Various musculoskeletal system disorders occur as a result of the use of computers, which have become an integral part of modern life. The most important among such disorders is known as cumulative trauma disorder (CTD). In this study, we attempt to investigate CTD's effects on daily life and the effectiveness of training and exercise programs in the management of this disorder at a state department where computers are widely used. Fifty patients with CTD between the ages 25 and 50 were recruited for the study and were randomized into two groups. The complaints of patients with CTD had appeared after they had started working in this job and they reported that their complaints were related to their occupation. The patients complained of head, neck, shoulder, back and wrist pains and most of them were diagnosed as Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS). The first group was given mobilization, stretching, strengthening and relaxation exercises five days a week for a period of two months following a training course. The second group was given a training course only. Both groups were assessed in terms of the following outcome criteria before and after the treatment: Numeric Rating Scale (NRS) and Pain Disability Index for pain; Tiredness Scale for tiredness; and Beck Depression Scale for depression. At 2 months, the treatment group was observed to have experienced statistically significant improvements in NRS (p < 0.001), pain disability index (p < 0.05) and Beck depression scale (p < 0.05) values as compared to the control group. Mobilization, stretching, strengthening and relaxation exercises reduce pain and depression levels of CTD patients in the short term. We propose that studies with long-term follow-up are needed to confirm the above results
OBJECTIVE: To determine the effectiveness of dynamic muscle training and relaxation training for chronic neck pain. DESIGN: Randomised controlled trial. SETTING: Five occupational healthcare centres, Tampere, Finland. PARTICIPANTS: 393 female office workers (mean age 45 years) with chronic non-specific neck pain randomly assigned to 12 weeks of dynamic muscle training (n = 135) or relaxation training (n = 128), plus one week of reinforcement training six months after baseline; or ordinary activity (control group; n = 130). MAIN OUTCOME MEASURE: Change in intensity of neck pain at three, six, and 12 months. RESULTS: No significant difference was found in neck pain between the groups at follow up. However, the range of motion for cervical rotation and lateral flexion increased more in the training groups than in the control group. CONCLUSIONS: Dynamic muscle training and relaxation training do not lead to better improvements in neck pain compared with ordinary activity.
CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain. DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002. SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland. PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension. CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.
OBJECTIVES: This study evaluated the effects on work-related neck and upper-limb disorders among computer workers stimulated (by a software program) to take regular breaks and perform physical exercises. Possible effects on sick leave and productivity were studied as well. A randomized controlled design was used with cluster randomization. Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were randomized into a control group, one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod. Questionnaires were administered before andafter the intervention, and questions were generated by the software during the intervention period. Computer usage was recorded online. RESULTS: The data on self-reported recovery suggested a favorable effect; more subjects in the intervention groups than in the control group reported recovery (55% versus 34%) from their complaints and fewer reported deterioration (4% versus 20%). However, a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups. No effects on sick leave were observed. The subjects in the intervention groups showed higher productivity. CONCLUSIONS: The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints. There seems to be no additional effects from performing physical exercises during these breaks.
STUDY DESIGN: A prospective randomized clinical trial was conducted.
OBJECTIVE: To evaluate the long-term effects of three training interventions on women with work-related trapezius myalgia.
SUMMARY OF BACKGROUND DATA: Studies with long-term follow-up evaluation of interventions for neck pain are scarce and usually cover fewer than 12 months.
METHODS: For this study, 126 women with work-related trapezius myalgia were randomized into strength, muscular endurance, or coordination training or into a nontraining reference group. Intervention training occurred three times a week for 10 weeks. Assessment of pain intensity, pressure pain thresholds, symptom frequency, perceived health, and work and exercise habits was performed before and immediately after interventions, then at clinical examinations 8 months and 17 months after the interventions. Participation rates at these follow-up assessments were 84% and 81%. At 3 years after the interventions, a questionnaire was answered by 94% of the participants, 17 of whom were dropouts that never participated in any of the four intervention groups.
RESULTS: All the training programs showed similar pain reducing effects immediately after the interventions. Pain reductions were maintained at follow-up evaluations, but at the 8-month follow-up assessment, there were no differences between the training groups and the reference group on any variable. At 3 years after the interventions, the intervention groups did not differ from the dropout group. Almost half (49%) of the women had persistent symptoms at the 3-year follow-up assessment.
CONCLUSIONS: The long-term effect of all the training programs was low. Pain in neck and shoulder muscles was persistent in a large proportion of the women over the 3 years.
To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.
OBJECTIVES: To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength.
DESIGN: Randomized trial.
SETTING: Three occupational health care centers.
PARTICIPANTS: Women industrial workers with nonspecific neck-shoulder pain. The International Classification of Diseases, 10th Revision (ICD-10) diagnosis was "cervicobrachial syndrome" (M53.1). Thirty-eight patients completed the isometric shoulder endurance training and 31 patients completed the isometric shoulder strength training.
INTERVENTION: Twelve weeks of training.
MAIN OUTCOME MEASURES: Self-reported pain and rating of perceived exertion (RPE), arm motion performance test, shoulder muscle strength, shoulder muscle endurance, and shoulder functional tests, as well as follow-up after supervised training had ended.
RESULTS: The isometric shoulder strength training resulted in an almost one-scale step decrease in RPE at work and a 5% to 15% improvement of arm motion performance compared with the endurance training. The isometric shoulder strength training more effectively improved left side shoulder abduction strength (p < .026), but no major differences were found for the other strength measurements. The isometric shoulder endurance training was not more successful than the strength training in the endurance test (p .51 to .81).
CONCLUSIONS: Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training, rather than endurance training only.
STUDY DESIGN: A prospective randomized clinical trial. OBJECTIVE: To compare the effectiveness of 2 physical therapy treatment approaches for impingement syndrome of the shoulder. BACKGROUND: Manual physical therapy combined with exercise is a commonly applied but currently unproven clinical treatment for impingement syndrome of the shoulder. METHODS AND MEASURES: Thirty men and 22 women (age 43 years +/- 9.1) diagnosed with shoulder impingement syndrome were randomly assigned to 1 of 2 treatment groups. The exercise group performed supervised flexibility and strengthening exercises. The manual therapy group performed the same program and received manual physical therapy treatment. Both groups received the selected intervention 6 times over a 3-week period. The testers, who were blinded to group assignment, measured strength, pain, and function before treatment and after 6 physical therapy visits. Strength was a composite score of isometric strength tests for internal rotation, external rotation, and abduction. Pain was a composite score of visual analog scale measures during resisted break tests, active abduction, and functional activities. Function was measured with a functional assessment questionnaire. The visual analog scale used to measure pain with functional activities and the functional assessment questionnaire were also measured 2 months after the initiation of treatment. RESULTS: Subjects in both groups experienced significant decreases in pain and increases in function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pretreatment mean (+/- SD) of 575.8 (+/- 220.0) to a posttreatment mean of 174.4 (+/- 183.1). In contrast, pain in the exercise group was reduced from a pretreatment mean of 557.1 (+/- 237.2) to a posttreatment mean of 360.6 (+/- 272.3). Strength in the manual therapy group improved significantly while strength in the exercise group did not. CONCLUSION: Manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial is better than exercise alone for increasing strength, decreasing pain, and improving function in patients with shoulder impingement syndrome.
This randomized clinical trial evaluated the effects of keyboard keyswitch design on computer users with hand paresthesias. Twenty computer users were matched and randomly assigned to keyboard A (n = 10) or B (n = 10). The keyboards were of conventional layout and differed in keyswitch design. Various outcome measures were assessed during the 12 weeks of use. Subjects assigned keyboard A experienced a decrease in hand pain between weeks 6 and 12 when compared with keyboard B subjects (P = 0.05) and demonstrated an improvement in the Phalen test time (right hand, P = 0.006; left hand, P = 0.06). Keyboard assignment had no significant effect on change in hand function or median nerve latency. We conclude that use of keyboard A for 12 weeks led to a reduction in hand pain and an improved physical examination finding when compared with keyboard B. There was no corresponding improvement in hand function or median nerve latency.
The present study aimed to investigate whether physiotherapy or Feldenkrais interventions resulted in a reduction of complaints from the neck and shoulders (prevalence, pain intensity, sick leave, and disability in leisure and work roles) in 97 female industrial workers (not on long-term sick leave). Range of motion of neck and shoulders, VO2, endurance score (i.e., summation of pain intensity ratings during a static shoulder flexion), cortical control according to the Feldenkrais methodology, and physiological capacity according to a dynamic endurance test of the shoulder flexors with simultaneous surface EMG were also recorded. The workers were randomized to: (1) physiotherapy group (PT-group; treatment according to the ergonomic program of the PTs of the occupational health care service), (2) Feldenkrais group (F-group; education according to the Feldenkrais methodology), or (3) control group (C-group; no intervention). Pre- and post-tests were made at one-year intervals. The two interventions lasted 16 weeks during paid working time. The F-group showed significant decreases in complaints from neck and shoulders and in disability during leisure time. The two other groups showed no change (PT-group) or worsening of complaints (C-group). The present study showed significant positive changes in complaints after the Feldenkrais intervention but not after the physiotherapy intervention. Possible mechanisms behind the effects in the F-group are discussed.
Various musculoskeletal system disorders occur as a result of the use of computers, which have become an integral part of modern life. The most important among such disorders is known as cumulative trauma disorder (CTD). In this study, we attempt to investigate CTD's effects on daily life and the effectiveness of training and exercise programs in the management of this disorder at a state department where computers are widely used. Fifty patients with CTD between the ages 25 and 50 were recruited for the study and were randomized into two groups. The complaints of patients with CTD had appeared after they had started working in this job and they reported that their complaints were related to their occupation. The patients complained of head, neck, shoulder, back and wrist pains and most of them were diagnosed as Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS). The first group was given mobilization, stretching, strengthening and relaxation exercises five days a week for a period of two months following a training course. The second group was given a training course only. Both groups were assessed in terms of the following outcome criteria before and after the treatment: Numeric Rating Scale (NRS) and Pain Disability Index for pain; Tiredness Scale for tiredness; and Beck Depression Scale for depression. At 2 months, the treatment group was observed to have experienced statistically significant improvements in NRS (p < 0.001), pain disability index (p < 0.05) and Beck depression scale (p < 0.05) values as compared to the control group. Mobilization, stretching, strengthening and relaxation exercises reduce pain and depression levels of CTD patients in the short term. We propose that studies with long-term follow-up are needed to confirm the above results
