes bibliographical references (p. 291-313)

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Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia)
IPEN/D-MPLO
Instituto de Pesquisas Energeticas e Nucleares, IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo

RESUMO: Introdução/Objectivo: A influência dos factores psicossociais, e nomeadamente da catastrofização da dor, na percepção da intensidade da dor e na incapacidade funcional, auto-reportada por indivíduos com dor crónica cervical (DCC), tem sido alvo de estudo em vários países, evidenciando o constructo multidimensional da DCC. Neste sentido, esta investigação pretende estudar se a catastrofização da dor, é uma variável preditiva relativamente à percepção da intensidade da dor, e à incapacidade funcional. Secundariamente procurou-se averiguar se as relações encontradas se mantêm estáveis antes e após exposição a uma intervenção em fisioterapia. Metodologia: Neste estudo participaram 40 indivíduos com DCC de origem músculo-esquelética e causa não traumática, que foram expostos a uma intervenção em fisioterapia no Centro de Medicina de Reabilitação do Alcoitão e na Clinica AlcaisFisio, que cumpriram os critérios de inclusão e aceitarem participar livremente no mesmo. A recolha de dados realizou-se em dois momentos distintos, antes e após exposição à intervenção em fisioterapia. A catastrofização da dor foi avaliada por meio da Escala de Catastrofização da Dor (PCS), a intensidade da dor pela Escala Numérica da Dor (END), sendo realizada a medição da incapacidade funcional através do Neck Disability Index versão Portuguesa (NDI-PT). A análise estatística incluiu duas fases: fase descritiva e fase inferencial. Foram desenvolvidos modelos de regressão linear com vista a testar o poder preditivo da catastrofização da dor sobre a intensidade da dor e a incapacidade funcional. O nível de significância para o qual os valores se consideraram satisfatórios foi de p<0,05. O tratamento dos dados foi realizado no software PASW versão 18. Resultados: Observou-se que existe uma relação moderada, positiva e significativa, nos dois momentos de avaliação, entre a catastrofização da dor e a percepção da intensidade da dor (p<0,001), apresentando um poder preditivo de 27,9% e 46,7%, das pontuações da intensidade da dor, antes e após exposição à intervenção em fisioterapia, espectivamente. Observou-se que a catastrofização da dor tem uma relação forte, positiva e significativa com a incapacidade funcional, nos dois momentos de avaliação (p<0,001), predizendo 51,8% e 61,8%, das pontuações da incapacidade funcional, antes e após exposição à intervenção em fisioterapia, respectivamente. Conclusão: A catastrofização da dor é um factor psicossocial que apresenta relação moderada com a percepção da intensidade da dor, e forte com a incapacidade funcional auto-reportada por indivíduos com DCC de origem músculo-esquelética e causa não traumática, antes e após exposição à intervenção em fisioterapia. Os resultados do estudo sugerem, assim, uma importante influência da catastrofização da dor sobre a percepção da intensidade da dor e a incapacidade funcional em indivíduos com DCC, realçando o constructo multidimensional da DCC. ------------ABSTRACT: Background and Purpose: The influence of psychosocial factors, particularly, the pain catastrophizing, on pain intensity and functional disability in individuals with chronic neck pain (CNP) has been report among recent research literature. The first aim of this research was to verify the predictive value of pain catastrophizing on pain intensity and patient’s functional disability. Secondly it aimed to verify the stability of these relations before and after a physiotherapy treatment. Methodology: A sample of 40 subjects with CNP of musculoskeletal and non-traumatic causes was recruited from the patient’s list of two private clinics in Lisbon district following verification of the inclusion criteria. All participants agree to participate in the study and signed a consent form. Data was collected immediately before and after a period of physiotherapy treatment. Pain catastrophizing was assessed by the Pain Catastrophizing Scale (PCS-PT), patient perception of pain intensity was measured by the Numerical Rating Scale (NRS), and functional disability was measured through the Neck Disability Index (NDI-PT). Data was analyzed through descriptive and inferential statistics. Linear regression models were developed in order to test the predictive power of pain catastrophizing on pain intensity and functional disability. The minimal level of significance established was p<0,05. Data analysis was performed using the software PASW version 18. Results: A positive moderate relationship between pain catastrophizing and pain intensity was founded in both moments, before and after physiotherapy intervention, of data collection (p<0,001) with a predictive power of 27,9% and 46,7%, respectively. A positive strong relationship between pain catastrophizing and functional disability was founded in both moments, before and after physiotherapy intervention, of data collection (p<0,001), with a predictive power of 51,8% and 61,8%, respectively. Conclusion: Pain catastrophizing is a psychosocial factor that is correlated moderately with the perception of pain intensity and strongly with self-reported functionaldisability for individuals with CNP musculoskeletal origin and non-traumatic causes,before and after a physiotherapy intervention. The results of this study suggest that pain catastrophizing has an important influence on the report levels of pain intensity and functional disability in CNP patients. These results also emphasize the multidimensional nature of chronic neck pain.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: as dores cervicais e lombares são frequentes nos alunos de Fisioterapia. Objetivo: analisar a prevalência das dores cervicais e lombares inespecíficas em alunos de Fisioterapia e estimar possíveis fatores de risco associados à presença de sintomatologia dolorosa. Metodologia: estudo observacional transversal, no qual foram incluídos 56 alunos dos vários anos de curso de Fisioterapia da Universidade Fernando Pessoa, de ambos os sexos, com uma média de idade de 21,04±1,90anos. Para a recolha de dados foram utilizados o questionário sociodemográfico, o Índice de Incapacidade Cervical e o Índice de Incapacidade de Oswestry. Resultados: 75,0% dos alunos refere dor lombar e 41,6% dor cervical. Na totalidade da amostra, 64,3% dos participantes não têm incapacidade na cervical, 30,4% tem incapacidade mínima e 5,4% tem incapacidade moderada. Os participantes do 1º ao 4º ano têm uma incapacidade mínima na região lombar (92,9%; 92,3%; 100% e 66,7%, respetivamente). Conclusão: a idade, o ano curricular são fatores de risco na ocorrência de dor cervical. E, a prática de atividade física é um fator protetor da ocorrência de dor lombar.
Introduction: cervical and lumbar pain are frequent in students of physical therapy. Objective: to analyze the prevalence of cervical pain and lumbar nonspecific in physiotherapy students and estimate potential risk factors associated with the presence of painful symptoms. Methodology: crosssectional study, which included 56 students of several years of course of physiotherapy at the University Fernando Pessoa, of both sexes, with a mean age of 21.04 ± 1,90 years. For the collection of data was used the demographic questionnaire, the neck disability Index and the Oswestry disability index. Results: 75.0% of students referred to backache and 41.6% cervical pain. In the entire sample, 64.3% of participants have no disability in cervical, 30.4% have minimum incapacity and 5.4% have moderate disability. The participants of the 1st to 4th grade have a minimal incapacity in the lumbar region (92.3% 92.9%;; 100% and 66.7%, respectively). Conclusion: the age, the curricular year are risk factors in the occurrence of cervical pain. And the practice of physical activity is a protective factor in the occurrence of low back pain.
N/A

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
A prevalência de dor lombar e cervical na adolescência é tão elevada quanto nos adultos e seu início, na adolescência, aumenta o risco de desenvolver dor crônica na vida adulta. Existem poucos estudos que tenham investigado como são os hábitos posturais dos adolescentes durante o tempo que estão em atividades passivas em casa e se esses hábitos estão associados à dor lombar e à dor cervical. Objetivo: Investigar a prevalência de dor lombar (DL) e de dor cervical (DC) em adolescentes e suas associações com hábitos posturais domiciliares enquanto estão assistindo a TV e/ou usando o computador. Métodos: Estudo transversal com adolescentes de uma escola pública de ensino médio do Rio de Janeiro. Os estudantes responderam questões relativas a variáveis sociodemográficas, ao estilo de vida, aos hábitos posturais (ilustrações), ao tempo assistindo a TV, ao tempo usando o computador, ao tempo usando o videogame e sobre a presença da DL e da DC. Foi utilizada regressão logística multivariada para analisar a associação entre hábitos posturais domiciliares e dor lombar e cervical. Resultados: Foram 1102 participantes. A prevalência de DL foi de 46,8% (18,2% dor lombar crônica [DLC] e 28,6% dor lombar aguda [DLA]. A prevalência de dor cervical aguda (DCA) foi de 32,9%. Posturas slump (excessivamente relaxadas) ao assistir a TV e ao usar o computador de mesa estiveram associadas com DLC (RC [razão de chances] 3,22, IC 95% 1,38 7,5 e RC 1,7, IC 95% 1,06 2,73). Participantes que assistiam a TV sentados na cama tiveram uma RC de 2,14 (IC 95% 1,06 4,32) para DLA e os que usavam o notebook em decúbito ventral na cama tiveram uma RC de 2,26 (IC 95% 1,02 5,01) para DLA. Os participantes que assistiam a TV em decúbito dorsal por 2 horas ou mais tiveram uma RC de 6,21 (IC 95% 1,45 26,52) para DCA. Aqueles que disseram que mudavam de postura com frequência, ao usar o computador de mesa por 2 horas ou mais, tiveram uma RC de 0,34 (IC 95% 0,14 0,85) para DCA. Conclusão: Os nossos achados apoiam a elevada prevalência de DL e de DC na adolescência e adicionam a associação com os hábitos posturais domiciliares.
The prevalence of low back and neck pain in teenagers is as high as in adults, and when it starts in adolescence, there is an increased risk of developing chronic pain in adulthood. There is a lack of studies investigating how the home postural habits of the teenagers are while in passive activities at home and if such habits are associated with low back and neck pain. Purpose: To investigate the prevalence of low back pain (LBP) and neck pain (NP) and their association with home posture habits watching TV and using a computer in adolescents. Methods: Crosssectional study with public high school adolescents in Rio de Janeiro, Brazil. Students answered questions regarding sociodemographic variables, lifestyle, posture habits (illustration), time watching TV, time using computer, time playing videogame and the presence of LBP and NP. Multivariate logistic regression was used to investigate the association between home posture habits and LBP and NP. Results: There were 1102 participants. The prevalence of LBP was 46,8% (18,2% chronic low back pain [CLBP] and 28,6% acute low back pain [ALBP]). The prevalence of acute neck pain (ANP) was 32,9%. Slump postures while watching TV and using a desktop computer were associated with CLBP (OR 3,22, 95% CI 1,38 7,5 and OR 1,7, 95% CI 1,06 2,73 respectively). Participants who watched TV seated on a bed yielded an OR of 2,14 (95% CI 1,06 4,32) for ALBP and who used the notebook lying belly down on a bed yielded an odds ratio (OR) of 2,26 (95% CI 1,02 5,01) for ALBP. The ones who watched TV lying supine on a bed for 2 hours or more yielded an odds ratio (OR) of 6,21 (95% CI 1,45 26,52) for ANP. Who frequently changed their positions while using a computer and used it for 2 hours or more yielded an OR of 0,34 (95% CI 0,14 0,85) for ANP. Conclusion: Our findings support the high prevalence of LBP and NP in adolescence and add the association with inappropriate home postural habits.

Aproximadament el 95% dels individus experimentaran dolor cervical passats 65 anys. La incidència anual és d’un 12,3% en la població general adulta, i més d’un terç es converteix en dolor crònic. La tracció cervical és un dels tractaments que habitualment s’utilitza, eixampla l’espai intervertebral, augmenta el moviment articular i enforteix el teixit musculotendinós vertebral. La literatura no aporta suficient evidència sobre el seu efecte per millorar el dolor. El nostre propòsit és reforçar aquesta evidència per ajudar en les decisions clíniques d’aquest tractament. Realitzem un estudi aleatoritzat, controlat i doble cec. La mostra són 72 individus, homes i dones entre 45 i 75 anys amb dolor cervical de més de 6 mesos d’evolució. Dividits aleatòriament en dos grups, el grup tractament que se li aplica una tracció cervical eficaç, i el grupo control que se li aplica una tracció ineficaç. Tots realitzen 15 sessions de tractament consistent en termoterapia profunda, exercicis cervicals i tracció cerivcal intermitent. Ni l’avaluador ni el pacient coneixen si la tracció aplicada és efectiva o no, només la coneix el fisioterapeuta que col·loca la tracció. Realitzem tres visites, la primera prèvia al tractament, la segona al finalitzar el tractament, i la tercera sis mesos després del tractament. Valorem el dolor a través de l’escala visual analógica (EVA). La nostra hipòtesi inicial planteja que amb la tracció cervical intermitent el 70% dels pacients del grup tractament aconsegueix disminuir 3 punts o més sobre 10 en l’EVA, enfront del 30% dels pacients del grup control
Aproximadamente el 95% de los individuos experimentarán dolor cervical pasados ​​65 años. La incidencia anual es de un 12,3% en la población general adulta, y más de un tercio se convierte en dolor crónico. La tracción cervical es uno de los tratamientos que habitualmente se utiliza, ensancha el espacio intervertebral, aumenta el movimiento articular y fortalece el tejido musculotendinoso vertebral. La literatura no aporta suficiente evidencia sobre su efecto para mejorar el dolor. el Nuestro propósito es reforzar esta evidencia para ayudar en las decisiones clínicas de este tratamiento. Realizamos un estudio aleatorizado, controlado y doble ciego. La muestra son 72 individuos, hombres y mujeres entre 45 y 75 años con dolor cervical de más de 6 meses de evolución. Divididos aleatoriamente en dos grupos, el grupo tratamiento que se le aplica una tracción cervical eficaz, y el grupo control que se le aplica una tracción ineficaz. Todos realizan 15 sesiones de tratamiento consistente en termoterapia profunda, ejercicios cervicales y tracción cerivcal intermitente. Ni el evaluador ni el paciente conocen si la tracción aplicada es efectiva o no, sólo la conoce el fisioterapeuta que coloca la tracción. Realizamos tres visitas, la primera previa al tratamiento, la segunda al finalizar el tratamiento, y la tercera seis meses después del tratamiento. Valoramos el dolor a través de la escala visual analógica (EVA). Nuestra hipótesis inicial plantea que con la tracción cervical intermitente el 70% de los pacientes del grupo tratamiento consigue disminuir 3 puntos o más sobre 10 en el EVA, frente al 30% de los pacientes del grupo control
Roughly 95% of population have neck pain after 65 years old. The annual incidence of neck pain is estimated at 12.3% on adult general population, and more than a third of patients will develop chronical pain. The intermittent cervical traction is a regular treatment for the neck pain, expanding intervertebral spaces, increasing the joint movement and strengthening the muscles and tendons around the vertebra. There aren’t enough evidences of his benefit to improve the pain in literature. Our purpose is to strengthen this evidence to assist in clinical decisions of this treatment. We did a prospective controlled and blinded study. The study population is composed by 72 individuals, men and women aged between 45-75 years old, with degenerative chronic neck pain for more than 6 month evolution. They are divided randomly into two groups of 36 patients, the treatment group was treated with cervical effective traction and the control group was treated with cervical ineffective traction. Both groups did 15 rehabilitation sessions and were treated with deep thermotherapy, cervical exercises and intermittent cervical traction. Neither the evaluator nor the patient knew if the applied treatment was effective or not. Only the therapist knew the type of traction that should apply. There are three evaluations, before treatment, immediately after treatment and 6 months after treatment. We were evaluating the pain with visual analogue scale. The initial hypothesis was to achieve a decrease of 3 points or more over 10 on the VAS in pain on 70% of patients in the treatment group compared to 30% of control patients.

Bakgrund: Cervikal dystoni är en neurologisk sjukdom som drabbar nackmuskulaturen med muskelsammandragningar som kan resultera i felställningar, smärta och tremor. Behandlingen består i dagsläget av injektioner med Botulinumtoxin och fysioterapi. Syfte: Syftet med denna studie var att undersöka den självrapporterade nivån av fysisk aktivitet och sambandet mellan fysisk aktivitet och smärta hos personer med cervikal dystoni. Metod: Detta var en icke experimentell tvärsnittstudie med 273 medlemmar i Svensk dystoniförening som deltagare. Insamling av data skedde via en enkät.  Den fysiska aktivitetsnivån mättes med IPAQ-sf och smärta med NRS. Resultat: Gruppen placerades i kategori två enligt International Physical Activity Questionnaire´s (IPAQ) riktlinjer med ett medianvärde på 925,5 MET-minuter vilket innebär måttligt aktiva. I gruppen uppnådde 34,05% de allmänna rekommendationerna för fysisk aktivitet uppsatta av WHO. Det förelåg ingen skillnad mellan män och kvinnor vad gäller fysisk aktivitetsnivå och en låg icke signifikant korrelation mellan smärta och fysisk aktivitetsnivå. Konklusion: För fysioterapeuter är det bra att ha i beaktning att personer med cervikal dystoni är mindre fysisk aktiva och behandlingen bör utformas efter individen för bästa möjliga behandling. Liknande studier med andra datainsamlingsmetoder behövs för att säkerställa resultatet.
Background: Cervical dystonia is a neurological disease which effects the muscles of the neck with muscle contractions that could lead to malalignments, pain and tremor. Todays treatment consists of injections with botulinum toxin and physical therapy. Aim: The purpose of this study was to examine the self-reported level of physical activity and the correlation between physical activity and pain among people with cervical dystonia. Method: This was a nonexperimental cross-sectional study with 273 members of Svensk dystoniförening as participants. Collection of data was gathered thru a questionnaire. The level of physical activity was measured with IPAQ-sf and level of pain with NRS. Results: The result showed that the group was placed in category two according to the International Physical Activity Questionnaire´s (IPAQ) guidelines with a median of 925,5 MET-minutes which means moderately active. Within the group 34,05% reached the current recommendations for physical activity stated by WHO. There was no difference between men and women as to level of physical activity (p=0,39, p=0,36), and a low insignificant correlation between pain and level of physical activity (r=-0,15). Conclusion: Similar studies with other data collection methods is needed to ensure a possible result. For physiotherapists, it is good to keep in mind that people with cervical dystonia are less physical active and that the treatment should be designed for the individual for the best possible result.

Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-Esqueléticas.
Introdução: O conhecimento acerca da influência das características dos indivíduos com dor cervical crónica (DCC) no prognóstico dos resultados alcançados com a Fisioterapia é ainda inconsistente, sendo escassos os estudos desenvolvidos neste âmbito. Objetivo: Este relatório pretende determinar se um modelo baseado em fatores de prognóstico é capaz de prever os resultados de sucesso da Fisioterapia, a curto prazo, em utentes com DCC, ao nível da incapacidade funcional, intensidade da dor e perceção global de melhoria. Metodologia: Trata-se de estudo de coorte prospetivo com 112 participantes. Os utentes foram avaliados na primeira semana de tratamento e sete semanas após o início da intervenção. Os instrumentos utilizados foram o Neck Disability Index–Versão Portuguesa (NDI-PT) e a Escala Numérica da Dor (END) nos dois momentos de avaliação, um Questionário de Caracterização Sociodemográfica e Clínica da Amostra na baseline e a Patient Global Impression Change Scale–Versão Portuguesa (PGIC-PT) no follow-up. As características sociodemográficas e clínicas foram incluídas como potenciais fatores de prognóstico e estes foram definidos com base nas diferenças mínimas clinicamente importantes (DMCI) dos instrumentos NDIPT (DMCI≥6) e END (DMCI≥2) e no critério de pontuação ≥5 na PGIC-PT. A análise dos dados foi realizada através do método de regressão logística (backward conditional procedure) para identificar as associações entre os indicadores e as variáveis de resultado (p<0.05). Resultados: Dos 112 participantes incluídos no estudo, 108 completaram o follow-up (média de idade: 51.76±10.19). No modelo multivariado relativo à incapacidade funcional, os resultados de sucesso encontram-se associados a elevados níveis de incapacidade na baseline (OR=1.123; 95% IC 1.056–1.194) e a duração da dor inferior a 12 meses (OR=2.704; 95% IC 1.138–6.424). Este modelo explica 30.0% da variância da melhoria da funcionalidade e classifica corretamente 74.1% dos utentes (sensibilidade: 75.9%; especificidade: 72.0%). O modelo relativo à intensidade da dor identificou apenas a associação do outcome com níveis elevados de intensidade da dor na baseline (OR=1.321; 95% IC 1.047–1.668), explicando 7.5% da variância da redução da mesma e classificando corretamente 68.2% dos utentes (sensibilidade: 94.4%; especificidade: 16.7%). O modelo final referente à perceção global de melhoria apresentou uma associação com a intensidade da dor na baseline (OR=0.621; 95% IC 0.465–0.829), com a presença de cefaleias e/ou tonturas (OR=2.538; 95% IC 0.987–6.526) e com a duração da dor superior a 12 meses (OR=0.279; 95% IC 0.109–0.719). Este modelo explica 27.5% da variância dos resultados de sucesso para este outcome e classifica corretamente 73.1% dos utentes (sensibilidade: 81.8%; especificidade: 59.5%). Conclusões: Utentes com DCC com elevada incapacidade na baseline e queixas de dor há menos de 12 meses apresentam maior probabilidade de obter melhorias ao nível da incapacidade funcional. Elevados níveis de intensidade da dor na baseline predizem resultados de sucesso na redução da dor após sete semanas de tratamento. Utentes com DCC com baixos níveis de dor na baseline, com cefaleias e/ou tonturas e com queixas de dor há mais de 12 meses apresentam maior probabilidade de obter uma melhor perceção de melhoria.
Abstract: Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047- 1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109- 0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: nos trabalhadores usuários de computador, as principais desordens acometem os membros superiores e a coluna vertebral. Objetivo: analisar a eficácia de TENS em pacientes com dor cervical crónica não específica, usuários de computador. Metodologia: a amostra foi constituída por 30 voluntários, trabalhadores de escritório da empresa Fumeiros Terra do Demo SA, de ambos os sexos, usuários de computador por mais de 4 horas diárias e com diagnóstico de dor cervical crónica não específica, com uma média de idade de 43,60 ± 9,90anos. A amostra foi dividida em dois grupos, experimental (GE) e controlo (GC). Foram entregues dois questionários a ambos os grupos Questionário de Caracterização da Amostra e Índice de Incapacidade Cervical (Neck Disability Index - NDI), e também foi utilizada a Escala Numérica da Dor (END). Após seis semanas de intervenção com TENS modo burst com uma frequência de 100Hz e um impulso de 150μs durante 30 minutos, duas vezes por semana no GE, foram entregues novamente os questionários a ambos os grupos e ainda um terceiro entregue apenas ao GE (Patient Global Impression Scale). Resultados: a prevalência da dor cervical inespecífica foi de 73,3% no sexo feminino e de 26,7% no sexo masculino. Em média, os trabalhadores apresentam sintomatologia dolorosa há 3,25 ± 3,49 anos. Maioritariamente os participantes apresentam uma incapacidade classificada como leve, sem haver associações significativas entre grupos em ambos os momentos de avaliação. No GE houve uma redução significativa de dor (p=0,000), evoluindo de 4 para 1, avaliada pela END. O mesmo aconteceu com o score do NDI (de 8 para 3). Conclusão: a utilização de TENS aparenta ter um efeito significativo na diminuição da dor cervical crónica nos trabalhadores de escritório usuários de computador. O uso desta técnica também revelou benefícios a nível de incapacidade relacionada ao pescoço e na condição geral dos participantes.
Introduction: in computer workers, the main disorders affect the upper limbs and the spine.Objective: to analyze the efficacy of TENS in patients with non-specific chronic cervical pain and computer users. Material and methods: the sample consisted of 30 volunteers, office workers of the company Fumerios Terras do Demo SA, of both sexes, computer users for more than 4 hours daily and diagnosed with chronic non-specific pain, with a mean age of 43.60 ± 9.90 years. The sample was divided into two groups: Experimental Group (GE) and Control Group (GC). Two questionnaires were given to both groups (Sample Questionaire and Neck Disability Index Questionaire - NDI), and the Numerical Pain Scale (NDT) was also used. After six weeks of intervention with TENS burst mode with a frequency of 100Hz and a pulse of 150μs for 30 minutes, twice a week in the GE, the questionnaires were again delivered to both groups and a third delivered to the GE only (Patient Global Impression Scale). Results: the prevalence of non-specific cervical pain was 73.3% in females and 26.7% in males. On average, the workers presented pain symptomatology for 3.25 ± 3.49 years. Most participants present a disability classified as mild, with no significant associations between groups at both time points. In GE there was a significant reduction of pain (p = 0.000), improving from 4 to 1, evaluated by NDT. The same happened with the NDI score (from 8 to 3).Conclusion: the use of TENS appears to have a significant effect on the reduction of chronic neck pain in office workers computer users. The use of this technique also showed benefits in terms of disability related to the neck and the general condition of the participants.
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Cervical cancer is one of the most common cancers in Thailand with around 10% of these women experiencing persistent pain. One third of those are under treated and it is claimed that programmes of self-management may contribute to better managing this pain. However, self-management is a Western concept and it is not clear whether this concept is helpful to Thai people or how it might be conceptualised or how Thai people self-manage their pain. The aim of this study to explore the way in which Thai women with cervical cancer manage their pain with specific reference to the potential for self-management in hospital and at home and how they might be supported in this activity by their family and health professionals. A single embedded case study design was adopted over six months in a regional cancer centre located in the North-East of Thailand. The participants were purposively sampled for the phenomenon under investigation. Six patients with cervical cancer experiencing moderate to severe pain, six identified family caregivers and seven health care providers were 0interviewed and observed. Framework analysis was used to analyse the observational and interview data. The finding revealed six main themes of self-management including problem solving, decision making, information finding and utilisation, forming patient/health care professionals partnership, taking action and, especially, perception. These themes are influenced by Thai family and culture resulting in a revision self-management model for Thais is developed. The model explains relationship between two main aspects, thinking and behaving that people behave self-management. Thinking and behaving influence each other and can be changeable due to the real situation. Factors influence these two aspects including backgrounds of experience, knowledge, and social context of Thailand. Conclusion, the patients developed their ability to self-manage their pain in their everyday life. To improve self-management in Thai patients, the individual circumstance of family and Thai culture are important factors to be aware.

A dor cervical encontra-se entre as disfunções musculoesqueléticas mais prevalentes e estima-se que metade das pessoas que apresentam cervicalgia desenvolvam sintomas crônicos, sendo encaminhados para serviços de reabilitação. Entre as estruturas anatômicas envolvidas no processo patológico da cervicalgia destaque-se o componente miofascial. A dor miosfascial pode conduzir a um distúrbio psicofisiológico envolvendo sistemas centrais reguladores de dor do sistema nervoso, resultando em respostas fisiológicas. Em relação a avaliação da dor miofascial, destacase o uso do Quantitative Sensory Testing (QST) definido como um conjunto de métodos capaz de avaliar as sensações transmitidas pelas fibras sensoriais, entretanto, ainda se faz necessário o respaldo científico quanto à confiabilidade desse instrumento na população com pontos gatilhos em dor cervical crônica. O objetivo deste estudo foi avaliar a confiabilidade intra e interexaminador do QST para avaliação do limiar térmico doloroso sobre pontos gatilhos miofasciais no músculo trapézio fibras descendentes de indivíduos que apresentam cervicalgia crônica e sua correlação com outros instrumentos de avaliação da dor. Foram inseridos 30 voluntários de ambos os gêneros, com faixa etária de 18 e 45 anos que apresentaram ponto gatilho miofascial bilateralmente, ativos e centrais no músculo trapézio fibras descendentes. Foram realizadas duas coletas por cada avaliador com um intervalo de uma semana entre elas, sendo empregadas na avaliação a Escala Numérica de Dor, Neck Disability Index, algometria, Escala de Pensamentos Catastróficos sobre Dor, termografia infravermelha e o QST. A análise dos dados apresentou valores de ICC intra-examinador variaram entre 0,876 e 0,896 e, os valores de ICC inter-examinador variaram 0,917 e 0,954. Assim, constatou-se no presente estudo moderada confiabilidade para a análise intraexaminador enquanto a avaliação inter-examinador apresentou excelente confiabilidade. Em relação às correlações, foram observadas associações significativas, entre a intensidade de dor e limiar térmico doloroso (calor), sendo fraca e negativa à direita; ente a intensidade de dor e limiar térmico doloroso (frio) , sendo fraca e positiva à direita e a esquerda. Com os demais instrumentos de avaliação, não foram observadas correlações significativas. Conclui-se que a mensuração do limiar térmico doloroso sobre pontos gatilhos miofasciais em indivíduos com cervicalgia crônica apresenta valores de confiabilidade aceitáveis respaldando o emprego do QST para a avaliação em pesquisas e no ambiente clínico, no entanto a sua associação com outros instrumentos de avaliação da dor são fracos ou inexistentes.
Neck pain is one of the most prevalent musculoskeletal disorders and it is estimated that half of the people with this disorder develop chronic symptoms and are referred to rehabilitation services. A lot of anatomical structures are involved in the pathological process of the neck pain with a focus on the myofascial component. Myofascial pain can lead to a psychophysiological disorder involving central nervous system pain regulators, resulting in physiological responses. Concerning the evaluation of myofascial pain the use of Quantitative Sensory Testing (QST) which is defined as a set of methods capable of evaluating the sensations transmitted by the sensory fibers has been highlighted, however, it is still necessary the scientific support about the reliability of this instrument in the population with trigger points in chronic neck pain. The objective of this study was to evaluate the intra and inter-rater reliability of the QST for assessing the pain threshold on myofascial triggers in the trapezius muscle fibers of individuals with chronic neck pain and their correlation with other pain assessment instruments. A total of 30 volunteers of both genders, aged 18 and 45 years, who presented myofascial trigger point bilaterally, active and central in the trapezius muscle were included. Two examinations were carried out for each evaluator with an interval of one week between them, using Numerical Pain Scale, Neck Disability Index, Algometry, Catastrophic Thoughts on Pain Scale, infrared thermography and QST. Data analysis showed intra-examiner ICC values ranged from 0.876 to 0.896 and interexaminer ICC values ranged from 0.917 to 0.954. Thus, the present study showed moderate reliability for the intra-examiner analysis while the inter-examiner evaluation presented excellent reliability. Regarding the correlations there were significant associations between pain intensity and pain threshold (heat) being weak and negative on the right, pain intensity and pain threshold (cold) being weak and positive on the right and left. With the other instruments evaluation, no significant correlations were observed. It is concluded that the measurement of the pain threshold on myofascial trigger points in individuals with chronic neck pain presents acceptable reliability values supporting the use of QST for evaluation in research and clinical settings, however, its association with other pain assessment instruments are weak or nonexistent.

A dor cervical é um problema musculoesquelético comum, cuja ocorrência é estimada em torno de 30-50% da população adulta em geral e também muito frequente entre os trabalhadores usuários de computador. A alteração no padrão de atividade muscular dos músculos flexores e extensores é uma das características da dor cervical, que nos usuários de computador parece estar associada à manutenção da postura sentada com anteriorização da cabeça ou flexão cervical. Dois fatores de análise importantes para avaliar déficits na atividade muscular são o fenômeno flexão-relaxamento (FFR) e a relação flexão-relaxamento (RFR). O objetivo principal deste estudo foi avaliar, através da eletromiografia de superfície, a ocorrência do FFR e mensurar a RFR nos músculos extensores da coluna cervical de trabalhadores usuários de computador com e sem dor cervical crônica e de indivíduos saudáveis, não usuários de computador. Foram avaliados 60 indivíduos, 20 usuários de computador com dor cervical crônica (GD), 20 usuários de computador sem dor cervical (GS) e 20 indivíduos saudáveis, não usuários de computador (GC). Os indivíduos responderam o Maastricht Upper Extremity Questionnaire (MUEQ-Br) e o Índice de Incapacidade Relacionada à dor no Pescoço (IIRP), e o FFR e RFR foram analisados através da eletromiografia de superfície dos músculos Semi-espinhal da Cabeça(SC), Esplênio da Cabeça(EC) e Trapézio Superior(TS). O limiar de dor por pressão (LDP) também foi avaliado nestes músculos e no músculo esternocleidomastóideo. Os resultados mostraram maior pontuação do grupo de trabalhadores com dor cervical crônica no domínio Posto de Trabalho do MUEQ-Br (GS 0,35, IC95% 0,14-0,56; GD 0,80, IC95% 0,32-1,28; p<0,05) e maior LDP do músculo EC no grupo com dor cervical em relação ao controle (GD 1,77, IC95% 1,55-2,00; GC 2,38, IC95% 2,02-2,75; p<0,05). O FFR foi verificado em proporção igual em todos os grupos, não sendo observado em todos os indivíduos. A integral do envoltório linear foi maior nos grupos de trabalhadores em relação ao controle no músculo SC em repouso (GS 0,91, IC95% 0,90-0,93; GD 0,90, IC95% 0,88-0,93; GC 0,86, IC95% 0,83-0,90; p<0,05). A relação entre flexão total e a extensão mostrou maior atividade EMG do SE dos grupos de trabalhadores na extensão em relação ao controle (GS 0,38, IC95% 0,32-0,43; GD 0,37, IC95% 0,30-0,44; GC 0,56, IC95% 0,52-0,60; p<0,05). A RFR foi maior no grupo de trabalhadores com dor cervical, diferenciando este grupo do controle (GS 2,33, IC95% 1,93-2,74; GD 3,10, IC95% 2,50-3,70; GC 1,99, IC95% 1,81-2,17; p<0,05). O teste da CIVM dos extensores cervicais apresentou reprodutibilidade boa a excelente, principalmente na CIVM e no grupo com dor cervical (CIVM GS ICC médio SE 0,93; ICC médio EC 0,57; ICC médio TS 0,19) (CIVM GD ICC médio SC 0,50; ICC médio EC 0,84; ICC médio TS 0,96). Os resultados demonstram que a dor cervical crônica e a incapacidade cervical são influenciadas por aspectos físicos relacionados ao trabalho com uso do computador. As relações entre a atividade EMG dos músculos extensores durante os movimentos de flexão e extensão sugerem que o uso de computador recrute de forma contínua a musculatura extensora, que apresenta alta atividade durante o repouso na posição neutra e a extensão, e se mantém ativa durante a flexão e flexão total. Além disso, o trabalho com computador, quando associado à queixa de dor cervical crônica, parece aumentar a sensibilidade dolorosa à pressão na musculatura extensora cervical
Neck pain is a common musculoskeletal problem, the occurrence of which is estimated at around 30-50% of the adult population in general and also very common among office workers. Activity muscle pattern alterated of flexion and extension muscles is one of the characteristics of neck pain, that office workers is associated with the maintenance of the sitting posture with forward head posture or neck flexion. Two important factor analysis to assess deficits in muscle activation are flexion-relaxation phenomenon (FFR) and the flexor-relaxation ratio (RFR). The aim of this study was to evaluate, using surface electromyography, the occurrence of FFR and measure the RFR in extension neck muscles of office workers with and without chronic neck pain and healthy subjects, not computer users. Sixty subjects were evaluated, 20 office workers with chronic neck pain (GD), 20 office workers without neck pain (GS) and 20 healthy subjects, not computer users (GC). Participants completed the Maastricht Upper Extremity Questionnaire (MUEQ-Br) and Neck Disability Index (IIRP), and the FFR and RFR were analyzed by surface electromyography of the semispinal capitis (SC) splenius capitis (EC) and Upper Trapezius (TS). Pressure pain threshold (PPT) was also evaluated in these muscles and the sternocleidomastoid. Results showed higher scores of the group of workers with chronic neck pain in the workplace domain MUEQ-Br (GS 0.35, 95% CI 0.14 to 0.56; GD 0.80, 95% CI 0.32 to 1 28, p <0.05) and higher EC LDP in the neck pain group compared to control group (GD 1.77, 95% CI 1.55 to 2.00; GC 2.38, 95% CI 2.02 to 2.75; p <0.05). FFR was observed in the same proportion in all groups, not being observed in all subjects. The integral of linear envelope was higher in workers groups than control group in SC at rest posture (GS 0.91, 95% CI 0.90 to 0.93; GD 0.90, 95% CI 0.88 to 0.93 ; GC 0.86, 95% CI 0.83 to 0.90; p <0.05). The relationship between full flexion and extension showed higher SE EMG activity of workers groups in extension compared to control group (GS 0.38, 95% CI from 0.32 to 0.43; GD 0.37, 95% CI 0.30 to 0.44; GC 0.56, 95% CI 0.52 to 0.60; p <0.05). The RFR was higher in the neck pain workers than control group (SG 2.33, 95% CI 1.93 to 2.74; GD 3.10, 95% CI 2.50 to 3.70; GC 1 99, 95% CI 1.81 to 2.17; p <0.05). The test of MVIC of neck extensor muscles showed good to excellent reproducibility, especially in the MVIC and in neck pain group (MVIC GS - ICC SE 0.93; ICC EC 0.57; ICC TS 0.19) (MVIC GD - SC ICC 0.50, EC ICC 0.84, TS ICC 0.96). The results showed that physical factors are related to chronic neck pain disability in office workers. Relations between the EMG activity of the extensor muscles during flexion and extension movements suggest that computer use recruit continuously the extensor muscles, which shows high activity during rest in the neutral position and extent, and remains active during flexion and full flexion. In addition, work computer use, when associated with chronic complaint of neck pain, seems to increase pain sensitivity to pressure on the neck extensor muscles

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: a articulação temporomandibular (ATM) e a coluna cervical atuam em harmonia. Uma disfunção na cervical pode provocar sintomatologia álgica na ATM e vice-versa. Objetivo: analisar a prevalência e as caraterísticas da dor cervical inespecífica e da disfunção temporomandibular (DTM) em jovens estudantes de ambos os sexos, e de diferentes anos do curso de Fisioterapia. Metodologia: a amostra foi constituída por 41 estudantes do 3º e 4º ano do curso de Fisioterapia da Universidade Fernando Pessoa (UFP), de ambos os sexos, 20 do sexo feminino e 21 do sexo masculino, com uma média de idade de 22,12±2,15 anos, variando de 19 a 27. Foram aplicados 2 questionários, o Índice de Incapacidade Cervical (Neck Disability Index - NDI) para a cervical e o questionário amnésico de Fonseca para a ATM. Resultados: a prevalência da dor cervical inespecífica é superior no sexo feminino (90%, vs. 47,6%), e nos alunos do 4º ano (85,0% vs. 52,4%). A prevalência de dor na ATM é mais elevada no sexo feminino (55% vs. 14,3%), e os alunos do 4º ano também seguem essa tendência (45,0% vs. 23,8%). Conclusão: Ser do sexo feminino aumenta significativamente a probabilidade de ter dor cervical e dor na ATM, e frequentar o 4º ano é um fator de risco no aparecimento de dor cervical. Existe uma forte correlação significativa entre a incapacidade cervical e nível/categoria de DTM.
Introduction: the tempomandibular joint and the cervical spine work together in harmony. A cervical dysfunction may cause symptoms of TMJ pain and the opposite can also happen. Objective: analyze the prevalence and characteristics of nonspecific cervical pain and temporomandibular dysfunction in young students of both sexes, and of different years of the physiotherapy course. Material and methods: The sample consisted of 41 students from the 3rd and 4th year of the physiotherapy course at the Fernando Pessoa University (UFP), of both sexes, 20 females and 21 males, with an average age of 22,12±2,15 years, varying from 19 to 27. Two questionnaires were applied, the neck disability index-NDI for cervical and the amnestic questionnaire of Fonseca for TMJ. Results: The prevalence of nonspecific cervical pain is higher among females (90%, vs. 47.6%), and in 4th year students (85.0% vs. 52.4%). The prevalence of pain in TMJ is higher among females (55% vs. 14.3%), and the 4th year students also follow this trend (45.0% vs. 23.8%). Conclusion: Being female significantly increases the probability of having cervical pain and pain in TMJ, and attending the 4th year is a risk factor in the onset of cervical pain. There is a strong significant correlation between cervical disability and TMD level/category.
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Background Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders. Methods A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations. Results Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head. Conclusion The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.

Introduction: Neck pain is a common problem in society and is more prevalent among women. The consequences of neck pain for the individual often include activity and participation limitations, thus affecting many dimensions of life. There is still a lack of understanding of the underlying mechanisms of the disorder and likewise of efficient rehabilitation for people with neck pain. However, coordination exercises have shown promising short-term effects. To carry this line of research forward, there is a need to improve methods for objective characterization of impairments and to investigate novel methods of rehabilitation. Aims: To characterize impairments of active cervical range of motion of the upper and lower cervical levels in women with chronic neck pain with a novel method (Study I and II) and identify the influence of head posture and movement strategies (Study II). Further, to investigate the effects of a novel method for neck coordination exercise on sensorimotor function and neck pain (study III) and the consistencies of motor variability metrics in a goal directed arm movement task to aid the design of future clinical research (Study IV). Methods: All studies were laboratory based with kinematic assessments of neck movements (Study I-III), balance (Study III) and goal directed arm movements (Study III, IV). The studies had designs that were: cross-sectional (I and II), randomized controlled trial (III) or test-retest reliability study (IV). Participants in Study I (n=135) and II (n=160) were women with chronic non-specific neck pain and healthy controls. In Study III, women with chronic non-specific neck pain (n=108) were randomized into three different individually supervised 11 week interventions. Study IV included healthy women (n=14). Results: It was found that cervical range of motion impairments in women with non-specific neck pain were direction- and level-specific; impairments were greater in extension in the upper and flexion in the lower levels of the cervical spine. The magnitude of impairments in range of motion was associated to self-ratings of functioning and health. Possible group differences in natural head posture were rejected as a cause for the direction specific effects. Neither could the effects be explained by a strategy to minimize torque in the cervical spine during movement execution. The neck coordination training was not superior to strength training (best-available) and massage treatment (sham) in improving sensorimotor functions or pain according to short-term and 6 months follow ups. The results from the study of the goal directed movement task showed that between and within-subject sizes of most motor variability metrics were too large to make the test suitable for application in clinical research. Conclusions: Women with chronic non-specific neck pain have direction- and level-specific impairments in cervical sagittal range of motion. The underlying causes of these specific impairments remains unresolved, but the direction specific impairments are not related to natural head posture. The clinical validity of the method of characterization of cervical range of motion was supported and it can be useful in future clinical research. The novel method of neck coordination exercise showed no advantages on sensorimotor functions or pain compared with best-available treatment in women with chronic non-specific neck pain.
Långvarig smärta i nacken är vanligt förekommande och orsakar både personligt lidande och stora kostnader för samhället. Långvariga nackbesvär är vanligare hos kvinnor än hos män. Det saknas kunskap om effektiva rehabiliteringsmetoder, men forskning har indikerat att träning som förbättrar nackens koordination kan vara effektivt. För att uppnå bättre rehabiliteringsresultat är det viktigt att utveckla metoder för att objektivt mäta funktionsnedsättningar och att utveckla samt utvärdera nya rehabiliteringsmetoder. Syftet med avhandlingen kan sammanfattas i tre delar: Att detaljerat mäta nedsättningar i nackens rörelseomfång hos kvinnor med långvarig nacksmärta; att utvärdera effekten av en ny metod för nackkoordinationsträning på rörelsefunktion och smärta hos kvinnor med långvarig nacksmärta; samt att utvärdera ett nytt test för att mäta precision och koordination vid målriktade armrörelser och ämnat för framtida klinisk forskning. Resultaten visade att kvinnor med långvarig nacksmärta hade specifika nedsättningar i nacken rörelseomfång; i övre nackregionen var bakåtböjning mer begränsad medan i nedre nackregionen var framåtböjning mer begränsad. Vi kunde utesluta att resultaten berodde på skillnader i huvudets normala hållning. Graden av rörelsebegränsning i nacken uppvisade samband med personernas självskattade funktion, symtom och hälsa. Nackkoordinationsträningen var inte var bättre än styrketräning eller massage för att förbättra rörelsefunktion eller för att minska smärta. Det nya testet för armrörelser var inte lämpat för kliniska studier av rörelseprecision. Slutsatserna från avhandlingsarbetet är att kvinnor med långvarig nacksmärta har begränsningar i nackens rörelseomfång vid framåt- och bakåtböjning av huvudet som är specifika vad gäller nivå i halsryggen och riktning. Att graden av rörelsebegränsning uppvisade samband med självskattad funktion, symtom och hälsa styrker testets kliniska validitet. Ytterligare forskning behövs för att förstå orsakerna bakom de specifika nedsättningarna. Nackkoordinationsträningen som utvärderades kan inte rekommenderas för kvinnor med långvarig nacksmärta eftersom korttidsuppföljning och 6-månadersuppföljning visade att träningsformen inte var bättre än styrketräning eller massage, vare sig när det gällde att förbättra sensomotorisk funktion eller att minska smärta.

The pain related to temporomandibular disorders (TMD) and cervical disorders have high prevalence in the population and the association between signs and symptoms of TMD and cervical dysfunction is widely explored in the literature. Nevertheless, two systematic reviews have recently been published regarding this topic and both were inconclusive, emphasizing the need for further evidence. Objective: To study the correlation between cervical disability, masticatory myofascial pain and generalized mechanical hypersensitivity in subjects with and without temporomandibular myofascial pain dysfunction. Casuistry and Methods: Two groups composed this controlled cross-sectional study: group I consisted of 27 individuals diagnosed with myofascial pain according to the criteria of the Brazilian version of diagnostic research for TMD (RDC / TMD), and group II consisting of 28 asymptomatic control patients. The clinical variables evaluated were: self-reporting of cervical disability determined using the Neck Disability Index (NDI); pain intensity measured by visual analogue scale (VAS); the pain threshold pressure of the temporomandibular joint, the anterior temporalis, masseter, sternocleidomastoid, upper trapezius and Achilles tendon, measured by a digital algometer. Results: Neck disability was significantly higher in patients with myofascial pain (11.8 ± 7.0) compared with the asymptomatic control group (2.7 ± 2.4). In contrast the PPT was significantly lower in group I when compared to group II, in the different measurement areas, anterior temporalis (2.0 ± 0.8 vs. 2.6 ± 1.1), upper trapezius (2.6 ± 1.2 vs. 3.8 ± 1.8) and Achilles tendon (5.6 ± 1.4 vs. 6.9 ± 2.3). The study verified a negative correlation between neck disability and PPT in all studied structures and a positive correlation between the values of PPT on trigeminal and extra-trigeminal areas (p <0.05).Conclusion: Individuals with TMD masticatory myofascial pain show widespread mechanical hypersensitivity, which is also associated to the report of cervical incapacity.
As dores relacionadas às disfunções temporomandibulares (DTM) e desordens cervicais possuem alta prevalência na população e a associação entre os sinais e sintomas de DTM e disfunção cervical é bastante explorada na literatura. Apesar disso, duas revisões sistemáticas foram publicadas recentemente a respeito deste tópico e ambas foram inconclusivas, destacando a necessidade de novas evidências. Objetivo: Verificar a existência de associação entre a incapacidade cervical, a dor miofascial mastigatória e a hipersensibilidade mecânica generalizada em sujeitos com e sem disfunção temporomandibular do tipo dor miofascial. Casuística e Métodos: Dois grupos compuseram este estudo controlado e de corte transversal: grupo I foi composto por 27 indivíduos diagnosticados com dor miofascial de acordo com os critérios da versão brasileira de diagnóstico em pesquisa para DTM (RDC/DTM), e grupo II, composto por 28 controles assintomáticos. As variáveis clínicas avaliadas foram: o auto-relato de incapacidade cervical determinado por meio do Neck Disability Index (NDI); a intensidade da dor medida pela escala visual analógica (EVA); o limiar de dor à pressão da articulação temporomandibular, dos músculos temporal anterior, masseter, esternocleidomastóideo, trapézio superior e do tendão de Aquiles, mensurado por meio de um algômetro digital. Resultados: A incapacidade cervical foi significativamente maior no grupo com dor miofascial (11,8 ± 7,0) em relação ao grupo de controles assintomáticos (2,7 ± 2,4). Em contraste o LDP foi significativamente menor no grupo I em relação ao grupo II, nas diferentes áreas de mensuração como temporal anterior (2,0 ± 0,8 vs. 2,6 ± 1,1), trapézio superior (2,6 ± 1,2 vs. 3,8 ± 1,8) e tendão de Aquiles (5,6 ± 1,4 vs. 6,9 ± 2,3). Foi verificada uma correlação negativa entre incapacidade cervical e o LDP de todas as estruturas avaliadas e uma correlação positiva ocorreu entre os valores de LDP de áreas trigeminais e extra-trigeminais (p<0,05). Conclusão: Os indivíduos com DTM do tipo dor miofascial mastigatória apresentam hipersensibilidade mecânica generalizada, que também está associada com o auto-relato de incapacidade cervical.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Objetivo: Verificar a efetividade dos efeitos da punção seca na dor, limiar de pressão à dor, mobilidade e funcionalidade em utentes com cervicalgia mecânica. Metodologia: A pesquisa via computador nas bases de dados PubMed/Medline, Lilacs, Scielo e Web of Science foi: ("Neck pain") AND (“Trigger points”) AND ("dry needling"). E foi as bases de dados Cochrane Library (CENTRAL) e PEDro com a combinação de palavraschave:"Neck pain" "dry needling" “Trigger points”. Resultados: Esta revisão inclui 6 artigos que apresentaram todos os critérios de elegibilidade, com uma pontuação media de 6,67/10 na escala de qualidade metodológica PEDro e um total de 475 participantes (338 do sexo feminino e 137 do sexo masculino). Conclusão: A punção seca em trigger points ativos em utentes com cervicalgia mecânica, parece mostrar efetividade na diminuição da dor, aumento da mobilidade, funcionalidade e limiar de pressão à dor.
Aim of the study: Verify the effectiveness of dry needling on pain, pain pressure threshold, mobility and functionality in patients with mechanical neck pain. Methodology: The computer research carried out in the data bases PubMed/Medline, Lilacs, Scielo and Web of Science, using the combination of keywords: ("Neck pain") AND (“Trigger points”) AND ("dry needling"). For the databases Cochrane Library (CENTRAL) and PEDro the keywords combination was:"Neck pain" "Dry needling" “Trigger points”. Results: This review includes 6 articles that met all eligibility criteria, with an average score of 6.67/10 on the methodological quality scale, PEDro and a total of 475 participants (338 females and 137 males). Conclusion: Dry needling in active trigger points in users with mechanical neck pain seems to show a positive effect in decreasing pain, increasing mobility, functionality and pain pressure threshold.
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Background: i disturbi temporomandibolari (TMD) rappresentano un gruppo di patologie che colpisce l’articolazione temporomandibolare (ATM) e le strutture associate.Il trattamento riabilitativo conservativo rappresenta il primo step per la gestione di questi disturbi, prima di considerare l'intervento chirurgico. Tuttavia, non sono presenti linee guida né consensi sulle strategie di intervento più efficaci. Obiettivo: Valutare lo stato dell’arte riguardo al trattamento riabilitativo dei TMD con un intervento sul rachide cervicale e la sua efficacia. A tal fine è stata condotta una ricerca che prendesse in considerazione questa tipologia di intervento, sia singolarmente sia in associazione ad altri interventi.
 Materiali e Metodi: la ricerca è stata effettuata nelle principali banche dati (PubMed, PEDro e The Cochrane Library). Sono stati inclusi gli studi clinici randomizzati (RCT) in cui fosse descritto il trattamento riabilitativo conservativo con intervento sul rachide cervicale e i risultati relativi, escludendo tutti gli studi in cui il trattamento descritto fosse unicamente di tipo farmacologico o chirurgico. Risultati:sono stati identificati ed analizzati 6 studi che rispettavano i criteri di inclusione riguardanti il quesito di ricerca. I risultati hanno mostrato diverse evidenze a supporto di questa tipologia di intervento, sia per l’ efficacia clinica sia la riduzione dei segni e sintomi dei disturbi TMD. Conclusioni: il trattamento riabilitativo conservativo risulta efficace nella maggior parte dei pazienti affetti da TMD. Gli articoli analizzati differiscono per quanto riguarda le strategie utilizzate, ma la mobilizzazione e la manipolazione della cervicale superiore sembrano essere l’intervento terapeutico più utilizzato ed affidabile.

Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results. The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS). Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances. Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain. Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain. The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up. In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

Orientador: Wilkens Aurélio Buarque e Silva
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O objetivo neste trabalho foi analisar a influência da dimensão vertical de oclusão na postura da coluna cervical e da cabeça por meio de aferições de medidas angulares craniocervicais. Foram selecionados 17 voluntários desdentados totais, com sinais clínicos de diminuição de dimensão vertical de oclusão, portadores de sinais e sintomas de disfunção temporomandibular e usuários de próteses totais, inscritos no cadastro de pacientes do CETASE (Centro de Estudos e Tratamento das Alterações Funcionais do Sistema Estomatognático) da Faculdade de Odontologia de Piracicaba. Os voluntários utilizaram o aparelho de cobertura oclusal plana para o restabelecimento da dimensão vertical de oclusão e do tônus muscular, por um período de 120 dias. Telerradiografias em norma lateral foram realizadas antes (com as próteses totais antigas) e após o período de 120 dias. Foram traçadas as linhas Sela-Násio (SN), a Linha Odontoídea (OD), a Linha CVT (Tangente da Vértebra Cervical), e o Plano mandibular (LM). Cinco medidas angulares craniocervicais foram realizadas: SN/OD; SN/LM; SN/CVT; LM/OD e OD/CVT e duas medidas lineares foram feitas: S-OD e S-CVT. Os dados obtidos foram submetidos à análise estatística pelos testes t de Student e teste de Wilcoxon pareado com nível de significância de p<0,05. As médias iniciais e finais dos ângulos SN/LM e LM/OD apresentaram diferenças estatisticamente significantes, alterando a postura da mandíbula em relação à coluna cervical e à base do crânio e as médias iniciais e finais dos ângulos SN/OD, SN/CVT e OD/CVT não apresentaram diferenças estatisticamente significantes, mostrando o movimento de extensão da cabeça após o tratamento instituído. Os resultados demonstraram que existe relação entre DVO, postura da cabeça e da coluna cervical e que a terapêutica com aparelhos oclusais interferiu melhorando o posicionamento da cabeça e da coluna cervical
Abstract: The aim of this study was to analyze since the influence of the vertical dimension of occlusion in the posture of the cervical spine and head through measurements of craniocervical angles. Seventeen volunteers edentulous were selected, with clinical signs of reduced vertical dimension of occlusion, with signs and symptoms of temporomandibular disorders and denture wearers. The volunteers used occlusal plane appliance coverage for the reestablishment of vertical dimension of occlusion and muscle tone, for a period of 120 days. Lateral cephalometric radiographs were taken before (with the old dentures), and after 120 days. In the radiographs were traced sella-nasion line (SN), Odontoid Line (OD), the CVT line (Cervical Vertebra Tangent), and mandibular plane (ML). Five craniocervical angle measurements were performed: SN/OD, SN/ML, SN/CVT, ML/OD and OD/CVT and two linear measurements were made: S-OD and S-CVT. The data were statistically analyzed by Student's t test and Wilcoxon test with a significance level of p <0.05. The average initial and final angles of the SN/LM and LM/OD showed statistically significant differences by changing the posture of the mandible in relation to the cervical spine and skull base and the mean initial and final angles of the SN/OD, SN/CVT and OD/CVT did not show statistically significant differences, showing the extension movement of the head after the treatment. Our studies demonstrated that a relationship exists between VDO, head posture and cervical spine and that therapy with occlusal devices interfered improving the positioning of the head and cervical spine
Mestrado
Protese Dental
Mestre em Clínica Odontológica

Desde hace unos años se está utilizando el kinesiotaping (KT) en la práctica del fisioterapeuta como parte del tratamiento en las distintas patologías del aparato locomotor. Entre los principales efectos descritos están la analgesia, por disminución de la presión en los receptores nociceptivos, la mejora de la circulación sanguínea y linfática y un efecto a nivel del tono del músculo esquelético. Existen diferentes técnicas de aplicación en función del objetivo que se busque y la zona donde se aplica, siendo la más utilizada a nivel de la musculatura esquelética. El objetivo de esta tesis es estudiar los efectos del Kinesiotaping aplicado con la técnica muscular a nivel del trapecio superior cuando éste se encuentra con una sobrecarga muscular. Para ello se ha planteado un ensayo clínico aleatorizado en la que han formado parte 102 voluntarios mayores de edad de ambos sexos que padecían dolor inespecífico de la columna cervical con dolor a nivel del trapecio superior derecho, izquierdo o ambos. Se valoró la percepción del dolor mediante la escala visual analógica (EVA) y un algómetro de presión, la movilidad articular activa (ROM) de la columna cervical, la fuerza muscular isométrica de la musculatura cervical mediante la MCU y la actividad muscular mediante la electromiografía de superficie (EMG), tomando como referencia la contracción voluntaria máxima y el test de fatiga o test isométrico para el trapecio superior. Se tomaron medidas basales, a los 3 días y a la semana de empezar el tratamiento. xxii A los individuos que se incluyeron en el grupo experimental se les aplicó la técnica muscular con el KT a nivel del trapecio superior, que se mantuvo durante 72 horas. Todos los participantes en el estudio realizaron cada día (hasta la 2 sesión) un estiramiento en tensión activa del trapecio superior derecho e izquierdo. El resultado obtenido mostró una diferencia estadísticamente significativa pre y post tratamiento, tanto en el grupo control como en el experimental, no encontrándose diferencias estadísticamente significativas entre ambos grupos de intervención. Por lo que no se pudo concluir que el kinesiotaping sea una técnica eficaz en el tratamiento sintomático del dolor cervical de origen inespecífico si se compara con la realización de estiramientos en tensión activa del músculo trapecio superior.

Dissertation submitted in partial compliance with the requirements for the Master’s degree in technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2013.
Background: Forward head posture (FHP) is a common postural abnormality that is commonly associated with weak deep cervical flexor muscles (DCF). The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting the C7 spinous process to the tragus of the ear. The smaller the angle, the greater the forward head posture. Weak DCF musculature and FHP has been linked to cervical dysfunction in the short and long term such as cervicogenic headache and premature development of cervical regional degenerative joint disease. Improving isometric endurance and neuromotor control of the DCF muscles using craniocervical flexion exercise (CCFE) has been shown to be efficient in patients experiencing cervical dysfunction such as headache, although the relevance of CCFE has not been established in the asymptomatic group. Deficiency in the activity of these muscles can be accurately measured using craniocervical flexion testing (CCFT). There is a paucity of information regarding the definitive relationship between weakness of the DCF and FHP in asymptomatic participants. This research will help establish an efficient and safe prophylactic treatment protocol preventing long term sequela associated with FHP. Objectives: To determine the effect of CCFE on cervical posture by assessment of the CV angle in asymptomatic participants as well as to determine the effect of CCFE on cervical range of motion by assessment of flexion, extension, bilateral rotation and lateral flexion movements in asymptomatic participants whilst measuring the effect of CCFE on isometric endurance and neuromotor control of the DCF muscles assessed by the CCFT in asymptomatic participants. Method: This is a quantitative pre/post intervention study comparing the results of one group of 45 asymptomatic participants before and after the CCFE protocol has been allocated to them over a period of 3-5 weeks. Participants FHP was assessed by measuring the CV angle. This was done by marking the C7 spinous process and extending a horizontal line toward the shoulder. Then marking the tragus of the ipsilateral ear and measuring the angle using the smart tool angle finder (MD products). iv CCFT measurements were taken and the CCFE protocol allocated to those who qualified to take part in the study. Lastly, cervical range of motion was measured. This group received a home exercise protocol of 3 sets of 10 supine chin tucks daily with each repetition being held for 10 seconds. The technique was first ensured by the researcher prior to leaving the consultation rooms and an exercise diary was given to the participant until the 5th and final consultation to record the progress and efficiency of the home programme as well as any complaints regarding this. Result: The asymptomatic group included in the study improved in both the seated and standing CV angle measurements in that the CV was greater at the conclusion of the pre/post intervention (p=0.00000002) and (p=0.000003) respectively . Cervical range of motion showed improvement in some but not all ranges. Flexion showed a reduction in range of motion (p=0.0086) which was significant. Extension showed an improvement in range of motion (p=0.0000002) which was significant. Rotation toward the left (p=0.00003) and right (p=0.00063) showed an improvement in range of motion which was significant. Lateral flexion showed improvement which was not significant in both, left (p=0.0145) and right (p= 0.24985) ranges of motion. Neuromotor control showed 100 percent improvement in that all 45 of the participants were able to perform CCFT correctly through all five stages at conclusion of the study. Conclusion: Therefore it can be concluded that asymptomatic participants will benefit from CCFEs In terms of CV angle improvement, cervical range of motion as well as neuromotor control of the DCF muscles.

M.Tech. (Chiropractic)
Introduction: The most common chronic pain condition in modern society is neck pain (Jensen and Harms-Ringdahl, 2007). Chronic neck pain is a common complaint for many, from young patients to older patients with stressful work situations. According to Graham, Gross and Goldsmith (2006) neck disorders are common, disabling to various degrees and costly. Various structures in the cervical spine capable of transmitting pain include facet joints, intervertebral discs, nerve root dura, ligaments, and muscles (Manchikanti, Singh, Rivera and Pampati, 2002). According to Rochester (2009) chiropractors treat patients with chronic neck pain by using spinal manipulative therapy (SMT) to address a segmental joint hypomobility within the cervical spine as determined by joint motion palpation and endplay assessment. Traction is commonly used for the treatment of the spine by various physical therapists. It may be included as part of a chiropractic treatment protocol. According to Hooper (1996) traction involves the application of both manual and mechanical forces to draw adjacent body parts away from each other resulting in decompressed irritated tissues, realign parts, and relaxing tight structures. There are several types of cervical traction. The short and medium term improvement for chronic neck pain as well as the comparative effect of manual cervical traction versus mechanical cervical traction in combination with spinal manipulative therapy has not yet been established. Aim: This particular research study aimed to compare the short to medium term efficacy of manual cervical traction with mechanical cervical traction combined with spinal manipulative therapy with regards to decreased pain and improvement of cervical spine ranges of motion in patients with chronic neck pain. Methodology: Participants who met the inclusion and exclusion criteria were eligible to participate in this study. Advertisements were placed on notice boards around the campus of the University of Johannesburg and participants were recruited from the use of advertisements as well as word of mouth to partake in this research study. Thirty participants who suffered from chronic neck pain, volunteered for this comparative research study. This study was a randomized comparative study, where participants were randomly selected to be either in Group 1 or in Group 2. Group 1 received manual cervical traction whereas Group 2 received mechanical cervical traction. Both groups received spinal manipulative therapy to the restricted motion segments found in the cervical spine. Participants received seven trial sessions, with six treatments, over a period of two weeks. At the final 7th visit, one month after the sixth visit, no treatment was performed. Subjective and objective measurements were recorded at each visit. The subjective measurements of this particular study consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon-Mior Neck Disability Index to evaluate the participants’ sensitivity to pain and disability. The objective measurements of this study included the Cervical Spine Range of Motion instrument to assess the participants’ cervical spine movement. Results: Both groups demonstrated a statistically significant improvement over time with regards to pain and disability, as well as increased range of motion to the cervical spine. The greatest percentage improvement with regards to range of motion was in lateral flexion and rotation of the cervical spine. Conclusion: According to the results of this study, it could be concluded that either manual cervical traction or mechanical cervical traction in combination with spinal manipulative therapy can be used effectively in the treatment of chronic neck pain as part of a chiropractic treatment protocol. Both groups proved to have a statistically significant improvement with regards to pain and disability as well as increased cervical spine range of motion...

碩士
國立陽明大學
物理治療暨輔助科技學系
99
Background: Neck pain, like back pain, is a common complaint that may result in functional limitation, disability, and high medical costs. Twenty to forty percentage of acute neck pain incidences develop into chronic neck pain. The traditional methods of physical therapy have been shown effective in reducing symptoms and neck pain recurrence. However, few studies investigated the effectiveness of Kinesio® tape for treating acute neck pain. Purpose: To find the immediate effect of Kinesio® tape for acute neck pain. Study design: An exploratory, randomized-control, and single blinded study. Materials and Methods: Fifty subjects diagnosed with acute neck muscle strain were recruited, and randomly assigned into 2 groups: therapeutic Kinesio® tape group or sham group. Basic data, self-reported pain (100mm VAS), disability, cervical pain-free active range of motion (C-ROM) and pressure pain threshold (PPT) over neck extensors were measured before taped. Self-reported pain, pain-free active range of motion (C-ROM), pressure pain threshold, and global rating of change scales were measured immediately and 24 hours after taping intervention. Repeated measures analysis of covariance (ANCOVA) was used to examine the effects of the treatment with group as the between-subjects variable and time as the within-subjects variable. Results: The group-by-time interaction was statically significant for cervical rotation to the right and to the left (p&lt; 0.05). The time effect was significant for all directions of cervical range of motion in Kinesio® taping group, and there was immediate improvement in self-reported pain, CROM, and global rating of change scales in both groups. No group difference was found regarding pressure pain threshold. Discussion and Conclusions: Our results showed Kinesio® tape was some assistance to clinicians in improving pain-free ROM immediately (24 hours) after tape application for patients with acute neck pain. Kinesio® tape is cheaper, convince, faster, and it is another treatment choice for patient with acute neck pain.

M.Tech. (Chiropractic)
Aim of this study was to compare which treatment either Proprioceptive Neuromuscular Facilitation or chiropractic manipulation, whether by itself or in combination, was more effective and beneficial in the treatment of mechanical neck pain. The effectiveness was measured by the use of a Visual Analogue Scale, Vernon- Mior Neck Pain and Disability Index questionnaire and the measurement of cervical spine range of motion using an analogous cervical spine range of motion inclinometer (CROM). The questionnaire and the measurements were taken prior to the treatments at the first, fourth and seventh consultations.Thirty participants who met the inclusion criteria were randomly placed into three groups of equal size (10 participants each). Group one received a Proprioceptive Neuromuscular Facilitation (PNF) stretching protocol to the cervical spine. Group two received a chiropractic manipulation to the cervical spine. Group three received a combination treatment, first receiving chiropractic manipulation and then a PNF stretching protocol to the cervical spine. Participants were treated six times out of a total of seven sessions, over a maximum of a three week period.Subjective data was collected at the beginning of the first, fourth and seventh consultations. This was done by means of a Visual Analogue Scale and a Vernon-Mior Neck Pain and Disability Index Questionnaire, in order to assess pain and disability levels. Objective data was collected by means of measuring cervical spine range of motion using a cervical range of motion (CROM) inclinometer. Analysis of collected data was performed by a statistician from STATKON, a department of the University of Johannesburg.Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with reference to pain and disability. Statistically significant changes were seen in all three groups with reference to pain and disability. Group 3 was shown to improve the most with regard to pain and disability. Group 1 had statistically significant improvement with regard to cervical range of motion in the ranges of left and right rotation. Group 2 experienced a decrease range of cervical motion with regard to extension. As the study consisted of a small group of participants further, more extensive studies are needed...

Faculty of Medicine School of Physiotherapy 82-29610 Tel: 011 452 3175
Physiotherapists commonly assess head and shoulder posture and correct poor posture on the grounds that there is an association between the patients’ cervical symptoms and their posture. The aims of this study were firstly to compare the sagittal head and shoulder posture and demographic variables of patients with chronic cervical pain to those of “healthy” volunteers. Secondly, to investigate the relationship between the frequency and severity of pain and the sagittal head and shoulder posture of patients with chronic cervical pain. Lateral view photographs were taken of nineteen patients (experimental group) and eighteen “healthy” volunteers (control group) in a supported sitting position. The following five static postural positions were assessed: (1) neutral or natural head and shoulder posture (2) maximum head protraction (3) maximum head retraction (4) maximum shoulder protraction and (5) maximum shoulder retraction. The active range of anteroposterior glide (total excursion) of the participants’ head and shoulders was also assessed. The participants completed a questionnaire that included their demographic variables, medical history and leisure time activities. Differences in head and shoulder posture were observed between the two groups. Some of these differences supported postural relationships that have been described in the literature. The experimental group had a more forward head resting position than the control group. The range of motion (total excursion) of the head and shoulders of the experimental group was less than the control group. In contrast to clinical assumptions that have been described in the literature, a forward resting head posture was not related to a protracted shoulder position or to upper cervical spine extension when measured in the sagittal plane. A relationship was observed between the frequency and severity of pain in certain body regions and selected postural measurements in the experimental group. It is suspected that most of the findings might be the result of poor cervical and scapular muscle control caused by chronic pain. This emphasises the need to assess the influence of tissue and joint extensibility and muscle control on head and shoulder posture. Analysis of the questionnaires demonstrated that the experimental group’s ability to carry out activities of daily living was significantly affected by pain (p=0,001). There was no significant difference in the number of hours worked per week between the experimental and control groups (p=1,000). There was a tendency (p=0,118) for the control group to devote a greater number of hours to “active” leisure time activities. The control group might have been less symptomatic as a result thereof. This highlights the necessity to further investigate the effect of exercise on postural correction and prevention of cervical symptoms.

M.Tech.
Purpose: This study aims to compare the effects of chiropractic manipulation versus mobilisation on Pressure Pain Threshold in chronic posterior mechanical cervical spine pain sufferers with regards to pain, disability and cervical spine range of motion. These effects were evaluated using a questionnaire consisting of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire, and by measuring cervical spine range of motion using a Goniometer as well as Algometer readings over the restricted facet joint/s in the cervical spine. The questionnaires were completed and the range of motion readings and algometer readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were divided into two groups of equal size (15 participants each). Group one received spinal manipulation to restricted cervical spine joint/s. The second group received spinal mobilisation to restricted cervical spine joint/s. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a Goniometer and Algometer in order to assess cervical spine range of motion and to measure the Pressure Pain Threshold at the restricted facet joint/s in the cervical spine. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and cervical spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 and group 2 with v reference to certain cervical spine range of motions as well as algometer readings to measure the Pressure Pain Threshold at the restricted facet joint/s. Conclusion: The results show that both spinal manipulation and mobilization are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing cervical spine range of motion and most importantly Pressure Pain Threshold at the restricted facet joint/s in patients with chronic posterior mechanical cervical spine pain. Although the study did not allow for a definite conclusion to be drawn, the results suggest that Chiropractic manipulative therapy is an effective treatment protocol to increase the Pressure Pain Threshold in chronic posterior mechanical neck pain sufferers. The advantage of this is that the treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits. It also shows that in cases where manipulation is contra-indicated mobilization will have a similar effect, but the long term benefits are questionable.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg 2017.
Neck pain is one of the most common debilitating musculoskeletal complaints seen in physiotherapy practice. It is often associated with headache, upper back and shoulder/arm pain (cervico-brachial pain) and such patients are more disabled than patients with neck pain only. Cervico-brachial pain syndrome is an upper quarter pain syndrome in which neural tissue sensitivity to mechanical stimulus is thought to play a role. Neuropathic pain is a problem associated with and prevalent in neck and arm pain. Psychosocial factors, such as fear-avoidance beliefs and catastrophising, have been shown to play an important role in treatment outcomes. Neural mobilisation (NM) is often used to influence the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. It seems reasonable to use neural mobilisation in cervico-brachial pain as neural structures play an important role in this condition The optimal treatment intervention for cervico-brachial pain is yet to be established. The prevalence of cervico-brachial pain in a South African population is also unknown. Aims of the study The aims of the study were to: i. To establish the prevalence of cervico-brachial pain in patients being seen in physiotherapy practices in Pretoria, South Africa. ii. To establish the effect of neural mobilisation on the pain, function and quality of life of patients with acute and sub-acute cervico-brachial pain. iii. To establish the influence of high catastrophising scores and neuropathic pain on treatment outcomes. iv. To establish the effect of demographic factors on the pain, function and quality of life of patients with cervico-brachial pain. Methods Research Question 1. A retrospective survey of physiotherapy patient records dated 1 January 2011 to 31 December 2011 was conducted. The prevalence of patients with neck pain in relation to other musculoskeletal complaints was calculated and expressed as a percentage. Symptoms recorded included the following; headache, dizziness, pins and needles, feeling of weakness, other sensations, more than one symptom and pain in other area/s. Based on body charts, areas of pain were coded as neck pain only, pain in the shoulder, shoulder and upper arm, shoulder to elbow, lower arm, hand, neck and arm up to wrist, neck and arm including hand. Research Questions 2, 3 and 4 A single blind randomised clinical trial was conducted to establish the effect of neural mobilisation on cervico-brachial pain. The intervention group (IG) received cervical and thoracic mobilisation exercises, advice and NM. The usual care (UC) had the same treatment without NM. Outcomes were assessed at 3 weeks, 6 weeks, 6 months and 12 months. The Numerical Pain Rating Scale was used to determine the effect of NM on pain. The Patient Specific Functional Scale was used to determine the effect of NM on function and the EuroQual5 instrument was used to establish the effect of NM on the quality of life. At 6 weeks the Global Rating of Change was administered to measure patient’s perception of recovery. The Neuropathic Diagnostic Questionnaire (DN4) was used to classify patients with neuropathic pain and the Pain Catastrophising Scale to identify catastrophisers. Results and Discussion Prevalence of neck and radiating arm pain in physiotherapy private practice, Pretoria South Africa The prevalence of neck pain in private physiotherapy practices in Pretoria, SA is high (46.4% of the total musculoskeletal complaints) with radiating arm pain (52.2% of neck pain population) and pain in other areas (22.6% of neck pain population) being commonly associated with neck pain. Furthermore, other symptoms such as headache (25.4% of the neck pain population) and paraesthesia (11.2%) are also frequently present. Neck pain is multi-faceted and this has implications for its management. Future studies with a bigger, representative population sample are needed to establish the prevalence of neck pain in SA. The effect of neural mobilisation on cervico-brachial pain All patients improved significantly in terms of pain, function and quality of life over the 12-month period. However, the IG had significantly less pain than the UC group at 6 months (p=0.03 95% CI 0.96 - 2.03) and this difference was more pronounced in patients with neuropathic pain (IG 2.91 95%CI 1.74 - 4.08 and CG 5.5 95% CI 3.45 - 7.55 p=0.01). There were no significant differences between groups in terms of function or quality of life. Patients with neuropathic pain had significantly more pain at 6 months (positive neuropathic pain 3.71 95%CI 2.57 – 4.84; negative neuropathic pain 1.44 95% CI 0.93 – 1.96 p=0.0001) and 12 months (positive neuropathic pain 3.23 95% CI 1.74 – 4.71; negative neuropathic pain 1.38 95% CI 0.88 – 1.91 p=0.01) compared to those without neuropathic pain. At 12 months function was also negatively affected by the presence of neuropathic pain (positive neuropathic pain 23.91 95%CI 20.96 – 26.86; negative neuropathic pain 27.15 95% CI 25.95 – 28.36 p=0.04). It did not have an effect on quality of life. Catastrophisers had more pain at 6 months (catastrophisers 4.25 95% CI -1.90 – 10.40; non-catastrophisers 1.70 95% CI 1.22 – 2.17 p=0.02) and 12 months (catastrophisers 3.56 95% CI 1.10 – 6.02) compared to non-catastrophisers (1.47 95% CI 0.96 – 1.99 p=0.02). There was no difference in their function at any time, however at baseline they reported a lower quality of life (Catastrophisers 61.96 95% CI 52.04 – 71.87; non-catastrophisers 75.79 95% CI 71.91 – 79.66 p=0.002). Conclusion The addition of NM to cervical and thoracic mobilisation, exercises and advice to stay active, in the management of cervico-brachial pain, resulted in less pain at 6-month follow-up. For patients with neuropathic pain the positive effect was more pronounced. Adding NM as an adjunct to usual care is effective to improve pain for patients with cervico-brachial pain especially for those with a neuropathic pain component. The presence of neuropathic pain and catastrophising resulted in poor pain-related outcomes.
MT2017

A dissertation presented in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1997.
The purpose of this investigation was to compare the effectiveness of chiropractic manipulation alone to the use of chiropractic manipulation together with therapeutic exercise in the management of chronic mechanical cervical spine conditions. Measurements in terms of objective and subjective clinical findings, were to be used to substantiate or refute the use of auxiliary therapeutic exercise in these conditions. It was hypothesised that therapeutic exercise would be a valuable adjunct to the chiropractic management of chronic mechanical cervical spine conditions in terms of objective (flexibility) and subjective (pain and disability) clinical findings. Thirty consecutive subjects suffering from chronic neck pain were obtained from local advertising (radio and newspapers) and randomly placed into two groups for comparison. The 0. age group of subjects accepted ranged from 16 to 60 and included both sexes from any race, who had suffered from neck pain for six weeks or longer. Subjects were assessed to determine whether there were any contra-indications to manipulation or exercise. Treatment commenced for a month with both groups receiving spinal manipulative therapy and one group doing daily therapeutic exercises. The eROM goniometer, McGill Pain Questionnaire, Numerical Pain Rating Scale - 101 Questionnaire and the CMee Neck Disability Index were
M

M.Tech.
Purpose: The cervical facet joints have attracted relatively little attention as possible sources of neck pain and referred pain. Multiple authors have described the management of cervical facet joint pain but not the cause (Manchikanti et al., 2002). Method: This study consisted of one group of 100 participants. The participants were between the ages of 18 and 40 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. All the participants received a cervical spine adjustment. Objective and subjective readings were taken. Procedure: The participants were seen only once. The Visual Analogue Scale was completed by each participant before treatment. Algometer readings were taken over the most restricted cervical spine facet joint and cervical spine range of motion (CROM) machine readings were taken measuring the ranges of motion of the cervical spine. The participants received an adjustment to the most restricted cervical spine facet joint as determined by motion palpation. The CROM machine and algometer readings were taken again immediately after the adjustment and the algometer readings were taken again 10 minutes later. Results: In terms of subjective measurements based on the Visual Analogue Scale, all participants experienced clinically significant pain before starting the trial.In terms of objective measurements based on algometer readings, a clinically significant difference was found as the pressure pain threshold increases over a period of time. In terms of the CROM machine readings there was a clinical improvement from the pretreatment ranges of motion to the post-treatment ranges of motion. The algometer and CROM readings were statistically incomparable to begin with. Conclusion: The results proved that there was a statistical significant noted immediately after the adjustment and 10 minutes later, however, this does not mean much as thegroups were not comparable to begin with. A statistically significant difference was noted for all ranges of cervical spine motion (flexion, extension, right and left lateral flexion and rotation), thus showing that the cervical spine adjustment was successfully delivered to the restricted segments.