Estudios primarios incluidos en esta revisión sistemática

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Estudio primario

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Effect of Targeted Strength, Endurance, and Coordination Exercise on Neck and Shoulder Pain Among Fighter Pilots: A Randomized-controlled Trial.

Autores Lange B , Toft P , Myburgh C , Sjøgaard G
Revista The Clinical journal of pain
Año 2013
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OBJECTIVES: : To explore in Danish F-16 pilots: (1) the effect on neck and shoulder pain of a 24-week training intervention including targeted training of the deep neck muscles; (2) selected clinical signs and symptoms at baseline; (3) the prevalence and intensity of neck and shoulder pain. METHODS: : Fifty-five F-16 pilots were randomized to 24 weeks of 3-times-a-week training (n=27) using individual training diaries or to a control group (n=28) that did not receive any treatment. The primary outcome was reduction in neck and shoulder pain over the previous 3 months and previous 7 days, estimated on an 11-point numeric box scale. Analysis of data was by intention-to-treat. Baseline clinical examination included palpation of muscles and joints and a craniocervical flexion test with an activation score of 10 as best and a cumulative performance index of 300 as best. RESULTS: : At baseline, 82% of the participants experienced neck pain within the last year. Tenderness of either the right or the left levator scapulae was significantly indicative of self-reported neck pain within the last 3 months (P=0.02). In craniocervical flexion test, the mean activation score was 6.7 (6.1 to 7.3) and the mean cumulative performance index was 127.6 (107.0 to 153.0). At follow-up, analyses of covariance revealed a clinically significant decrease from 2.0 to 1.0 in neck pain during the previous 3 months in the training group (P=0.01) compared with the control group. DISCUSSION: : High prevalences of self-reported neck and shoulder pain and clinical signs and symptoms were found among Gz-exposed F-16 pilots with repeated whiplash-like exposures. Twenty-four weeks of targeted training combining deep neck muscle, strength, and endurance training proved effective in reducing neck pain.

Estudio primario

No clasificado

INFLUENCE OF VESTIBULAR REHABILITATION ON NECK PAIN AND CERVICAL RANGE OF MOTION AMONG PATIENTS WITH WHIPLASH-ASSOCIATED DISORDER: A RANDOMIZED CONTROLLED TRIAL.

Revista Journal of rehabilitation medicine
Año 2013
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OBJECTIVE: To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated with balance performance or self-perceived dizziness handicap. SUBJECTS: A total of 29 patients, 20 women and 9 men, age range 22-76 years. METHODS: Patients with whiplash-associated disorder and dizziness were randomized to either intervention (vestibular rehabilitation) or control. Neck pain intensity, cervical range of motion (CROM), balance and self-perceived dizziness handicap were measured at baseline, 6 weeks and 3 months. RESULTS: There were no differences in neck pain intensity or CROM between the 2 groups either at baseline, 6 weeks or 3 months (p = 0.10-0.89). At baseline, neck pain intensity correlated with CROM (-0.406) and self-perceived dizziness handicap (0.492). CROM correlated with self-perceived dizziness handicap and with 1 balance measure (-0.432). Neck pain intensity did not correlate with balance performance (-0.188-0.049). CONCLUSION: Neck pain intensity and CROM was not influenced by vestibular rehabilitation. Importantly, the programme did not appear to increase pain or decrease neck motion, as initially thought. Neck pain intensity and CROM correlated with self-perceived dizziness handicap. CROM also correlated with 1 balance measure.

Estudio primario

No clasificado

Changed activation, oxygenation, and pain response of chronically painful muscles to repetitive work after training interventions: a randomized controlled trial.

Revista European journal of applied physiology
Año 2012
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The aim of this randomized controlled trial was to assess changes in myalgic trapezius activation, muscle oxygenation, and pain intensity during repetitive and stressful work tasks in response to 10 weeks of training. In total, 39 women with a clinical diagnosis of trapezius myalgia were randomly assigned to: (1) general fitness training performed as leg-bicycling (GFT); (2) specific strength training of the neck/shoulder muscles (SST) or (3) reference intervention without physical exercise. Electromyographic activity (EMG), tissue oxygenation (near infrared spectroscopy), and pain intensity were measured in trapezius during pegboard and stress tasks before and after the intervention period. During the pegboard task, GFT improved trapezius oxygenation from a relative decrease of -0.83 ± 1.48 μM to an increase of 0.05 ± 1.32 μM, and decreased pain development by 43%, but did not affect resting levels of pain. SST lowered the relative EMG amplitude by 36%, and decreased pain during resting and working conditions by 52 and 38%, respectively, without affecting trapezius oxygenation. In conclusion, GFT performed as leg-bicycling decreased pain development during repetitive work tasks, possibly due to improved oxygenation of the painful muscles. SST lowered the overall level of pain both during rest and work, possibly due to a lowered relative exposure as evidenced by a lowered relative EMG. The results demonstrate differential adaptive mechanisms of contrasting physical exercise interventions on chronic muscle pain at rest and during repetitive work tasks.

Estudio primario

No clasificado

Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial.

Revista British journal of sports medicine
Año 2012
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<b>BACKGROUND: </b>Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed.<b>METHODS: </b>A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0-9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)).<b>RESULTS: </b>The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF. Among those with pain ≥3 at baseline (n=256), all three training groups achieved significant reduction in neck pain compared with REF (p&lt;0.01). From a baseline pain rating of 3.2 (SD 2.3) in the neck among neck cases, 1WS experienced a reduction of 1.14 (95% CI 0.17 to 2.10), 3WS 1.88 (0.90 to 2.87) and 9WS 1.35 (0.24 to 2.46) which is considered clinically significant. DASH was reduced in 1WS and 3WS only.<b>CONCLUSION: </b>One hour of specific strength training effectively reduced neck and shoulder pain in office workers. Although the three contrasting training groups showed no statistical differences in neck pain reduction, only 1WS and 3WS reduced DASH. This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace.

Estudio primario

No clasificado

¿Puede un ejercicio postural funcional mejorar el rendimiento en la prueba de flexión cráneo-cervical? - Un estudio preliminar

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Revista Manual Therapy
Año 2012
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Deterioro del músculo flexor profundo cervical (DCF) es común en los pacientes con dolor de cuello. Función de Reconversión a menudo se inició con un enfoque reaprendizaje motor, lo que requiere el paciente para practicar y mantener una posición de flexión cráneo-cervical en posición supina. Reaprendizaje motor requiere múltiples repeticiones que es difícil de lograr si sólo el ejercicio en decúbito supino. Este estudio preliminar investigó los efectos de la formación de la DCF con un ejercicio funcional: asunción de una posición postural lumbo-pélvica y vertebral en posición vertical, añadiendo una maniobra alargamiento del cuello. El efecto del ejercicio fue evaluada por los cambios en la actividad del músculo esternocleidomastoideo (ECM) en la prueba de flexión cráneo-cervical (CCFT). Veinte sujetos con dolor de cuello fueron asignados aleatoriamente a un grupo de ejercicio o control. El grupo de ejercicio entrenado durante dos semanas. Pre y post-intervención, las señales de electromiografía (EMG) se registraron a partir de los músculos ECM durante las cinco etapas de la CCFT. Los resultados indicaron que el ejercicio mejora el rendimiento. Amplitudes de señal SMC EMG disminuyó en todas las etapas CCFT, aunque significativa sólo en la primera y tercera etapas de la prueba; 22 mmHg (p = 0,043) y 26 mmHg (p = 0,003). No hay diferencias eran evidentes en el grupo de control (todos p & gt; 0,05). No hubo diferencias entre los grupos para las medidas de dolor y discapacidad. Este estudio inicial indica que un ejercicio postural, conveniente para llevar a cabo durante la jornada de trabajo, mejora el patrón de actividad muscular SMC en el CCFT. Aunque se necesita más investigación, estas observaciones sugieren que el valor de este ejercicio para aumentar otro tipo de formación en la rehabilitación de pacientes con dolor de cuello.

Estudio primario

No clasificado

Effects of heart rate variability biofeedback in subjects with stress-related chronic neck pain: a pilot study.

Revista Applied psychophysiology and biofeedback
Año 2011
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Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.

Estudio primario

No clasificado

A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain.

Revista BMC musculoskeletal disorders
Año 2011
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<b>BACKGROUND: </b>Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.<b>METHODS: </b>Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire.<b>RESULTS: </b>Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase.<b>CONCLUSIONS: </b>This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.<b>Trial Registration: </b>ClinicalTrials.gov: NCT00566930.

Estudio primario

No clasificado

Eficacia de pequeñas cantidades diarias de entrenamiento de resistencia progresiva para la frecuencia de cuello / hombros el dolor: ensayo controlado aleatorizado.

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Revista Pain
Año 2011
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Este artículo está incluido en 2 Revisiones sistemáticas Revisiones sistemáticas (2 referencias) 1 Síntesis amplia Síntesis amplias (1 referencia)

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El ejercicio físico regular es la piedra angular de los programas de rehabilitación, pero la adherencia al ejercicio integral sigue siendo baja. Este estudio determinó la eficacia de las pequeñas cantidades diarias de entrenamiento de resistencia progresiva para aliviar el cuello / el dolor de hombro en adultos sanos con síntomas frecuentes, y las mujeres 174 y 24 hombres que trabajan al menos 30 horas por semana y con frecuencia el cuello / hombros el dolor fueron asignados al azar a la resistencia la formación con un tubo elástico para 2 o 12 minutos al día 5 veces a la semana, o la información semanal sobre la salud en general (grupo control). Los resultados primarios fueron cambios en la intensidad del dolor de cuello / hombros (escala de 0 a 10), sensibilidad examinador verificada de los músculos del cuello / hombros (puntuación de sensibilidad total de 0 a 32) y la fuerza muscular isométrica a las 10 semanas. En comparación con el grupo de control de cuello / hombros el dolor y la ternura, respectivamente, la disminución de 1,4 puntos (intervalo de confianza 95% -2,0 a -0,7, p <0,0001) y 4,2 puntos (intervalo de confianza 95% -5,7 a -2,7, p <0,0001 ) en el grupo de 2 minutos y 1,9 puntos (intervalo de confianza 95% -2,5 a -1,2, p <0,0001) y 4,4 puntos (intervalo de confianza 95% -5,9 a -2,9, p <0,0001) en el grupo de 12 minutos. En comparación con el grupo control, la fuerza muscular aumentó 2,0 Nm (95% intervalo de confianza 0,5 a 3.5Nm, p = 0,01) en el grupo de 2 minutos y 1.7Nm (95% intervalo de confianza 0,2 a 3,3 Nm, p = 0,02) en el 12 minutos de duración del grupo. Para concluir, tan sólo 2 minutos de ejercicio diario progresivo de la resistencia durante 10 semanas en resultados clínicamente relevantes reducciones de dolor y sensibilidad en adultos sanos, con frecuencia el cuello / hombros síntomas. El registro de ensayos: www.isrctn.org/ISRCTN60264809. En los adultos generalmente sanos con dolor frecuente músculo del cuello / hombros, tan sólo 2 minutos de entrenamiento de resistencia progresiva al día reduce el dolor y la ternura.

Estudio primario

No clasificado

Effect of brief daily exercise on headache among adults--secondary analysis of a randomized controlled trial.

Revista Scandinavian journal of work, environment & health
Año 2011
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OBJECTIVE: This paper investigates secondary outcomes (headache) in a randomized controlled trial with physical exercise among office workers with neck/shoulder pain. METHODS: A total of 198 office workers with frequent neck/shoulder pain were randomly allocated to either one of two intervention groups (10 weeks of resistance training with elastic tubing for 2 or 12 minutes per day, 5 times a week) or the control group, which received weekly health information. Secondary outcomes included changes in frequency, intensity, and duration of headache after ten weeks. RESULTS: Compared with the control group, headache frequency decreased in the 2- and 12-minute intervention groups [0.64 days/week (95% confidence interval [95% CI]) 0.23-1.0) and 0.79 days/week (95% CI 0.37-1.2), corresponding to a 43% and 56% decrease from baseline, respectively]. Intensity and duration of the remaining headaches were unaffected. CONCLUSIONS: Two minutes of daily resistance training for ten weeks reduces headache frequency among office workers with neck/shoulder pain. The vast number of adult workers suffering from one or two days of weekly headaches and who could potentially comply with and benefit from brief exercise programs stresses the applicability of our findings.

Estudio primario

No clasificado

Qigong versus ejercicio versus ningún tratamiento para los pacientes con dolor de cuello crónico: un ensayo controlado aleatorio.

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Revista Spine
Año 2011
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Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 3 Revisiones sistemáticas Revisiones sistemáticas (3 referencias)

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DISEÑO DEL ESTUDIO: estudio clínico controlado aleatorizado. Objetivo: Evaluar si el qigong es más eficaz que ningún tratamiento y no inferior a ejercer la terapia. RESUMEN DE DATOS DE ANTECEDENTES: La prevalencia de vida de dolor de cuello crónico es cercana al 50%. Qigong es a menudo utilizado por los pacientes, si bien, la evidencia todavía no está claro. MÉTODOS: Los pacientes (edad 20-60 años) con dolor crónico de cuello (escala analógica visual, VAS ≥ 40 mm) fueron asignados aleatoriamente a 1) qigong o 2) el tratamiento con ejercicios (18 sesiones más de 6 meses) o 3) la lista de espera (sin tratamiento ). Al inicio del estudio y después de 3 y 6 meses, los pacientes completaron cuestionarios estandarizados que evalúan el dolor de cuello (VAS), dolor de cuello y de invalidez, y de calidad de vida (Short Form SF-36, SF-36). El criterio de valoración principal fue el dolor promedio en los últimos 7 días en VAS a los 6 meses de seguimiento. El análisis estadístico incluyó modelos de ecuaciones de estimación generalizadas, ajustada por los valores basales y las expectativas del paciente. RESULTADOS: Se incluyeron un total de 123 pacientes (edad 46 ± 11 años, 88% mujeres) que sufren de dolor crónico de cuello de 3,2 (DE ± 1,6) años. Después de 6 meses, se observó una diferencia significativa entre el qigong y esperando la lista de grupos de control (EVA diferencia de medias: -14 mm [IC del 95% = -23.1 al -5,4], P = 0,002). La media de las mejoras en el grupo de ejercicio fueron comparables a los del grupo de qigong (diferencia entre los grupos -0.7 mm [IC = -9.1 a 7.7]), pero no pudieron demostrar la significación estadística (p = 0,092). El dolor de cuello y la discapacidad, y SF-36 resultados también arrojaron superioridad de qigong sobre ningún tratamiento y resultados similares en los grupos de tratamiento con ejercicios de qigong y. CONCLUSIÓN: Qigong fue más eficaz que ningún tratamiento en pacientes con dolor de cuello crónico. Estudios adicionales podrían diseñarse sin esperar la lista de control y deben utilizar un número mayor de muestras para aclarar el valor de qigong en comparación con el ejercicio de la terapia.